Documentos de Académico
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The
Aligning practice with policy to improve patient care
Volume 5, Issue 2
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CAUTI
ALERT
THE OR CONNECTION
SSI Reduction
Let Us Hear Back To Basics:
From You! Retained Objects
Survey Inside r
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The
OR Connection
Aligning practice with policy to improve patient care
We also welcome any suggestions you might have on how we can continue to improve
The OR Connection! Love the content? Want to see something new? Just let us know!
Content Key
We've coded the articles and information in this magazine to indicate which patient
care initiatives they pertain to. Throughout the publication, when you see these icons
you'll know immediately that the subject matter on that page relates to one or more of
the following national initiatives:
• IHI's Improvement Map
• Joint Commission 2009 National Patient Safety Goals
• Surgical Care Improvement Project (SCIP)
We've tried to include content that clarifies the initiatives or gives you ideas and tools
for implementing their recommendations. For a summary of each of the initiatives,
see pages 8 and 9.
Editor
Sue MacInnes, RD, LD
PATIENT SAFETY
Clinical Editor
8 Three Important National Initiatives for Improving Patient Care
Alecia Cooper, BS, MBA, RN, CNOR
Senior Writer 12 New Joint Commission Report Shows Continued Improvement
Carla Esser Lake in Quality of Patient Care
Creative Director
13 The Joint Commission Tracer Methodology: Surgical
Mike Gotti
Site Infections
Clinical Team
Jayne Barkman, RN, BSN, CNOR 22 #2 on the Joint Commission List: Retained Foreign Objects Page 10
Margaret Falconio-West, BSN, RN, APN/CNS,
48 CAUTI Alert: Proceed with Caution
CWOCN, DAPWCA
Rhonda J. Frick, RN, CNOR
54 Reducing CAUTI with Bladder Ultrasound
Anita Gill, RN
Kimberly Haines, RN, Certified OR Nurse OR ISSUES
Jeanne Jones, RNFA, LNC
10 Ambulatory Surgery Center Quality Collaboration
Carla Nitz, RN, BSN
Connie Sackett, RN, Nurse Consultant Expands Mission
Claudia Sanders, RN, CFA 18 Indiana Surgeon Lowers Surgical Site Infection Rates Page 22
Megan Shramm, RN, CNOR, RNFA
Angel Trichak, RN, BSN, CNOR
30 Harm is Not an Option: Lessons from HROs
Perioperative Advisory Board 58 New Regulations for Infection Prevention in Ambulatory
Larry Creech, RN, MBA, CDT Surgery Centers
Carilion Clinic, Virginia
Sharon Danielewicz, MSN, BSN, RN, RNFA
SPECIAL FEATURES
St. Luke’s The Woodlands, Texas
Tracy Diffenderfer, RN, MSN
5 Let’s Talk About You! Survey
Vanderbilt University Medical Center, Tennessee 20 The Future is Now for New Learning Technologies Page 30
Barb Fahey RN, CNOR
42 Preparing Your Organization for Color-by-Discipline Uniforms
Cleveland Clinic, Ohio
Susan Garrett, RN
62 A State-of-the-Art Hybrid Program for the OR
Hughston Hospital Inc., Georgia 65 Never Lose Sight of Why We Are Nurses
Zaida I. Jacoby, RN, MA, M.Ed 68 Medline Hosts 5th Annual Breast Cancer Awareness Breakfast
NYU Medical Center, New York
Jackie Kraft, RN, CNOR
Huntsville Hospital, Alabama CARING FOR YOURSELF
Tom McLaren 74 Win-Win Negotiation: How to Get More of What You Want
Page 42
Florida Hospital, Florida
82 Healthy Eating: Syrian Salad
Donna A. Pritchard, RN, BSN, MA, CNOR, NE-BC
Kingsbrook Jewish Medical Center, New York
FORMS & TOOLS
Debbie Reeves, RN, CNOR, MS
Hutcheson Medical Center, Georgia 85 2009 AAAHC/CMS Crosswalk for Infection Control
Diane M. Strout, RN, BSN, CNOR 89 Pressure Ulcer Prevention Checklist: Perioperative Services
Chesapeake Regional Medical Center, Virginia
93 WHO Surgical Safety Checklist
Margery Woll, RN, MSN, CNOR
North Shore Shore University Health System, Illinois
Page 58
About Medline
Medline, headquartered in Mundelein, IL, manufactures and distributes more than Meeting the highest level of national and international quality standards, Medline is FDA
100,000 products to hospitals, extended care facilities, surgery centers, home care QSR compliant and ISO 13485 registered. Medline serves on major industry quality
dealers and agencies and other markets. Medline has more than 800 dedicated committees to develop guidelines and standards for medical product use including
sales representatives nationwide to support its broad product line and cost manage- the FDA Midwest Steering Committee, AAMI Sterilization and Packaging Committee
ment services. and various ASTM committees. For more information on Medline, visit our Web site,
www.medline.com.
©2010 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.
Wow! This edition of The OR Connection is just full of You will also find updates on the activities of the
informative material! Ambulatory Surgery Center Quality Collaboration,
tracking surgical site infections using The Joint Com-
Beginning with the cover, let me introduce to you Dr. mission Tracer Methodology, and on pages 38 and 39,
Michael Turner, a neurosurgeon with Goodman Camp- some highly recommended books to read!
bell Brain and Spine in Indianapolis, Ind. We were
delighted to meet with Dr. Turner, who invited us to join As you know, for the past five years Medline has been
him in surgery to observe what he is doing to reduce an active supporter of breast cancer awareness.
surgical site infections. See page 18 for more information This year, once again, we hosted a Breast Cancer
or go to http://www.medline.com/turner-video to Awareness breakfast attended by the biggest crowd
“
view a short video clip of Dr. Turner describing his ever, over 1,200 people! Our guest speaker was Peggy
Medline is committed
techniques. Fleming, Olympic Gold Medalist from 1968 and a
to providing quality
breast cancer survivor. I can remember when she won;
Next, you’ll notice on the opposite page a fun survey the young girl in the chartreuse dress, winning the only products, educational
you can take online. We have survey information from gold medal from the United States at the Grenoble offerings and innova-
AORN attendees, but now we want to open it up to Olympics. Prior to the breakfast, I had the pleasure of tions to make your
”
everyone who reads The OR Connection. We will be interviewing Peggy Fleming. I was in third grade when job easier.
posting the survey results in our next edition and sharing she won, and now so many years later I was inter-
success stories from our readers on innovative viewing her for The OR Connection. Today, she is every
programs, initiatives and solutions in the OR! Can’t wait bit the person I remembered… graceful, calm and
to show you what we have so far. oh, so strong. Take a look at page 68 for highlights
from Congress.
