FRIGHTFUL REMINDER The Medarva Stony Point Surgery Center uses a mannequin named Bruce to help illustrate the horrors of surgical fires.

You might read about something, or you might see pictures. "But when you actually see it in real life, it means a whole lot more to you," says Shane Stanford, BSN, MSN, MBA. That's why the Medarva Stony Point Surgery Center in Richmond, Va., this year's OR Excellence award winner for Patient Safety, doesn't settle for mere discussion when it comes to preventing surgical fires.

Instead, once a year, they wheel out a mannequin nicknamed Burning Bruce to show staff and physicians how quickly a surgical fire can erupt, and what one looks and feels like. The demonstration takes place in the parking lot behind the surgery center. Bruce, wearing a surgical gown and lying on a gurney, is treated with an alcohol-based skin prep as the group is reminded that such preps need to dry for at least 3 minutes.

Up in flames
Then a clinician is randomly selected from the crowd, and everyone gets a dramatic demonstration of how outpatients can quickly become inpatients as a result of impatience. After about 90 seconds of drying time has elapsed, the clinician directs a flame toward the prep, and whoosh, up goes Bruce in flames — flames that rapidly spread across his entire body.

His job done and the point made, Bruce — affectionately named after Bruce Kupper, the president and CEO of Medarva Healthcare and an outspoken safety advocate — is snuffed out and cooled off, before going back into storage to wait for the following year's demonstration.

"So far, he's survived," says Mr. Stanford, the surgery center's director of clinical services. "But he's showing the effects. We're probably going to have to replace him in a few years."

But the char marks on Bruce are a badge of honor, a testament to the impact he's having. "When a clinician sees how easily a patient's skin can be ignited, and sees the flames on the body, it leaves an impression that this is something they can't afford to take lightly," says Mr. Stanford. "Fire in the OR can easily be prevented and this ensures that no mistakes take place."

More than prep
Since skin preps are only one kind of fire hazard, the trainers are also careful to cover other important aspects of fire safety, including a demonstration of how oxygen feeds fire, and how easily fire can engulf and even melt an oxygen tube. And drapes, they point out, can both lengthen the drying process, and obscure a fire until it's too late to prevent severe injury.

Staff learn about the fire triangle (fuel, oxygen and heat) and that turning off the fuel source is the first step if a fire breaks out. They learn to use saline or distilled water to put out a fire, and to never try to blow it out. They learn to watch out for prep that may have pooled in a drape or dripped into a patient's hair, or somewhere else that may take longer to dry. And maybe most importantly, they learn to never let an impatient physician try to short-change the needed drying time.

There are hundreds of surgical fires in the U.S. every year, but there's never been one at Stony Point or its sister surgery center in West Creek. Bruce and his keepers plan to keep it that way.

HONORABLE MENTIONS
Every Detail Matters When it Comes to Keeping Patients Safe

LISTEN UP! When it's time out at the Surgery Center of Key West (Fla.), Dan Michael Jones, MD, makes sure he has everyone's undivided attention.

Whistle stop. Everyone stops when the whistle blows in the OR at the Surgery Center of Key West (Fla.). It's a shrill and impossible-to-miss signal that time out is being called, and everyone needs to focus on one thing and one thing only: making sure they get every detail right. The man with the whistle is gastroenterologist Dan Michael Jones, MD, who's helped lead the charge for patient safety for many years, says administrator Tara Cormack, RN, CNOR. Their time out takes on even greater importance, she notes, because site-marking isn't always possible in a GI facility. When they hear the whistle, "everyone's attention is redirected while the doctor performs the time out," she says.

Above and beyond. Following all standards and regulations is important, says Laura Dewar, RN, BSN, but "it's what we do that goes beyond safety standards that makes Elliot exceptional." Elliot is the Elliot 1 Day Surgery Center in Manchester, N.H., where "from the moment patients walk into our smoke-free, weapon-free building to the time they are discharged, our staff works meticulously to maintain safety," says Ms. Dewar. Among the safety checks are laminated warning labels on anesthesia carts to warn caregivers when a change in practice might change the way medications are administered, and a strict "quiet policy" in the OR, during the critical periods of intubation and extubation.

Safety is Job #1. An "open, honest, non-punitive working environment where all team members have a voice and learn from one another," is a foundational component of optimal patient safety at HonorHealth-Thompson Peak Medical Center in Scottsdale, Ariz., says Monica L. Heyn, MSN, RN, CNOR, Peak's perioperative education coordinator.

Facility leaders help make sure staff get the ongoing education they need, via regular in-services, monthly staff meetings and educational conferences. HonorHealth also sponsors a growth, recognition and reward program called HonorNurse.

Patient safety is at the forefront from the moment staff arrive. At the beginning of every shift, staff must perform 3-minute scrubs. From there, carefully thought-out safety regimens include time outs before regional blocks, having no breaks during total joint cases, debriefings after surgery and SBAR (situation, background, assessment, recommendation) reporting for all handoffs in both pre-op and PACU.

— Jim Burger

Realistic drills
The emphasis on realism at Stony Point extends to other areas of patient safety, as well. For mock code-blue scenarios, they arrange ahead of time with the local county emergency medical services and fire department, so staff experience actually calling 911.

"We might simulate a scenario where someone has just had surgery but has decompensated in PACU," says Mr. Stanford. Staff need to clearly explain the situation to an operator, and paramedics are dispatched to the surgery center to help walk everyone through the whole scenario — all the way up to loading a mannequin into the ambulance, Mr. Stanford explains.

"We try to be as scenario-based as possible, trying to think of things you might actually see in a surgery center," he says. "It's more realistic, and it helps build team relationships."

After all, the worst scenario is to be caught unprepared, he points out. The center also conducts annual disaster drills, covering what needs to be done in the event of an earthquake, tornado or hurricane. An active-shooter drill with the local sheriff's department is in the planning stages.

No mixed messages
Not surprisingly, for malignant hyperthermia drills, the staff does much more than just go through the motions.

"We have the staff actually draw up the dantrolene, so they can see how hard it is to do," says Mr. Stanford. "That way, if an actual emergency ever happens, they'll realize it's going to take some effort to mix those medications."

Just as it takes considerable effort to make sure patients are as safe as possible every time they walk through the door at the surgery center — effort that staff and physicians know will pay off in a big way if a real emergency ever arises. OSM

— Jim Burger