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5 tips to innovate RSI education

Publish Date: 8/1/2012

A miscount occurs, or maybe worse, a patient leaves the OR with a retained surgical item (RSI). Like many safety practices in the operating room, preventing RSIs depends on the correct behavior and attitude to get it right.

“Each perioperative team member has to get to the place where they want to do it correctly because they see the value in it and realize that it’s about keeping our patients safe from harm,” stresses AORN Perioperative Nursing Specialist Sharon Van Wicklin, MSN, RN, CNOR/CRNFA, CPSN, PLNC.

Van Wicklin and RSI expert Verna Gibbs, MD, FACS, suggest tips for reshaping RSI education to help team members see the value in implementing safe, standardized accounting practices.

1: Get to the root of the problem 

Be a visible presence in the OR to observe where slips are occurring. Make sure everyone understands and follows the rules. Give team members a chance to express their concerns, especially if inefficient accounting practices are causing issues.

“We have to look at everything so we aren’t just shaking our finger and saying, ‘do it correctly’,” Van Wicklin acknowledges.

2: Stick to the facts 

Clearly explain the recommendations in the AORN Recommended Practices for Prevention of Retained Surgical Items and your facility policy on surgical item accounting practices.

“It’s important for perioperative personnel to be familiar with the evidence-based, peer-reviewed research used to shape these recommendations,” Van Wicklin stresses. “Sometimes safe practice information can be like the telephone game—the information has been repeated and varies from the original message.”

3: Make it relevant 

Present real situations with miscounts and RSIs that have occurred, including legal cases.

NoThingLeftBehind® Director Gibbs uses real scenarios to prepare OR team members for common RSI risks. For example, Gibbs uses this example in her teaching about the errors that can occur when sponges are counted, rather than accounted for:
The circulator and scrub person counted 10 sponges, 8 in the sponge holder and noting that two were in the patient’s vagina. Unfortunately the patient left the OR with the two sponges still inside and a count documented as “correct.”

Gibbs says, “Having all the sponges in one place at the end of the case makes it clear that you can prove where all the sponges are.”

Van Wicklin suggests educators partner with risk managers to add legal cases to education so the events of a real RSI event can be described. She says risk managers are too often an untapped resource for educators.

4: Talk it through 

Use dialogue as a teaching tool by asking perioperative RNs and scrub technicians to talk through an RSI case scenario and share how they would react.

“Engaging the individuals who are actively performing the counts in this way helps them to think about the ‘why’ of safe practices in the context of the practice setting,” Van Wicklin notes.

5: Tell it from the patient’s perspective 

Discuss the experience of a patient who had an RSI and ask perioperative personnel to put themselves in the patient’s position.

“Thinking about the patient perspective can remind perioperative personnel to take that extra caution before closure to make sure everything is out of the patient that should be,” Van Wicklin reiterates.

Gibbs stresses, “The very fact that a patient has to undergo TWO operations when only one is needed is harmful to the patient and a strong example of bad practices. These events are called never events because they should never happen.”

Additional resources 

Access “Implementing AORN Recommended Practices for Prevention of Retained Surgical Items” in the February 2012 issue of AORN Journal.

Look to the AORN Perioperative Job Descriptions and Competency Evaluation Tools to develop education programs that meet practice requirements.

Find RSI resources at nothingleftbehind.org.

Connect with other educators through the Clinical Educators Specialty Assembly on ORNurseLink to share RSI education strategies and to seek new ideas for education.


Guidelines for Perioperative Practice


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