Another part of the survey asks questions about tech-
nologies you use, such as cell phones and Blackberries Finally, I am so excited to show you our newest nurse
and iPhones. We have been taking a close look at how doll. She is the “Pink Glove Doll,” and her name is Deb.
our lives have changed and continue to change based Deb is a true inspiration of the caring spirit we have
upon new and exciting technology releases. We know inside and the support we bring to such a great cause.
that as more and more new nurses and physicians Take a closer look at Deb on page 73.
enter the work force, the way they communicate may
be much different from someone who has been in Medline is committed to providing quality products,
health care for 25 or 30 years. educational offerings and innovations to make your job
easier. We want to continually lead the way in developing
It is important that the industry keeps in step with the cost-effective, safe and practical solutions. There are a
rest of our culture, so we are excited to announce that host of things on the horizon, and we are excited to
Medline has just released its first-ever iPhone app. It’s hear your reaction.
on Medline University now, and it’s FREE! You can
download the app on your iPhone or iPod Touch. Some Please call or e-mail me any time! I’d love to hear
of the app features include real-time industry news, from you.
video courses, audio download courses, competencies
and the list goes on. Now learning can be fun and
interactive! Medline University “students” also have the
ability to report completed courses to their employer. Sue MacInnes, RD, LD
Learn anywhere, anytime! How’s that for keeping up Editor
with the times?
On the cover:
Indianapolis neurosurgeon Michael Turner, MD,
applies Arglaes after closing a surgical incision.
4 The OR Connection
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You!
All winne
will be featu rs
upcoming is red in
sues of
The OR
Connection
!
First Prize
The entire Medline Doll collection
A plaque awarding the 2010 Contribution to The OR Connection!
Second Prize
There will be several second place award winners, who will all
receive the entire Medline Doll collection.
Everyone
can be a winner!
You can submit the survey three ways:
1. Complete the survey online at
www.medline.com/orconnection
2. Manually complete the survey, tear it out
and fax it to 847-949-3073.
3. Mail it back to us at Medline Industries, Inc.,
One Medline Place, Mundelein, IL 60060
Attn: Marketing Department – The OR Connection
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1. Tell us about yourself 5. What are your top three priorities? 10. Are the number of Foley catheters
Name ________________________________ placed for surgical procedures increasing
1. __________________________________
or decreasing at your facility?
Credentials (i.e., RN, LPN, etc.)______________ 2. __________________________________
3. __________________________________ ❏ Increasing ❏ Decreasing
Facility ______________________________
❏ Staying the same
Street Address ________________________ 6. Which of the following is most helpful
in improving patient care? 11. Circle your top three worst custom
City/Town ____________________________
procedure tray experiences below:
State/Providence ______________________ ❏ Continuing Education
❏ Competency 1. Unauthorized changes/situations
Zip/Postal Code ________________________
2. Delays in requested change
Phone ( ) ________________________ 7. How often do you believe education 3. Running without - supply(ies) missing from
is transferred by the clinician to kit/tray
E-mail ______________________________
bedside practice? 4. Foreign body found in tray (e.g., insect,
6 The OR Connection
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❏ Yes ❏ No
❏ Yes ❏ No
Hospitals sign up through IHI and can choose to implement some or all of the recommended interventions.
IHI provides how-to guides and tools for all participating hospitals.
The IHI Improvement Map covers the entire landscape of outstanding hospital care to help hospitals make sense of countless requirements
and focus on high-leverage changes to transform care. There are 70 processes grouped into three domains: leadership and management,
patient care and processes to support care.
Joint Commission-accredited organizations are evaluated for compliance with these goals. The Joint Commission offers
guidance to help organizations meet goal requirements.
Over the next year, the current National Patient Safety Goals (NPSGs) will undergo an extensive review process. As a result,
no new NPSGs will be developed for 2010; however, revisions to the NPSGs will be effective in 2010.
SCIP aims to reduce surgical complications in three target areas. Participating hospitals collect data on specific process and
outcome measures. The SCIP committee believes it could prevent 13,000 perioperative deaths and up to 300,000 surgical
complications annually (just in Medicare patients) by getting performance up to benchmark levels.
8 The OR Connection
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Patient Safety
Top 5 Key Processes Viewed by Improvement Map Users Top 5 Key Processes Shared by Improvement Map Users
1. Acute Myocardial Infarction (AMI) Core Processes 1. Central Line Bundle
2. Set Direction: Aims 2. CA-UTI
3. CA-UTI 3. Anti-Biotic Stewardship
4. Communication and Teamwork 4. Falls Prevention
5. Central Line Bundle 5. Heart Failure Core Processes
To learn more about the IHI Improvement Map and the 70 processes to transform hospital care, go to www.ihi.org/imap/tool
Visit www.qualitynet.org
“ Our goal is to help ASCs learn about the new regulations and
supplement their existing infection control programs with
helpful tools and resources for key infection control processes.
”
10 The OR Connection
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OR Issues
Patient Safety
Source:
Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2009. Available at:
http://www.jointcommission.org/NR/rdonlyres/22D58F1F-14FF-4B72-A870-378DAF26189E/0/2009_Annual_Report.pdf
12 The OR Connection
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Patient Safety
As surveyors trace a patient’s path of care, they may identify compliance issues
in one or more elements of performance. The process allows the surveyor to
identify trends in compliance that may point to potential system-level issues.
Emergency
OR
Patient Room
Recovery
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Let’s take a look at a typical tracer that involves a patient who The Mock Tracer Workbook provides practical exercises to
was admitted to a community hospital through the same-day help healthcare professionals practice skills needed to conduct
surgery area, entered the operating room for a left hip an effective tracer in any healthcare setting. During an on-site
replacement and two days after surgery was discovered to survey, surveyors use tracers to evaluate the care of an indi-
vidual or to evaluate a specific care process as part of a system.
have an SSI.
By doing so, the tracer provides an accurate assessment of
the daily functions at a healthcare organization.
The surveyor typically begins the tracer in the area where the
patient is currently located and receiving post operative care,
Order your copy today!
in this case, on the orthopedic unit. Questions that the Mock Tracer Workbook
surveyor may ask the staff nurse include the following: Price: $89
• How did you assess the patient for SSI risk factors Item number: MTW09
associated with orthopedic surgery? ISBN: 978-1-59940-306-9
• What did you do when you suspected the patient had 148 pages
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• What is the process to receive orders for and To order, call 877-223-6866 (M-F, 8 am to 8 pm Eastern time),
administer prophylactic antibiotics? or online at www.jcrinc.com/Books-and-E-books/Mock-Tracer-
• What education was provided to the patient about his Workbook/1637.
surgery and SSI prevention?
• What is your hospital’s SSI prevention plan?
• How do you monitor for SSIs after surgery?
Questions for the staff in the operative area may possibly
• How do you conduct and document assessments after
include the following:
a patient has surgery?
• Describe how you prepare the patient’s surgical site.
• How are the patient and their loved ones told about an SSI?
• What is your organization’s policy on hair removal?
• What type of ongoing training do you receive about
On prophylactic antibiotic use?
preventing SSIs?
• How would you care for a patient with a
preoperative infection?
The next step would be to follow the path that the patient took
• Describe your staffing levels.
two days earlier into the operating room suite. The entire
• What and how do you communicate when the patient
operative process as it relates to SSI prevention should be
transitions out of the operating room to the post
traced. Specific measures in the pre-, peri- and postoperative
anesthesia recovery room?
areas can be examined to determine their effectiveness in
• What is the organization’s SSI reduction program?
preventing SSIs.
