3 EBPs to eliminate RSI
Publish Date: 5/8/2013
After putting two patients (in one year) through the trauma of a second surgery to retrieve a retained surgical item (RSI), perioperative leaders at Sinai Hospital in Baltimore said, "enough is enough." They scrapped the hospital’s previous policy and procedures for unintentional retained surgical Items and went back to the drawing board.
Knowing that perioperative team members wanted a stronger voice in shaping the new policy, OR Manager Annette Anderson, MSN/Ed, MBA, MA, BSN, RN, and APRN Melanie Braswell, DNP, RN, CNS, CNOR, decided to help these frontline team members collaborate with a multidisciplinary performance improvement team to write, test and operationalize the new policy.
"As soon as we invited perioperative staff to this multidisciplinary team to collect the evidence for shaping their own policy, we immediately saw this group combing the literature and speaking with other hospitals to find evidence-based solutions that also made sense for everyday practice," acknowledged Braswell, who also serves on AORN’s board of directors. "Where there once was resistance, now they are preaching the policy."
"It’s really about empowerment," Anderson adds. "They [perioperative nurses and surgical technologists] have done a total 180, they feel their voices were heard."
Shaped with evidence-based information, consensus-based standardization from all team participants, and adjunct barcoding technology, Sinai Hospital’s new efforts to prevent unintentional retained surgical items are a success. They are happy to report no RSI incidents over the past year across all invasive procedure settings, and teams are empowered to keep it that way.
Here are Sinai Hospital’s evidence-based keys to eliminating RSIs:
1. Standardize accounting practices:
Based on AORN Recommended Practices for Prevention of Retained Surgical Items and recommendations from No Thing Left Behind
2. Use a standardized, pre-formatted grease board to track surgical item accounting: Based on recommendations from the article "Increasing Patient Safety and Surgical Team Communication by Using a Count/Time Out Board" published in the Oct. 2010 issue of AORN Journal
- Sinai Hospital’s policy outlines (in detail) the steps for standardized accounting of surgical items, beginning with the baseline count (which is documented/scanned) of surgical items from the field, then to the mayo stand, then to the back table, and finally to the kick bucket/bag counter.
- Specific roles are outlined in detail in the policy for team members to account for surgical items and act if a miscount occurs.
3. Use a standardized, consensus-based approach for sterile set-up configuration: Based on team consensus, and AORN practice recommendations for preventing RSI and for sharps safety, and recommendations from No Thing Left Behind
- Each operating room displays this pre-formatted grease board to document surgical item accounting information.
The grease board is displayed prominently for sterile and non-sterile team members to see.
- Other information displayed on the board includes the patient’s name, medical record number, procedure, allergies, and all other pertinent information related to the SCIP (Surgical Care Improvement Project) measures.
A key to success for creating and implementing this new RSI policy was bringing together both experienced and novice perioperative professionals. The experienced team members shared their time-honored traditions related to accounting surgical items, and the novice team members brought new input on preventing RSI from their recent educational programs.
"The collegiality within this group was phenomenal," Braswell notes. She says this type of collaboration is especially important for operationalizing RSI prevention policy because accounting for surgical items is often a matter of habit that requires behavioral changes.
Anderson stresses that the work of implementing this new RSI prevention policy and procedures is ongoing. "You can never stop auditing and tweaking practices, especially for RSI prevention because any changes introduced in the OR can affect accounting practices."
No Thing Left Behind
Alexander's Care of the Patient in Surgery
- Led by surgical technologists, several options for standardized sterile set-ups were evaluated. Together the team chose one standardized set-up that is used in every operating room.
- This supports more accurate surgical item accounting practices, better hand-offs to relief team members, increased patient safety and an overall improvement in OR efficiency.