OR Excellence Award Winner

A patient once came into Houston Physicians' Hospital in Webster, Texas, and a pre-assessment testing nurse noticed that the man's arms and legs were covered with bruises.

"Tell me about those bruises, sir," the nurse said. "What's going on?"

"Well, I've been falling a lot lately," said the patient.

That got the nurse to thinking. The hospital didn't have a system in place to flag patients who were at high risk of falling. Soon thereafter, leadership started looking at the falls occurring in the hospital and discovered that there were 7 falls in 2017.

"Everybody started talking about why we were having so many falls. What was going on?" says Karen Acosta, MSN, RN, CNOR, director of surgical services at Houston Physicians' Hospital, the winner of the 2018 OR Excellence Award for Patient Safety.

Always concerned about patient safety, the hospital implemented a "Patient Fall Initiative" to identify those patients at risk of falling and developed a system to let all staff along the patient's journey know they were dealing with a patient who was likely to fall.

Here's how it works. They screen all patients in pre-op to identify those at a higher risk of falls. They fit those patients designated as high risk with yellow wristbands and yellow slip-resistant socks so any member of the perioperative team can easily identify them.

"We needed a good visualization in all departments, so that anybody walking by to see that patient would know that they were at high risk of falling," says Ms. Acosta. "You can see the patient's feet in the pre-op bays. If a nurse walks by and sees the yellow socks and the patient says, "?Hey, I need to get up and go to the restroom,' then the nurse can see the patient is at high risk for falls and get someone to help that patient."

The Patient Fall Initiative is only one of many steps Houston Physicians' Hospital has taken to protect patients. Here's what else.

Taking time for time outs

Patient safety at HPH begins at the front desk when an admissions tech places identification bands on patients during the registration process for all procedures, including radiology exams. The identity of that patient is confirmed at registration to ensure that the correct patient is having the correct procedure.

The hospital has also implemented a time out performed in the preoperative unit. Driven by anesthesia, the time out involves perioperative team members and encourages the participation of patients and their family members. This participation leads to engagement of the patients and families during the preoperative process resulting in improved patient satisfaction and improved patient outcomes, says Ms. Acosta.

"The hard stop originated in our preoperative unit prior to performing nerve blocks and has continued to evolve to include a time out for all patients regardless of the type of procedure," she says.

The OR staff performs observational audits of the time out process and those audits are used as a tool to identify process improvement initiatives in addition to aiding in the prevention of wrong-site surgeries.

Counting on the count board

They assess the fire risk during the time outs and documents in the perioperative nursing care plan as well as on newly designed count boards. The surgical nursing task force designed a large count board for each OR and procedure room. It's a custom color board that provides a visual reference for all members of the surgical team.

"The circulator notes the patient's name and allergies, and does a full surgical count," says Ms. Acosta. "And as they do during their time out process, they do their fire risks for the patient. Everybody in the room, especially the surgeons, acknowledges the fire risk and why."

Streamlining SPD

To improve safety and overall efficiency, the hospital streamlined its sterile processing department. Instrument trays now include only necessary items. All peel-pack instruments now include tip protectors and hinged instruments are packaged to ensure steam sterilization parameters are met. Every peel pack instrument in the facility has been repackaged.

"We took an inventory of everything that we had in the house and asked ourselves if we really needed all of those instruments sitting there on the shelf," says Ms. Acosta. "They were crammed into little bins. You'd pull out one and you may get three or four of them."

So now only the necessary instruments are available and they're all categorized: all the ortho instruments are together, all the ENT instruments are together and all the spine instruments are together. "Now everybody in the department knows the sections," says Ms. Acosta. "So if I'm in ortho, I can go over to the ortho section and look through those instruments."

The hospital also conducts an annual safety tour, which begins during new staff orientation. The tour starts with a walk-thorough of every department and outlines where the fire exits are as well as the locations of the fire extinguishers throughout the hospital.

The hospital maintenance department organizes a yearly fire safety review and gets participation from the Webster Fire Department, which brings trucks out to the hospital. Staff members can participate in games that encourage the knowledge of fire safety and that include demonstrations of the proper use of fire extinguishers. Additional training is provided through online courses.

"Safety is a high priority not only for me as a leader in the organization, but also for every employee that works here," says Ms. Acosta. "Every patient is the most important person to us at the time." OSM