The surveyor may then ask the patient if she could ask him a The surveyor may ask the infection preventionist the following
few questions about his hospital experience. The patient may questions:2
express concern about the infection, but hopefully the surveyor • What policies and procedures are implemented regarding
will hear that the physician has explained how the infection SSI prevention?
occurred and what is being done to treat it. • What data do you collect regarding SSIs?
• How do you evaluate the data and communicate to
The next step for the surveyor would be to conduct a broader key stakeholders in the organization?
system-based infection control tracer. At this point, the infec- • How often are the data communicated?
tion preventionist would share their surveillance data related to • What kinds of improvements have you implemented as
SSIs. The surveyor would ask how this data is communicated a result of your data collection and analysis?
to key stakeholders and what kinds of risk assessments are • What kind of initial and ongoing training about SSIs is
performed. The surveyor will be looking for an ongoing process provided to surgical staff?
that is effective in reducing surgical site infections.
Using a focused approach like the tracer methodology allows
you to examine your organization from the patient’s perspec-
tive. This can provide valuable information about your systems
and processes and can help you make improvements that will
improve the quality and safety of the care that you provide.
References
1. 2009 Hospital Accreditation Standards. Oakbrook Terrace, IL : Joint Commission
Resources, Inc.; 2009.
2. Tracer methodology 101: infection control tracer—surgical site infection focus.
The Joint Commission: The Source. 2010; 8(3):6-10.
16 The OR Connection
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ARGLAES IN THE OR
ANTIMICROBIAL SILVER TECHNOLOGY
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
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OR Issues
Dr. Turner and his team had always applied surgical prep to
the patient’s skin to lower colony-forming units, followed by an
iodine-impregnated drape. But the challenge was finding a
way to destroy and avoid spreading the infection-causing Dr. Turner also uses Arglaes surgical wound dressings to lower
organisms that emerge when the hair follicles and sweat the rate of abscess infections at suture sites. He said the
glands are exposed after making the surgical incision. antimicrobial silver and creation of an anaerobic environment
combine for good wound healing.
Surgical staff next have to touch the organism-laden incision to
make room for the implant. In the process, they pick up Before using Optifoam and Arglaes, study data from Methodist
organisms on their gloved hands, which then transfer onto the Hospital Surgery Center showed high infection rates among
implant, further spreading the organisms in the process. patients with pump implants. Dr. Turner said these rates
declined significantly after using Optifoam and Arglaes. He also
“So we needed to put a barrier there,” Dr. Turner said. “A num- found greatly reduced infection rates in one of the most high-
ber of studies have shown it only takes 100 organisms to risk groups of stimulator implant patients: obese smokers.
develop a clinical infection. Trying to get rid of the 100 organ-
isms is really where we’re aiming – and Optifoam does that.” “We’ve continued to use Optifoam long after our study, and
really find that our infection rate continues to drop as we
Dr. Turner applies Optifoam to the edges of the incision sec- become better at putting it on earlier and maintaining that
onds after making the cut. “We found that Optifoam has a environment of not touching the skin with our gloves at any
great consistency, and it contains silver to kill organisms.” time,” Dr. Turner concluded.
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Opt
ifoam ®
Dres
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Prot ted An
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1. Data on file.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. www.medline.com
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The Future
is NOW
for New Learning
Technologies
Don’t get left behind!
Advances in technology have resulted in numerous online Other colleges and universities are catching on to the
educational opportunities that are both free and easy to iPhone as an educational tool as well. Students enrolled in
access. In fact, electronic learning tools have nearly elimi- the undergraduate journalism program at the University of
nated the need to actually attend a class for continuing Missouri are required to have an iPod Touch® or an iPhone
education. Online webinars, e-textbooks and podcasts are to download course material.2 And the Blackboard app is
just a few of the options. And how about iPhone® apps? gaining popularity at many high schools and colleges as a
way to post assignments, grades, documents, discussion
Beginning with the 2008-2009 school year, all incoming boards and anything else associated with a course.3
freshmen at Abilene Christian University in Texas are
required to have an iPhone. Apps are used to turn in home- Posted on wired.com by: Panacea | 12/8/09 | 6:04 pm1
work, look up campus maps and check class schedules The community college where I teach nursing piloted giving
and grades. For classroom participation, there’s even iPods to students a few years ago, with the idea of using
polling software so students can digitally raise their hand to iTunes U. They like being able to replay lectures. I don’t do
answer questions.1 a traditional lecture in class anymore. The students down-
load their lectures. Class time is for interactive assignments
William Rankin, a professor at Abilene Christian, comments, such as care mapping, case studies, and discussion. Stu-
“This is a question of how do we live and learn in the 21st dents still get to ask questions about the iTunes content.
century now that we have these sorts of connections? Grades have been steadily improving over the last 3 years
I think this (the iPhone) is the next platform for education.”1 since I’ve moved to iTunes U. Retention has improved 15%.
20 The OR Connection
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Special Feature
Teaching & Learning: THE PRINT AGE Teaching & Learning: THE DIGITAL AGE
Course activity typically focuses on presentation of infor- Course activity typically focuses on students contextualizing,
mation with students contextualizing, practicing or using practicing, or using information with presentation of infor-
information at home. mation occurring at home through media or online access.
The classroom is the primary site of access to course con- Access to course content is augmented by electronic
tent, and access is often “linear” – students cannot typically sources and media, and access is often recursive or
return to previous class presentations. “on-demand,” allowing students to return to content when
and as often as they’d like.
Students and teachers have access to one another prima- In addition to classroom access, students and teachers
rily in the classroom. have access to one another via “virtual” means – online
discussions, e-mail, chat, social networking, etc.
Source: Dr. William Rankin, “Abilene Christian University 2008-09 Mobile-Learning Report.” Available at: http://www.acu.edu/technology/mobilelearning.
References:
1. Chen BX. How the iPhone could reboot education. Wired – Gadget Lab. Available at: http://www.wired.com/gadgetlab/2009/iphone-university-abilene. Accessed March 29, 2010.
2. Dignan L. Apple’s iPod Touch, iPhone as education tool: should universities dictate whether you’re a Mac or PC? Available at: http://blogs.zdnet.com/BTL/?p=17775. Accessed March 29, 2010.
3. The Next Generation of Educational Leadership: A blog for educational leaders who want to learn, share and discuss 21st-century education leadership strategies. March 29, 2009. Available at:
http://nextgeneduleaders.blogspot.com/2009/blackboard-app-for-iphone-great-tool.html. Accessed March 31, 2010.
