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Be a Time Out SUPER HERO

Publish Date: May 31, 2017

“Ethically and morally, nurses have a responsibility to protect the patient and, as the evidence of nursing science changes, so too should the practice of nursing,” notes AORN’s CEO and Executive Director Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN.

She says research around a culture of safety is providing important new findings nurses can put into practice every day as they fulfill their role in practicing the Time Out and other proactive safety actions.

That’s why AORN is partnering with The Joint Commission in taking National Time Out Day on June 14 as an opportunity to ask every perioperative team member to be a SUPER HERO for patient safety. This SUPER HERO acronym stands for nine elements of a safety culture that can come into play as part of practicing a Time Out, including:

Support a safety culture

Use The Joint Commission’s Universal Protocol and AORN Surgical Checklist

Proactively reduce risk in the OR

Effect change in your organization

Reduce harm to patients

Have frank discussions about hazardous situations

Empower others to speak up when a patient is at-risk

Respect others on the surgical team

Openly seek opportunities for improving patient safety

For example, during a Time Out if all surgical team members aren’t able to fully engage in the Time Out to proactively reduce risk in the OR, this is the perfect opportunity to halt the beginning of surgery until every one is ready, explains Coleen Smith, RN, BSN, MBA, CPHQ, high reliability initiatives director, Joint Commission Center for Transforming Healthcare. She explains further, “Say the Surgical Technologist realizes an instrument needed for the procedure is missing. His attention might be momentarily diverted and he might be He might be tempted to not engage in the Time Out. However, this is the perfect opportunity for him to speak up and share the situation with the team and ensure the instrument is secured before the procedure begins.”

Ask Thoughtful Questions

Smith and Groah agree that National Time Out Day provides perioperative teams with the perfect opportunity to talk about their Time Out. This conversation can serve to assess what’s working and what can be improved as part of broader efforts to address areas for improvement with safety culture.

Here are Groah’s answers to four key questions regarding Time Out practices that she believes are great places to start this dialogue:

  1. What does Time Out Day mean to you? 

    Groah: To me, Time Out Day gives national attention and local opportunities for shared conversation to reestablish best practices and processes around the Time Out that we implement with every patient, every time.

  2. What is the importance of having a Time Out Day? 

    Groah: This day gives the perioperative team an opportunity to remind their colleagues about the importance of taking a fully engaged Time Out that is focused on advocating for the patient to prevent adverse safety events. Dedicating a day to honor the Time Out helps perioperative nurses renew the conversation about this very important topic.

  3. Why do wrong site surgeries continue to happen despite having the Time Out?

    Groah: We know that breaks in communication are often identified as key contributing factors to a wrong site surgery. If the Time Out is not honored as a shared opportunity for each member of the team to have an equal role and voice, errors such as prepping the wrong surgical site are more likely to occur. In contrast, a fully engaged Time Out gives each member of the team a systematic process to speak up with a concern. In a strong safety culture this voice is not only respected, it is expected.

  4. What advice would you give other organizations or nurses having a hard time speaking up during the Time Out?

    Groah: The practice of taking a Time Out must be developed by a multidisciplinary group and then reviewed by all members of the team—preferably in a multidisciplinary education session attended by representatives from the C-Suite so all members of the team are aware that this is an important strategy that must be implemented to protect patients from harm. In my experience when the staff nurses know that management will support them in implementing a new procedure like the Time Out, they find their voice to speak up to protect the patient as the patient’s advocate.

Stand Up For Safety

“While the SUPER HERO theme provides a fun focus for National Time Out Day this year, the safety culture components of the theme are serious and should resonate with perioperative teams in their shared goal to create the safest surgical experience for their patients,” Groah stresses.

She emphasizes the critically important role perioperative nurse leaders and physician leaders play in convening a multidisciplinary team that includes staff nurses, surgeons, anesthesia care providers, surgical technologists, risk managers and a member from the C Suite to collaboratively develop procedures and protocols to address Time Out. 

As part of this work, she says a process for routine monitoring of the Time Out provides a systematic mechanism for reviewing Time Out practices, addressing non-compliance and discussing areas for enhancing and refining the Time Out. “We must all remember that a patient is very vulnerable during a surgical procedure—they trust that their surgical team will protect them.”


Check out AORN’s collection of resources for recognizing National Time Out Day 2017


Learn more from The Joint Commission about the fundamental tenets of a safety culture that leaders can support and reinforce.