FROM THE BOARD
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Victoria Steelman, PhD, RN, CNOR, FAAN AORN Board of Directors |
Promoting a culture of safety
On June 17th, we recognized National Time Out Day. This annual event raises awareness of the importance of perioperative patient safety and provides members of the surgical team an opportunity to collaborate and make a conscious commitment to safety initiatives, including The Joint Commission's Universal Protocol.
We all agree that medical errors should never occur. However, wrong patient/procedure/site surgery continues to be a problem. In 2008, The Joint Commission reported that wrong site surgeries remained the most frequently reported sentinel event. So, our work is far from done.
AORN resources are available to refine processes used for prevention of wrong site surgery, including an updated Correct Site Surgery Tool Kit with videos and other reminders and resources that can be used to educate staff members and raise awareness.
Additionally, as part of the World Health Organization (WHO)'s Safe Surgery Saves Lives campaign, the Surgical Safety Checklist has been created to reduce the number of surgical deaths around the world through a preoperative checklist with many of the criteria of The Joint Commission's Universal Protocol, as well as a postoperative checklist that includes other safety issues, such as specimen management. Over 300 organizations, including AORN, have endorsed the WHO Surgical Safety Checklist. A video on how to use the checklist is available here. Find the WHO checklist and more information on the Safe Surgery Saves Lives campaign here.
Even simple strategies can make a big difference and, sometimes, creativity can enhance the positive side of a safety practice, and encourage collaboration with other disciplines. For example, using an acronym, such as SAFE, focuses on the positive goal:
- Suspend all activities
- Activate the checklist
- Final step before the procedure
- Everyone participates
Grassroots safety campaigns developed at our own facilities can enhance the positive side of a safety practice, and encourage collaboration with other disciplines.
Last year, the University of Iowa Hospitals and Clinics hosted a "Time Out Taco Bar" to celebrate National Time Out Day. This event reminded team members of the steps required in the Time Out. Each ingredient in the taco represented a step in the Time Out. A perioperative nurse helped team members build their "Time Out tacos", while reinforcing the importance of each step.
Ingredients for a "Time Out" Taco
Step of the Time Out Ingredient
Correct patient Plate
Correct procedure Tortilla
Correct site and side Beef or chicken
Correct position Refried beans
Implants, special equipment,
or other requirements available Shredded cheese
Pathology/diagnostic/radiology
test results available Sour cream
Images properly labeled
and displayed Guacamole
Safety precautions reviewed Black olives
Need for special medications
or fluids for irrigation Taco sauce
Whether using resources developed by AORN or designing our own creative strategy, we can work together to reinforce safety practices and cultivate a culture of patient safety.
Victoria M. Steelman, PhD, RN, CNOR, FAAN
Member, AORN Board of Directors
Read more news in AORN Connections.