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Patient Safety
Back to Basics Twelfth in a Series
“Foreign objects like sponges, scalpels and surgical instru- Whether or not you have been part of a retained objects
ments should never be left in the body cavity after an oper- lawsuit, it’s important to know that the issue of retained
ation. Surgeons who commit this serious and completely foreign objects (RFOs) is a serious, preventable complication
avoidable medical error must be held accountable. At Fried- that is increasing in incidence and complexity.
man, Domiano & Smith, our lawyers file medical malprac-
tice lawsuits in Ohio courts, calling attention to this serious The California Department of Public Health reported 141
problem and working to achieve the best possible results retained foreign objects in patients during fiscal year 2007-
for our clients. To talk confidentially about how a retained 2008, and the count increased to 196 for 2008-2009. In
object has affected you, contact the law offices of Friedman, addition to sponges, found objects included catheters,
Domiano & Smith.”1 dentures, drill bits, electrodes and screws.5
eign objects and other hospital-acquired conditions.7 It’s still Another study found that 88 percent of retained foreign
too soon to tell whether this measure will help reduce the objects were associated with a count that was thought to
incidence of these conditions.7 be correct. Similarly, a study by Cima et al. showed that 62
percent of retained foreign object cases involved a correct
Reasons for RFOs sponge, sharp and instrument count.9
With sponge counting as a routine procedure in most ORs,
and heightened awareness of patient safety, why are for- In a study looking at the reasons for count discrepancies,
eign objects continuing to be retained after surgery? Several 41 percent of the discrepancies were attributed to human
studies suggest possible explanations. errors involving addition mistakes, incorrect documentation
or miscounting. For these reasons, the American College
A 2003 study by Gawande et al. reviewed medical records of Surgeons (ACS) and the Association of periOperative
associated with a retained surgical sponge or instrument Registered Nurses (AORN) recommend methodical wound
between 1985 and 2001. The study included 54 patients exploration in addition to a surgical count.9
and a total of 61 retained foreign bodies.8 Findings showed
that patients with retained foreign bodies were more likely to
have had emergency surgery or an unexpected change in
surgical procedure. These patients also had a higher mean
body mass index (BMI) and were less likely to have had
counts of sponges and instruments performed during their
surgery.
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Developers of the RFID system note that the idea for the
device was conceived by an operating room nurse. After
conducting observations in operating rooms across the
country, the nurse concluded that sponge counts were
problematic in every surgery. Therefore, the RFID system
was created with an internal counting mechanism to safe-
guard against miscounts.
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©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
SmartSponge® is a registered trademark of ClearCount Medical Solutions.
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Multiple Choice 10. For FY 2007, the Centers for Medicare & Medicaid
6. Which of the following sponge detection technologies Services (CMS) recorded 750 incidents of foreign
does NOT include a wand? objects retained after surgery, which incurred an
a Bar coding average cost of an additional $__________
b. RF per case.
c. RFID a. 1,153
d. None of the above b. 63,631
c. 138,954
7. Which of the following is NOT recommended by the d. 14,849
Joint Commission if a foreign object is retained in
the patient?
a. Conduct a root cause analysis to thoroughly
investigate how and why the situation occurred. This course is approved for
b. Develop a detailed action plan to prevent similar one continuing education hour
occurrences in the future. by the Florida Board of Nursing
c. Find out who is to blame for the incident. and the California Board of
d. Report the incident according to state regulations. Registered Nursing
28 The OR Connection
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References
1
Braden Scale for Predicting Pressure Sore Risk. Available at:
www.bradenscale.com/braden.PDF. Accessed November 6, 2008.
2
Recommended practices for positioning the patient in the perioperative practice setting. In:
Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
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30 The OR Connection
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OR Issues
Because you know that all pilots follow very specific proven tol for justice. Except for a few famous people, such as the Den-
procedures that all but guarantee they won’t forget anything. nis Quaid twins, these accidents and deaths have gone unnoticed.
That’s why even though 3,400 commercial airlines controlled by The sad truth is that because these deaths occur one-by-one in a
6,800 pilots fly across the United States every day, not a single litigious culture that swears to secrecy and vows to “cover each
passenger died in a five year span from 2001 to 2006. Airlines, other’s backs,” the dramatic impact of the 21 people per hour who
like nuclear power plants, infectious disease researchers, atomic die from preventable healthcare errors is virtually ignored.
submarines and high-rise construction companies are all high re-
liability organizations (HROs) that have one thing in common. They The same is not true for other industries. For example, when Gen-
have learned how to make their organizations exceptionally safe eral Motors experiences a fatality or serious accident in their facil-
despite operating in an extremely challenging environment. These ity, the plant immediately shuts down until the system issue is
organizations simply can’t afford not to get it right the first time. addressed so the error will never happen again. When a worker is
harmed or killed at a petroleum refinery, everything comes to a halt
When you or a close relative is scheduled for surgery, do you immediately, and everyone is briefed about the event.
request a particular surgeon? If you work in a hospital, then you
most likely do. Why? Because you have witnessed firsthand that But when two patients died within one month on the same teleme-
outcomes vary. You know which surgeons or teams you like to try unit as the result of communication errors at a Florida hospital,
scrub in with, as well as the ones you would rather avoid at all 99 percent of all hospital staff never knew the events occurred –
“
costs. Most of all, you know exactly who you will recommend to
your loved ones for their surgical procedure.
THE VOLUME AND COMPLEXITY
Do you know the healthcare safety record during the same five
OF KNOWLEDGE TODAY
years there were no accidents in aviation? If you translated it into has exceeded our ability as individuals
aviation terms, the equivalent of 1,427 Boeing 747s filled with pas- to properly deliver it to people – consistently,
sengers crashed, and 500,000 people died. These healthcare- correctly, safely. We train longer, specialize
related deaths still have not made the headlines; and there are no more, use ever-advancing technologies,
major TV documentaries or advocacy groups storming the Capi- and still, we fail.” A. Gawande
Continued on page 34
32 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:19 PM Page 33
WITHOUT COMPROMISE
SensiCare® surgical gloves address a rising concern in the OR — latex allergies.
The American Latex Allergy Association estimates that • SensiCare® with Aloe – standard thickness,
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References:
1
American Latex Allergy Association. Latex Allergy Statistics. Available at: www.latexallergyresources.org/topics/LatexAllergyStatistics.cfm. Accessed March 2, 2010.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:19 PM Page 34
even weeks later. A hospital is supposed to be a high reliability did things a certain way simply because no one was willing to risk
organization, but the vast majority of hospitals still have not the lives of any or all of the team members.
adopted the practices that have demonstrated time and again
how to prevent human error in a dangerous and complex system. So what exactly is it that HROs do to perform so well in a time-
compressed, high-risk and stressful environment? They realized
What is an HRO? that reducing the number of variables was critical, so these
By definition, a high reliability organization (HRO) is an organization organizations standardized processes and procedures whenever
that manages an inherent risk with great precision and few, if any, possible. They defined roles, practiced rigorously and conducted
serious accidents or incidents ever occur. The term HRO was both a pre-procedure and post-procedure briefing for every com-
coined by Karl Weick, a professor of organizational behavior and plex procedure, and by doing so, they became predictably safe.
