To address the top 10 safety issues identified by perioperative nurses in a 2012 survey of members of the Association of periOperative Registered Nurses, two healthcare professionals offered evidence-based strategies in an AORN Journal article.
The authors reviewed current evidence for each safety issue and suggested ways perioperative nurses can further improve safety. Recommendations focused on enforcing evidence-based guidelines, collaborating across disciplines and communicating effectively. Here are 30 of their recommendations. Their full recommendations are available in the AORN Journal.
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1. Preventing wrong site/procedure/patient surgery
• Collaborate with scheduling personnel from surgeons' offices to implement a checklist for scheduling surgery.
• Before the patient is transferred to the operating room, preoperative nurses should verify all necessary documents are available and surgeons should verify and mark the site using these documents.
• Strictly enforce adherence to the time out.
2. Preventing retained surgical items
• Minimize distractions and multitasking while managing counted items.
• Alert the team that the count will be starting.
• Participate in evaluating and selecting adjunct technology, and consider the ability of technological devices to detect failures in managing sponges.
3. Preventing medication errors
• Separate medications for adults, pediatric patients and neonates.
• Provide medication reference sheets with IV titration dosing guides for all medications in all concentrations available.
• Standardize medication trays within the facility, including stocking the separate trays with appropriate doses for the patient receiving care.
4. Preventing failures in instrument reprocessing
• Establish centralized oversight of a facility-wide reprocessing program.
• Ensure personnel competency.
• Require documentation of reprocessing steps.
5. Preventing pressure injuries
• Conduct a preoperative skin assessment.
• Position and transfer patients in a manner that prevents shearing.
• Collaborate with wound ostomy nurses to review internally collected data about pressure injuries and take corrective action based on this evidence.
6. Preventing specimen management errors
• Label specimens accurately.
• Eliminate multitasking during specimen management.
• Ensure verification before sending the specimen out of the OR.
7. Preventing surgical fires
• Perform a fire risk assessment before making the initial incision.
• Communicate about the use of an open source of oxygen or flammable prep agent before making the incision.
• Allow ample time for flammable prep agents to dry.
8. Preventing perioperative hypothermia
• Conduct multidisciplinary education about the pathophysiology of perioperative hypothermia and the effectiveness of interventions.
• Use preoperative as well as intraoperative active warming.
• Use prewarmed IV fluids.
9. Preventing burns from energy devices
• Educate perioperative personnel on how to use the device safely.
• Have staff demonstrate competency.
• Use the device in a manner consistent with the manufacturer's instructions.
10. Responding to difficult intubation or airway emergencies
• Collaborate with anesthesia professionals, otolaryngologists and nurses in other areas in which anesthesia is administered to develop a comprehensive and institution-wide difficult airway management program.
• Conduct a preanesthesia risk assessment.
• Designate a rapid response team.
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