We originally created the role of safety nurse to prevent wrong-site surgeries. While our safety nurses continue to ensure that we perform the right procedure on the right site on the right patient, we've expanded their role so that they now serve as patient ambassadors. They contact patients 2 days before surgery, complete medical histories, confirm that necessary labs and H&Ps are complete, and contact patients to confirm arrival times on the day of surgery.
Who's best for the job?
Look for an RN who possesses extreme attention to detail and who's willing to transition from starting IVs and working cases to checking forms and following up on the actions of their colleagues. Here's how safety nurses function in our facility:
- Check paperwork. After pre-op nurses meet with patients, perform pre-op assessments, take vital signs, start IVs and review consent forms, the safety nurse steps into action. She first checks to make sure procedures on the surgical schedule match the procedures noted on consent forms. Next, she discusses with patients what surgery they're having that day and prompts them to repeat the information back to her, which serves as their verbal confirmation. She then has patients recite their name, date of birth and the physician they're there to see, and confirms that the information matches what appears on their wristbands. Finally, she makes sure H&Ps are complete and in hand, and that the dates on them match the dates on consent forms.
- Confirm the surgical site. The safety nurse checks that the marked surgical site coincides with the intended procedure noted on the consent form and surgical schedule. Develop a site- and side-verification form (see "On the Web") that includes spaces where the safety nurse can note the date, the planned procedure and the procedure's intended site and side (the side is as important to note as the site, especially in orthopedic procedures). Before we wheel the patient into the OR, the safety nurse, anesthesia provider, circulating nurse, surgeon and patient must sign the form after confirming that the correct surgical site was identified and marked.
Pleasant and persistent
We rotate 5 RNs through the role at my center, but consider assigning the same person for days or even weeks at a time to develop some consistency, which will help ensure that small details don't slip through the cracks. The safety nurse's presence doesn't lessen the responsibilities of the rest of your staff. She simply provides backup to the precautions they should already be taking. Your staff shouldn't be any less involved in protecting patients.