Patient safety should be top of mind at all times, even when high-volume days and high-pressure situations threaten to distract the clinical team from taking the necessary steps to reduce the risk factors that
can lead to adverse events. That demands creating a culture of transparency and making sure you're up to speed on the latest ways to protect patients from harm. We hope this quiz helps with those efforts, so sharpen your pencils and let's
get started!
1. Monitoring patients for hypothermia prior to and during the preoperative period is just as important as intraoperative body temperature monitoring.
- a. True
- b. False
- Reveal
Answer: a
The overall clinical significance of preoperative warming is not yet fully understood or appreciated at many facilities, according to Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, director
of evidence-based perioperative practice at the Association of periOperative Registered Nurses (AORN). "Seeing the big picture is important when addressing patient hypothermia and should include both subjective and objective
data," explains Dr. Spruce. As such, she says, preoperative assessments should include not only checking a patient's temperature but also asking them if they feel cold. Explaining to patients the importance of hypothermia
prevention is an important aspect of patient and family education.
Current AORN guidelines instruct providers to measure and monitor the patient's temperature during all phases of perioperative care. Dr. Spruce notes
that longstanding recommendations from the U.K.'s National Institute for Health and Care Excellence (NICE) address prewarming even beyond the facility. NICE advises that patients, along with their families and caregivers,
be informed that staying warm before surgery lowers the risk of postoperative complications and that the surgical environment might be colder than their own home.
"From the provider's perspective, it's important that
patients are not coming into the perioperative suite cold because it can take a while to get their temperature back up to normal," says Dr. Spruce. "Hypothermia results from direct heat loss in a cool operating room environment
and impaired thermoregulation that is associated with anesthesia. It's important, then, that the patient's body isn't using its metabolic resources such as shivering to compensate for a low body temperature preoperatively."
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2. After an unexpected event during surgery, a patient is wheeled to the PACU before an RFID or barcode system could be used to count surgical items used during the procedure. In this case, the adjunct technology should be used once the patient is stabilized.
- a. true
- b. false
- c. follow your facility's policy and procedure for use of the device
- Reveal
Answer: b
Once the patient is in the PACU, the opportunity to confirm that there are no retained surgical soft goods has passed. "At that point, anything left inside the patient would be considered a
retained surgical item," says Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-CP, senior perioperative practice specialist at AORN. "If there's something left in the wound and you've already closed — applied the final stitch,
staple or surgical glue — then that is a retained surgical item. Making sure you get everything back before closing is crucial."
Patients with a retained sponge require a removal procedure that is not reimbursed.
That can lead to patient dissatisfaction, potential implications to the reputation of the facility and possible second victim phenomenon for involved personnel, notes Dr. Cahn.
Facilities should strictly follow the
manufacturer's instructions for use when using adjunct technology. "Clarify in your policy and procedure when these devices will be used during your manual counting processes," says Dr. Cahn. While AORN recommends that
counting processes and reconciling of counting discrepancies should be completed before wound closure, individual facility policies may vary.
Adding explicit instructions to your policies and procedures to ensure
the use of the adjunct technology at the correct stage of the surgery is especially important because the tech is employed toward the very end of procedures. "Many things are occurring simultaneously at that time, which
can cause distractions and interruptions," says Dr. Cahn. "Clarifying standardized procedures for use of this technology during the counting process can empower staff to ensure that adequate time is dedicated to correct
use of the device as part of patient safety measures."
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3. Smoke evacuation is purely a staff safety issue, as patients aren't exposed long enough to surgical smoke to experience any negative effects.
- a. true
- b. false
- Reveal
Answer: b
The health hazards of surgical smoke exposure for OR staff have been well-documented and described, but what about the patient? "Surgical smoke contains harmful chemicals and lung-damaging
particles, and everyone who is in the operating room — even our patients — could be exposed to these hazards," says Emily Jones, MSN, RN, CNOR, NPD-BC, perioperative practice specialist at AORN. "Research shows that the
concentration of fine particles accumulates to unhealthy levels within seconds after smoke production starts, and that exposure to even a small amount of plume could be harmful. That's why smoke should be evacuated and
filtered in all surgical settings. It's a simple way for perioperative staff members to protect one another and the patients in our care."
AORN's Surgical Smoke Safety Guideline points to the patient experience aspect
of smoke evacuation as an important consideration. The guideline cites a single-blinded randomized controlled trial of 160 adult patients undergoing wide-awake outpatient Mohs micrographic surgery that compared patient
experiences when smoke evacuation was used for some procedures and not for others. "As you can imagine, patients noticed and were more bothered by the smell of surgical smoke when smoke evacuation was not used," says Ms.
Jones.
In a smaller comparative pilot study cited in the guideline, 36 patients were surveyed about their perception of electrosurgery smoke after undergoing Mohs surgery where smoke evacuation was used during closure,
but not during staging. All patients reported perceiving a burning odor when smoke evacuation was not employed during staging, compared to 40% of patients who perceived an odor during closure when the smoke evacuator was
on. Two-thirds of the patients reported that the odor during surgery was unpleasant, while just one-sixth reported an unpleasant odor during closure when the evacuator was operating.
"Surgical smoke evacuation can
also improve patient satisfaction," says Ms. Jones. "A patient who is awake during surgery, such as with local-only anesthesia procedures, will likely have a better surgical experience if they don't smell the bothersome
odor of surgical smoke."
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