The Importance of Taking Care of Your Scrub Person
Your scrub person is the direct link between you and the patient. If they have what they need, the surgeon has what they need. If they are not stressed, they present a calm front to the surgeon.
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By: Heather Kooiker, MSN, RN, CNL, CNOR, CRNFA
Published: 11/6/2023
The intraoperative time out can become mundane and routine; in fact, teams sometimes forget it was even done. How many times has it been asked, “Did we do a time out?” The time out is one part of the Universal Protocol developed by The Joint Commission. An effective time out prevents wrong-site, wrong-procedure, and wrong-person surgery, each of which is considered a never event by the National Quality Forum and The Joint Commission.¹,² It also is a tool that can protect the patient from potential surgical risk that could cause harm like pressure and positioning injuries, hypothermia, and fire.
Although the time out is a part of every surgery, there are still sentinel events occurring. Take, for instance, the 97 unintended retentions of a foreign object (eg, sponges) and 85 wrong-patient, wrong-site, and wrong-procedure surgeries reported to The Joint Commission in 2021; these two examples are the third and fourth highest reported events of the year.3 While these numbers seem low in the overall picture, they only reflect a small proportion of the actual events (less than 2%)3 and underscore the need for continued work. Utilizing the time out to recognize and verbalize patient risk is the first step.
The time out is an avenue for team communication and risk identification. Identifying risks and communicating them during the time out ensures that the team is aligned with the planned patient safety interventions that will take place throughout the procedure. Examples of safety interventions include preplanned ongoing micromovements (intraoperative manual offloading of identified pressure points without disturbing the case) and intentional reassessment of positioning throughout the case⁴ to decrease the risk for pressure injury and temperature management to prevent hypothermia. A strong commitment to the time-out process is needed for these strategies to work.⁵
An average time out can take anywhere from 30 seconds to two minutes. To the surgical team, this can seem like a lifetime. In a busy surgical setting, the time out is often rushed and lacks team participation. Like the moments before a big race, anticipation and excitement can distract the team. The time out loses its purpose and becomes a meaningless task, resulting in poor patient outcomes. By verbalizing identified patient risk factors and setting expectations for the implementation of an intraoperative nursing intervention plan, the time out becomes meaningful. When the surgical team agrees on the expectations for the plan of care, confusion surrounding the interventions decreases and team alignment is created.
If there is a chronic lack of engagement by the surgical team when the time out begins, consider some of the following strategies to create buy-in to help ensure a complete pause takes place during the time out.
Whatever the case may be, the time out is the team’s communication platform and should not be taken for granted or marginalized. Set the stage for patient safety by utilizing the time out to strengthen the team; improve communication; verbalize expectations; and, most importantly, improve patient outcomes.
Your scrub person is the direct link between you and the patient. If they have what they need, the surgeon has what they need. If they are not stressed, they present a calm front to the surgeon.
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