Patient Safety in the Operating

Patient Safety in the Operating Room

Patient safety is an essential important element in all institutional medical care, yet the patient is the most vulnerable to error and potential harm while he or she is in a state of sedation. Generally, such events occur during procedures but patients are most likely to be in a full state of unawareness in the operating room. It is for this reason that operating room safety is an absolutely essential aspect of patient safety and advocacy in any institution. Over the years, as operating rooms have become exceedingly busy, performing back to back surgeries for the entire day the need to confront issues of patient safety has come to the forefront, as the increased numbers of procedures also increases the potential for error.

The answer has always been to increase the checks and balances of procedural preparation, performance and closure and these procedural checks and balances have improved patient safety, yet the goal of the institution is and will remain 100% patient safety 100% of the time. This is the reason that many operating rooms, pre-op areas and post op recovery rooms have implemented technology-based tracking systems that reduce avoidable errors, such as instrument loss, wrong patient and wrong limb errors. The purpose of this work is to demonstrate briefly the manner in which such technology has been created and implemented to help reach the high standards of a zero error policy.

Patient Safety & Technology in the or Pelletier has created an overview of a new text on Patient Safety, the Impact of Information Technology on Patient Safety by Russell F. Lewis (2002). The focus of the work is how it has impacted patient safety, and discusses such topics as computerized physician order entry, order management, integrated clinical systems. The impact to nurse regarding the automation of processes and procedures that are most likely to put a patient at risk in the or and elsewhere is significant but can be one of the greatest tools that institutions have to ensure the adherence to zero error policies. Information technology has had a significant impact on work flow and processes an the most outstanding goal of the systems associated with operating rooms and preparation for procedures has been automated information technology tools which do everything from keeping a physical count of instruments to checking, often by barcode to make sure that the patient is in the correct surgical suite, for the correct procedure and that the patient is having the correct procedure on the correct extremity. Nurses interact with such it programs to help ensure that the checks and balances, that were once done by hand are now done electronically, creating yet another set of eyes and ears in the or and elsewhere. (Pelletier, May 2005, pp. 1087-1088)

Also to be found in the AORN Journal is an article describing common errors made in operating rooms that significantly impact patient safety and then breaks down these errors utilizing examples of how it can help prevent these same errors. "Technology can contribute to improved patient care by providing real-time knowledge, eliminating handwritten patient records and errors caused by health care providers' illegible handwriting, and reducing nonclinical time so caregivers can spend more time on patient care. " (Cobb, August 2004, pp. 295-302) O'Meara, also supports the finding of other AORN researchers and writers, stressing that electronic documentation greatly improves the chances that all the pertinent members of the health care staff have the information needed to make safe decisions for patients while they are in the or and elsewhere in the hospital.

O'Meara stresses that a system known as a Decision Support System of DSS can be integrated into existing it to identify potential errors that could be made on any given case and provide the staff with flags to help them avoid such errors. (December 2007, pp. 970-979) DSS technology can seriously improve the chances that patients will not receive inadequate care or that services and potential challenges to them get noted and flagged appropriately to alert nurses to ways in which common mistakes can be made. DSS systems could alert the nurse of patient allergies, noted mechanical checks, crosschecking medication administration and any number of things that support patient safety.

Conversely Giordano, stresses that patient safety, in spite of it and other technology now utilized for patient care is essentially the nurses responsibility, therefore it is absolutely essential that the nurse advocates for safety and does not rely so much upon technology that she or he reduces the needed physical checks and balances associated with patient safety. Giordano states:

Perioperative nurses must be diligent guardians of surgical patients' safety at all times because potential hazards exist not only with new technology (eg, interactive, image-guided, stereotactic neurosurgery systems) but also with familiar, standard equipment (eg, electrosurgical and laparoscopic units)....New technology is beneficial when it eliminates time-consuming manual tasks, reduces surgical time, and facilitates less-invasive surgical procedures. Misapplication or misuse of this technology, however, can result in needless patient injuries. Patient advocacy and control of the surgical environment are the responsibilities of perioperative nurses. (February 1995, p. 314)

Giordano's point is well made, though supportive of technology she stresses that dependence on such technology does not do the patient much good if the peri-operative nurse relies so heavily on it that he or she does not continue with due diligence to protect the safety of the patient.