psychology at the University of Michigan. Dr. Weick identified a
group of organizations that stood out because of consistently High stress…High tech….High chance something could go
superior performance despite the fact that all of their environments wrong. By nature, most people want to do their best. But stress
were exceptionally demanding and contained significant elements can be exceedingly high, processes can be flawed and preventa-
of time compression and stress. ble errors are still a common occurrence in hospitals. All HROs
conduct a pre-procedure briefing and a post-procedure debriefing
Common Characteristics of HROs every single time for every error-intolerant process. They report all
1. High individual and organizational accountability incidents, regardless of whether there was any actual or perceived
2. Preoccupation with avoiding failure harm, in order to learn and apply this knowledge to avoid future
3. Broad knowledge base and high situational awareness accidents. HROs recognize that in time- and task-intensive envi-
4. Rebound quickly after an undesired event ronments, good people still have the potential to make serious
5. Consistently link cause and effect – continuous learning errors, but the impact of those errors can be significantly reduced
or even eliminated if they are identified early. Standard operating
He found that these organizations were “highly reliable” because procedures are followed without exception, as well as checklists
the errors they experienced were caught and corrected before for best practice, because they’re not willing to bet their life (or
they progressed to a catastrophic event. Because failure of one another team member’s life) on the chance that someone could
member of the team could mean death to the whole team, they inadvertently make a mistake. Today’s healthcare culture, how-
Continued on page 36
34 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:19 PM Page 35
more than 96% wood pulp, EcoDrape will biodegrade Fibers More than 96% No wood
wood pulp pulp
in only two to five months in a landfill – polypropylene
Petrochemical 0% 100% PP
drapes take hundreds of years to break down. EcoDrape ingredients (plastics)
has all the same great features as other Medline Additives Bio-based Fluorine
drapes, including hook-and-loop line holders, large
reinforcement zones, and premium tape and incise
film flush to the fenestration. To schedule a FREE demonstration of the
EcoDrape contact your Medline representative,
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©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
EcoDrape is a trademark of Medline Industries, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:19 PM Page 36
ever, tolerates quite the opposite. A recent data review revealed Case Study – Individual
that physician compliance with protocols is far from ideal.1 There Dr. Z., a high energy, demanding emergency physician, was the
are many exceptions to the rule; and even best practices are not biggest skeptic. He was known for his volatile temper, which was
always implemented. Here are some examples: evident every time things weren’t going smoothly, and he put staff
on edge. He even went to administration complaining about the
Last week the surgeon walked into the OR with his cof- “toxic culture” of the unit. One day he attended a workshop on
fee cup, unmasked. We wrote it up in an incident report, HRO team processes – not because he wanted to further his
and the next day, he did the exact same thing – with an knowledge, but rather to show what a waste of time it was. He
attitude. So we stopped writing it up. came away with a profound sense of amazement and actually
went back to administration to say he thought his own behavior
“I don’t want to hurt my team’s feelings because I
and attitudes had been contributing to the chaos in the ED. He
depend on them, so let’s pretend this whole thing
finally recognized that the more effectively the team functions, the
(sentinel event) never happened.
better it communicates, and the better the collective decision-
making for the patient. Even the EMTs noticed the ED was less
A review of 189 closed malpractice claims demonstrated
chaotic and functioned more smoothly. And both patient and staff
that 40 percent of adverse outcomes related to intra-
satisfaction increased significantly.
partum fetal hypoxia may have been avoided if 24-hour
in-house coverage had been available. Despite this
information, this coverage does not represent the cur-
Case Study – Organizational Use of HRO Techniques1
The rate of cesarean deliveries in the United States has continu-
rent standard of care.2
ally increased (except for a plateau trend in the 1990s because of
VBACs). Malpractice claims have increased with the rise of
An HRO culture would simply not allow maverick behavior, non-
cesarean delivery rates. The use of three specific drugs was noted
compliance or failure to report an error or do the right thing. A pilot
as a common denominator, and protocols for administration and
who “didn’t feel like using the takeoff checklist” because he was
checklists were put in place, combined with effective peer review.
in a hurry; or an infectious disease specialist who didn’t use best
Incorporating HRO features at 120 facilities improved outcomes,
practice for isolating a Level 3 virus because it was too costly,
reduced the cesarean delivery rate, lowered maternal and fetal
would be quickly unemployed. Yet, the current healthcare culture
injury and reduced litigation five-fold.1
still tolerates non-HRO practices? Why?
36 The OR Connection
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HRO 101. The element that is undoubtedly the most crucial part
of becoming an HRO is effective communication. Members of the Six-Step Communication Procedure in the OR3
team are encouraged to speak up any time to anyone. High func- 1. Make sure team members know each other.
tioning HRO teams realize silence is never an option. They 2. Verify patient’s identity and procedure.
embrace their responsibility as a member of the team to share 3. Specify what the procedure involves, and review
their observations and knowledge using precise, standardized ter- necessary supplies:
minology. HRO teams focus on making every critical communica- a. Ask the surgeon to articulate the procedure and
tion clear, timely and solutions-driven, despite the inevitable chaos specific steps.
of daily events. HRO leaders understand that it is their ethical and b. Complete process for identifying and marking the
moral responsibility to remove the hierarchy and create an envi- proper site.
ronment where everyone feels safe. In the operating room, the sur- 4. Ask questions: Nurse circulator should ask if there are
geon is in the best position to encourage questions and create an any questions.
atmosphere conducive to a two-way flow of information. Follow- 5. Discuss past procedures: Was anything done in a past
ing this six-step communication procedure is a great start for any procedure that could influence today’s operation?
ambulatory surgery center or OR. 6. Debrief after every procedure: This is the best opportunity
to improve communication, safety and quality.
“
(Editor’s note: This procedure is similar to the Surgical Safety Check-
Healthcare is a decade or more behind list developed by the World Health Organization (WHO). A copy of the
WHO checklist is available at www.who.int/patientsafety/safesurgery/en
other high risk industries in its attention
”
and in the “Forms & Tools” section of this issue.)
Must Reads
To help you enhance your high reliability organization
38 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/14/10 5:14 PM Page 39
To Err is Human: updated, the second edition of Managing the Unexpected uses
Building a Safer HROs is a template for any institution that wants to better organize
Health System for high reliability.
Linda T. Kohn, Janet M. Corrigan,
and Molla S. Donaldson, eds. The authors reveal how HROs create a collective state of mindful-
National Academy Press, 2000 ness that produces an enhanced ability to discover and correct
errors before they escalate into a crisis. A mindful infrastructure
This now classic Institute of Medicine
continually:
report, according to many experts,
• Tracks small failures
marks the beginning of the patient
• Resists oversimplification
safety movement in U.S. health care.
• Is sensitive to operations
• Maintains capabilities for resilience
As many as 98,000 people die each year from medical errors that
• Takes advantage of shifting locations of expertise
occur in hospitals. That's more than die from motor vehicle acci-
dents, breast cancer, and AIDS – making medical errors the fifth
Why Hospitals
leading cause of death in this country. The Institute of Medicine
Should Fly
seeks to improve the quality of care in America by focusing on the
John Nance, JD
facts and making wide-ranging recommendations. Skilled and Second River Healthcare
caring professionals can – and do – make mistakes because, after Press, 2008
all, to err is human. It's time to build a better system.
