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Preventing surgical errors: Your role

Publish Date: 4/10/2013
Do you understand your specific role in preventing surgical errors? What are your responsibilities? Do you know how your function affects the safety efforts of others in your organization? In this two-part series, we will discuss how clarity of role, function and responsibilities leads to better practices for the prevention of surgical errors for four perioperative professional positions: administrator, educator, circulator and OR manager.

In this column, part one of the series, Darin Prescott, MSN, MBA, RN, CNOR, CASC, nursing administrator for the SW Minnesota Region of Mayo Clinic Health System, discusses the role administrators play in helping prevent surgical errors while Teresa Casio, RN, CNOR, nursing professional development specialist for Mayo Clinic Health System, discusses the responsibilities of the educator.

Here are five critical ways Prescott says administrators help prevent surgical errors.

1. Conveying the mission and vision of the organization. "As a nurse administrator, the role certainly speaks to conveying the mission and vision of the organization down through the departments," Prescott says. This would include an organization's commitment to patient, staff and provider safety as well as optimal outcomes for patients and families.

2. Representing perioperative nursing to multi-disciplinary groups. "Administrators represent perioperative nursing at the tables where decisions are made," he says. "We really advocate the work of those individuals who are providing the direct care to the patients to multi-disciplinary groups that could affect decisions in those areas as well as the outcomes of the patient."

For example, one area where administrators represent perioperative nursing concerns how the organization maintains compliance with regulatory and accrediting bodies. "Meeting OSHA requirements such as sharps safety is a good example," Prescott says. "Administrators would share the needs of perioperative nursing to ensure sharps safety and then gain buy-in and support for efforts in this area from other senior leaders such as physician leaders, the materials department and other entities."

Another example of an area where administrators would represent the safety needs of perioperative professionals is with decisions concerning staffing levels. "This is particularly evident with some of the more complex procedures," Prescott notes. "Procedures using robotics, for example, may require additional staffing to ensure patient safety. Administrators are in a position to explain this need to those groups involved in staffing decisions."

3. Lobbying for additional education and training needs. Administrators will often need to lobby for additional safety education and training to multidisciplinary decision-making bodies, Prescott says. "Education as a whole oftentimes gets grouped into one pot. We need to look at education specific to the needs of specific patient populations. Administrators should advocate for internal and external education opportunities, which will enhance patient safety through enhancing the competence of the nurses and the team taking care of the patient."

4. Maintaining accountability. "I think there's a need for accountability at every level of care, from the staff nurse to the educator to the manager," he says. "For the administrator, it's making sure we're all holding each other accountable for providing the safest care possible. But it's a two-way street. We're responsible for our job duties but also for patient outcomes by making sure nursing professionals are working to their fullest capacity for each patient."

5. Analyzing data for evidence-based decisions. Administrators have a responsibility to analyze data and then suggest and support evidence-based decisions that would benefit patients and staff. "We need to be looking at data in areas including patient satisfaction, patient safety and staff satisfaction, and then facilitating a team-oriented approach to using that information as a basis for improvement in those areas," Prescott says. "I think there's more buy-in when you facilitate the team approach to improving patient satisfaction and safety than there is by simply directing it."

Casio identifies five important ways educators help prevent surgical errors.

1. Assessing requests for education. While educators frequently receive requests for education on a new piece of equipment or a procedure, Casio says it is vital for educators to "do a little legwork" before putting together the education.

"Educators should first do an assessment of why there is the request for the education," she says. "Oftentimes this assessment will reveal that there are actually some process issues that need to be addressed."

This is an area Casio believes educators can really help managers and administrators identify issues that need fixing. "If we just keep reeducating the staff on the same thing thinking we'll get a different result, we usually just end up with the same result," she says. "You should give due diligence to find out what was the impetus of someone asking for the education and then adjust your education to address these needs."

2. Staying current. Educators must remain aware of the current evidence for best practices, safety recommendations from different organizations and requirements from regulatory bodies. "We need to remain current, so we can help staff learn what's current," Casio says. "If the staff is kept informed, they can improve their practices to provide the safest possible care."

3. Incorporating new technology. Part of staying current is identifying, analyzing and incorporating new technology that can help perioperative professionals provide safer care. "One of the areas we've been focusing on is our surgical counts," Casio says. "We've been working on adding the latest technology developed to assist with sponge counts. Educators need to remain informed about new tools that are meant to help keep patients safe. They also need to help staff learn about these tools to put them into practice."

4. Ensuring changes do not compromise best practices. "New procedures and new supplies can help make patient care efforts safer, but only if we're careful not to become complacent," Casio says. "Whenever changes are made, educators should try to make sure best practices aren't changed or forgotten just because something new may seem to be easier."

5. Checking on new staff. Whenever new staff joins a team, Casio says educators should provide additional levels of support while these individuals are settling into their role. "You just want to be available to new people and inquire if they have questions about practices, policies and procedures," she says. "Check in with them periodically to make sure what they're learning meets the standard of we want them to learn."

Guidelines for Perioperative Practice


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