Did you know that a checked bag on
This report called for a comprehensive effort by healthcare an airline flight is still exponentially safer
providers, government, consumers and others. Claiming that than a patient in an American hospital?
knowledge of how to prevent these errors already existed, it set a It is not very comforting to consider that
minimum goal of 50 percent reduction in errors over the next five a toothbrush has a better chance of
years. Though not currently quantified, as of 2007 this ambitious reaching its destination than a patient has of leaving a hospital
goal had yet to be met. unscathed. This begs the question…why? John J. Nance, JD
frames the issue this way:
Managing the Unexpected:
Resilient Performance in “Nine long years after the Institute of Medicine told us nearly
an Age of Uncertainty 100,000 patients die each year from avoidable errors in our hos-
Karl E. Weick and pitals (To Err Is Human, 2000), the struggle to significantly reduce
Kathleen M. Sutcliffe major patient injuries has barely begun. The primary reason it’s so
Wiley and Sons, 2007 tough to change the system is that no less than the culture of
medical practice has been challenged and is, in effect, resist-
Why are some organizations better able ing change.
than others to maintain function and
structure in the face of unanticipated Hospitals will only fly when doctors, nurses, CEOs, trustees and
change? The authors answer this question by pointing to high every healthcare stakeholder overcomes the inertia that is
reliability organizations (HROs), such as emergency rooms in anchoring hospitals to the failed cultural foundations of the past
hospitals, flight operations of aircraft carriers, and firefighting units, and embraces a new paradigm of patient-centered care.
as models to follow. These organizations have developed ways of
acting and styles of learning that enable them to manage the unex- The time to take this flight is now and this is your boarding call.
pected better than other organizations. Thoroughly revised and
Summary
There is no doubt that HRO best practices reduce risk, gain
efficiencies, enhance our ability to function as a productive team
and communicate more effectively.
40 The OR Connection
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MEDLINE UNIVERSITY
Your source for clinical training and resources
FREE Continuing Education
Join the thousands of nurses who log on to Medline
University every day to earn continuing education
credits on a wide variety of subjects.* Over 50 courses!
New courses added every month.
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• Online, interactive courses
• Downloadable podcasts (audio files)
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• NEW! iPhone® apps available at The Apple® store
Informative
• Video of today’s leading healthcare industry
experts sharing their insights on critical issues.
• Online magazine articles from The OR Connection,
Healthy Skin and Infection Prevention Now
• Links to up-to-date healthcare news stories
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
iPhone and The Apple® Store are registered trademarks of Apple, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:19 PM Page 42
COLOR BY
42 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:19 PM Page 43
Special Feature
Healthcare uniforms have come a long way since the days Building support
when registered nurses wore only white. Today’s nurses – The prospect of changing uniforms has the potential to be un-
and nearly all other hospital staff members – wear scrubs. And popular at first. We’re all creatures of habit, and change can be
because scrubs come in all different colors, patterns and uncomfortable. Another argument staff often raise is that uni-
styles, it can be difficult to differentiate a registered nurse from forms strip them of their individuality. Employees at the Med-
a respiratory therapist or a housekeeper. ical Center of the Rockies found a new way to express their
personality – with accessories! Kay Miller, the medical center’s
Staff members representing as many as 13 different disciplines vice president and chief nursing officer, said some nurses dec-
may enter a patient’s room each day, leaving the patient won- orate their name badges with cute pins, and others wear fun,
dering, just “who is my nurse?” It’s not uncommon for patients brightly colored shoes. In addition, the dress code allows staff
to report that “the nurse” gave them instructions, only to find to wear theme print tops underneath their scrubs for special
out later that it was a physical therapist or a dietitian. occasions such as Halloween and Christmas.
In an effort to improve patient care and satisfaction by making Similarly, at the Medical University of South Carolina (MUSC)
it easier for patients to identify their caregivers, many hospitals hospital in Charleston, S.C., staff can choose to wear either
across the country have converted to color-by-discipline uni- solid-color scrub tops and bottoms designated for their disci-
form programs. The color of the scrub uniform denotes the pline or solid-color bottoms with a print top. Registered nurses
discipline the healthcare professional represents. Patients and are also allowed to combine white with their color or print top.
staff are provided with a color key, allowing them to immedi- This decision was well-received and allowed staff members to
ately recognize each healthcare discipline according to the express their individuality.1
color they wear. At the Medical Center of the Rockies, in Love-
land, Colo., for example, nurses wear blue, lab employees When building support for your proposed color-by-discipline
wear black and radiology employees wear burgundy. program, introduce the idea gradually by generating discus-
Preparing your
Organization for
Color-by-Discipline
Uniforms
Continued on page 46
44 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:20 PM Page 45
Support Staff
Housekeeping
Patient Transfer
Nursing (RNs)
Respiratory Therapy
Physical Therapy
Volunteers
Nursing Assistants
WITH COLOR-BY-DISCIPLINE
SuiteStyles by Medline is a color-by-discipline uniform With SuiteStyles you will also receive:
program that helps patients quickly identify an em- • Scrubs sizing events to try on garments
ployee by the color they are wearing. The apparel line before ordering
features breathtaking colors and fabulous styles. • Bag-by-name delivery - orders are individually
bagged, boxed by department and delivered to
What people are saying about SuiteStyles… each department
“
• Custom online store for employee reorders that
…I have personally been able to compare the
complements your unique uniform program
before and after! I had surgery in December when
everyone was wearing whatever they wanted. Then,
in July, I had an emergency operation and was
thrilled to know who (nurse, tech, other) was walking
into my room before he/she got close enough for me
to see their tag. Wow, what a difference!”
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:20 PM Page 46
46 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:20 PM Page 47
For more information on Medline’s color-coded uniform Your Medline Doll Can Look
programs, visit www. SuiteStyles.com.
as Great as You Do!
SuiteStyles Nurse Scrubs
and Accessories Set
48 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:20 PM Page 49
Patient Safety
CAUTI ALERT:
PROCEED WITH CAUTION
Jayne Barkman BSN, RN, CNOR past six months that the evidence-based CAUTI strategies
were in place, the rate of catheter-associated urinary tract
Joe and Sandy exchanged a knowing glance as they took infections had dropped from 16 percent to zero hospital
their seats at the monthly patient safety council meeting. wide. After congratulating the nursing units on this accom-
They were pleasantly surprised to see both the CEO and plishment, Brianna asked the representative from each unit
CNO. The agenda included discussion of the efficacy of the to explain the initiatives they took to reduce and prevent
strategies recently implemented throughout the hospital to CAUTI. She signaled to Joe and Sandy, the OR representa-
prevent catheter-associated urinary tract infections (CAUTI). tives, to speak first.
Brianna, the infection control practitioner, arrived, and the
meeting was underway. Joe said initially he and Sandy collaborated with the sur-
geons in each specialty to review and revise the standing
Brianna was pleased to announce that the prevent CAUTI orders for Foley catheter insertion. As a result of this initiative,
interventions had been an enormous success. During the Foley catheter use in the OR had dropped by 50 percent.
50 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:21 PM Page 51
“
when inserting urinary catheters. Your patients’ safety is in The new MD Education component of Medline’s
your hands. Pressure Ulcer Prevention Program is critical for
References acute-care facilities to ensure that physicians
1. Smith JM. Indwelling catheter management: from habit-based to evidence-based understand their role in recognizing and accurately
practice. Ostomy Wound Management. 2003;49(12).
Available at: http://www.o-wm.com/issues/994. Accessed March 16, 2010. documenting POA pressure ulcers.”
2 Smith JM. Indwelling catheter management: from habit-based to evidence-based Michael Raymond, MD,
practice. Ostomy Wound Management. 2003;49(12). Available at:
Associate Chief Medical Quality Officer,
http://www.o-wm.com/issues/994. Accessed February 24, 2010.
NorthShore University HealthSystem,
Skokie Hospital, Skokie, IL
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:21 PM Page 53
E D U C IN G
R
C A U T I
W I T H
BLAD ND D ER
LT R A S O U
U
54 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/14/10 5:20 PM Page 55
Patient Safety
Urinary catheters are commonly used throughout the acute care setting, from
the emergency department to surgery, yet up to 50 percent are placed
unnecessarily.1 The problem is that urinary catheterization can lead to urinary
tract infections. In fact, catheter-associated urinary tract infections (CAUTIs)
account for more than 40 percent of all nosocomial infections.2 The best way
to avoid the risk of CAUTI is by using alternatives to catheterization. One alter-
native, bladder ultrasound, will be explored here.
56 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:21 PM Page 57
BioCon™- 500
Bladder Scanner
Safely Measures
Bladder Volume
Minimize unnecessary catheterization
Research has shown that 80 percent of urinary tract
infections acquired at healthcare facilities are associated
with an indwelling urethral catheter.1 This type of infection
is known as CAUTI, or catheter-associated urinary tract
infection. What’s more, Medicare no longer reimburses
for treatment of CAUTI if it happens while a patient is
hospitalized, giving hospitals a major incentive to prevent
it. But how?
In May 2009, the Centers for Medicare & Medicaid Serv- Disease Control and Prevention (CDC) has noted
ices (CMS) updated the conditions of participation (CfCs) an increasing trend in healthcare-associated infections
for ambulatory surgery centers (ASCs). Included in this related to poor infection prevention techniques within ASCs.
update are new requirements for infection prevention
requiring ASCs to administer an infection prevention program One example is a 2008 outbreak of hepatitis and HIV at an
overseen by an infection prevention professional. The main ASC in Nevada. This very large outbreak was linked to
goal is to provide a “safe and sanitary environment for poor injection practices. An article in the January 6, 2009
surgical services, to avoid sources and transmission of edition of the Annals of Internal Medicine revealed
infections and communicable diseases.”1 the occurrence of 33 outbreaks of viral hepatitis in
non-hospital healthcare settings over the last decade.
Why focus on infection prevention? All of these outbreaks involved failure on the part of health-
You may be asking what prompted CMS to take a care providers to adhere to fundamental infection control
closer look at infection prevention techniques in ambu- practices, most notably by reusing syringes.2
latory surgery centers. One reason is the Centers for
58 The OR Connection
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OR Issues
2.
3.
6
Elements of a Complete
Infection Prevention Program
1. Infection prevention and surveillance plan
Surveillance data and reporting
Infection prevention employee education
4. Reporting and preventing transmission
of communicable diseases
5. Environment of care monitoring
6. Employee health program
8
Eight Tips for Safe Injection Practices
The following recommendations apply to the use of needles,
cannulae that replace needles, and, where applicable,
intravenous delivery systems:2
1. Use aseptic technique to avoid contamination of
sterile injection equipment.
2. Do not administer medications from a syringe to
multiple patients, even if the needle or cannula on the
syringe is changed. Needles, cannulae, and syringes What to expect during a regulatory survey
are sterile, single-use items; they should not be reused A spontaneous regulatory survey can be stressful. Organi-
for another patient or to access a medication or zation is the key to reducing staff anxiety and demonstrating
solution that might be used for a subsequent patient. confidence and knowledge to the survey team. Keep your
3. Use fluid infusion and administration sets documents current. Record and report any clusters or out-
(i.e., intravenous bags, tubing and connectors) for breaks of disease to the appropriate regulatory agencies.
one patient only and discard appropriately after use. Regulatory survey teams look for documentation showing
Consider a syringe or needle/cannula contaminated how you prevented the spread of contagion, so document
once it has been used to enter or connect to a patient’s what you did, when you did it and who you notified.
intravenous infusion bag or administration set.
4. Use single-dose vials for parenteral medications Regulatory survey teams will observe and interview staff
whenever possible. to ensure infection prevention policies have transferred into
5. Do not administer medications from single-dose vials clinical practice. Conduct mock surveys to help prepare for
or ampules to multiple patients or combine leftover a surprise survey. Coaching your staff to answer questions
contents for later use. will enable them to respond easily and briefly to the survey-
6. If multidose vials must be used, both the needle or ors’ questions. The infection preventionist will be interviewed
cannula and syringe used to access the multidose and expected to answer questions about the organization’s
vial must be sterile. infection prevention program, policies and data collection
7. Do not keep multidose vials in the immediate patient methods. Share your employee education program and
treatment area and store in accordance with the required staff infection prevention competencies with the
manufacturer’s recommendations; discard if sterility surveyors.
is compromised or questionable.
8. Do not use bags or bottles of intravenous solution as Finally, after reviewing your written infection control program,
a common source of supply for multiple patients. touring the facility, observing and interviewing staff and
physicians; the facility administration plus the survey team
These guidelines are from the Safe Injection Practices section of will participate in an exit conference to share the findings.
Standard Precautions, from the 2007 CDC/HICPAC Guideline for
Isolation Precautions
60 The OR Connection
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Get Ready!
For further help preparing for the infection
control portion of the CMS survey, contact
your Medline representative about Medline’s
new CMS Survey Readiness Program for
Ambulatory Surgery Centers.
A State-of-the-Art Hybrid
Program for the OR
by Maria Ash and Mario Muff
62 The OR Connection
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Once the packs have Through OR analysis, BCHLS finds that many accessory
been sterilized, they
must stay in the cool pieces of disposable apparel are added to the case carts
down room until the to complete the pick list. These are often disposable
batch has been
examined. Once gowns, drapes and towels that can be replaced with high
cleared, the packs quality reusable linens made from advanced barrier fabrics
are scanned to
tickets for shipment
that make them stronger, lighter and easier to drape. These
to hospitals. fabrics also handle wash and dry cycles and sterilization
better than ever before. Many other items within the custom
pack can be reusable as well, such as Mayo stand covers,
back table covers, ¾ sheets, half sheets and full custom
drapes.
Soiled linen is stored
in large bags on an “Adding a reusable component to the CDS is truly an
automated future rail outstanding way to make a huge positive impact on the
system and sorted
by type. The bags environment and help cost-conscious hospitals save large
are then transferred sums of money by reducing unnecessary touch points,”
to a specified station
for processing. This Grummel said.
design reduces the
need for manual
movement of linen All pick list items, custom packs, accessories and reusable
in carts on the plant components are delivered daily in a whole case cart. Then
floor and reduces
congestion. BCHLS picks everything up at the end of day and does it all
over again the next day. Daily delivery and return by BCHLS
makes this a true Complete Delivery Hybrid Solution!
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Special Feature
Never of Why
Lose We Are
Sight Nurses
I began my career as an administrator of an to the demands of this role, it is not uncommon to get
ambulatory surgery center directly upon comple- caught up in day-to-day tasks and find the days flying by
tion of my associate degree. The first day I ever before your eyes. Being a type A personality, I generally
stepped foot into an operating room was one of the most attempt to maintain a very strict schedule that allows me
memorable moments in my career. I have been a nurse to complete administrative responsibilities early in the
for 19 years, and I have gone from earning an associate morning so I can focus on and actively participate in
degree to obtaining two master’s degrees in nursing and patient care throughout the day. I encourage others in
health care administration. Throughout the last 19 years, I leadership roles to do this as much as possible so that you
(like most other nurses) have experienced and witnessed never lose sight of our number one priority – the patients.
everything imaginable to the human mind that pertains to
nursing. Being in a leadership role for my entire career, it One recent evening at approximately 7:00, I was leaving
has always been part of my responsibility to attempt to work after a long and very intense day. The exit from the
motivate the nurses I oversee on a daily basis. department to the parking lot requires a walk through the
family waiting room, where I was greeted by a screaming
Leadership comes with a price tag. You are continually infant. I saw a couple, maybe in their 70s, pacing as the
attending meetings, addressing administrative responsi- woman attempted to calm the child. I placed my bags on
bilities, putting out fires and attempting to make sure that a nearby chair and asked if I could be of assistance. The
patients, surgeons and staff are as happy as possible. Due couple explained that the mother of the infant (their grand-
daughter) was in the recovery area. The baby was hungry, but here. My advice to others is never be too busy to stop and take
his mother had his bottle. The woman explained that she was a moment to assist patients, who are much more than just
not comfortable with the baby and had attempted everything to another person coming through your department. It only takes
stop him from crying without any success. I asked her if she one experience such as this one to create many moments of
would mind if I held the child while I let her go to the recovery memories you will carry for a lifetime. It is not about the thanks
area to get the bottle from her granddaughter. The woman you will receive; it is about the care you will give that comes
handed me the baby and left to get the bottle. While holding the from your heart. Never lose sight of the patient.
child, I noticed he needed to be changed, so I asked the
grandfather for a diaper and proceeded to change the
About the author
infant. Shortly thereafter, the woman returned with the bottle.
Sharon Danielewicz, RN, MSN, MHA, BSN, HSA, RNFA is a
She was again apprehensive about feeding the child, so I director of perioperative services with 19 years of experience. She
offered to feed him. I sat with the child, fed him his bottle and began her career in 1991 after completing an associate degree in nurs-
rocked him off to sleep. ing from a then small community college in Nanticoke, Penn. She later
relocated to Lansdale, Penn., where she worked in the surgery serv-
Before I knew it, 45 minutes had passed, and the child’s mother ices department of a small community hospital for five years. In 2004,
Sharon, her husband and two children relocated to San Antonio, Tex.,
exited from the recovery area. She was very grateful that I had
and Sharon began working for a large medical center. After a few
assisted her grandparents with the baby. She also explained years, she accepted a position for Job Corps as a health services
that the baby was born just three weeks before, and he had administrator while pursuing two master’s degrees. In 2008 she
colic. She felt badly about leaving him with her grandparents in received both a Master of Nursing and Master of Health Care Admin-
the waiting room, but she had no one else to watch him. She istration. Shortly thereafter, she accepted a position as director of
could not thank me enough for helping them. I explained that it perioperative services for a facility in Houston, Tex.
66 The OR Connection
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“
Systematic efforts at education, heightened awareness This has been a great learning experience for
and specific interventions by interdisciplinary healthcare our staff and for our facility as a whole. I am
teams have demonstrated that a high incidence of thankful Medline had this program and that we
pressure ulcers can be reduced.1 The main challenges were able to access it. I can’t imagine recreating
to having an effective pressure ulcer prevention program this wheel!”
are: lack of resources; lack of staff education; behavioral Katrina “Kitty” Strowbridge, RN
challenges; and lack of patient and family education.2 Quality Improvement Coordinator
St. Luke Community Healthcare Network
Medline’s comprehensive Pressure Ulcer Prevention
Ronan, Montana
Program offers solutions to these challenges.
References
1
Holmes A, Edelstein T. Envisioning a world without pressure ulcers. ECPN. 2007;122(8):24-29.
2
CMS Roundtable, Omni Hotel, Chicago, Ill. March 10, 2008.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:23 PM Page 68
Medline Hosts
68 The OR Connection
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Awareness Breakfast
at the AORN 57th Congress
The crowd was also treated to surprise appearances by Raising breast cancer awareness among nurses is a key
the staff members from Providence St. Vincent Medical goal of Medline’s campaign, as it is the leading cause of
Center in Portland, Ore., who starred in the “Pink Glove death for women age 40-55. The average age of a
Dance,” a YouTube video sensation that has more than 8.7 nurse is 46.
million views to date.
At the event, Medline President Andy Mills presented
“My mother was diagnosed with breast cancer at the age National Breast Cancer Foundation (NBCF) President
of 80,” said Kate Moser, a nurse at William S. Middleton Janelle Hail with a check for $117,000 to help fund
Memorial Veterans Hospital in Madison, Wisc. “Now she is mammograms for underserved women. Of that total,
85 and going strong. Hearing Peggy Fleming’s story and $17,000 came directly from the sale of Medline’s Gen-
seeing the people from the Pink Glove Dance today is eration Pink exam gloves.
exciting and inspiring.”
Over the past four years, Medline has donated more
Fleming, who won a gold medal at the 1968 Olympics at than $500,000 to the NBCF as part of its campaign to
the age of 19, was diagnosed with breast cancer in 1998. promote early detection and awareness of breast can-
She is now cancer free. cer. Early detection (mammography is among the best
forms of screening for breast cancer) can increase
the five-year survival rate by more than 95 percent.
70 The OR Connection
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”
Medline President Andy Mills presents a check for $117,000 to Martie Moore, assistant administrator, nursing and patient care,
National Breast Cancer Foundation President Janelle Hail. Of the Providence St. Vincent Medical Center, Portland, Ore., site of the
total, $17,000 came from the sale of Medline’s Generation Pink Pink Glove Dance video, which has received more than 8.7 million
exam gloves. hits on YouTube – and counting.
Participants enjoy a buffet breakfast before the Exhibit showcases previous Medline Breast Cancer
presentations begin. Awareness Breakfasts at AORN Congress.
©2010 Medline Industries, Inc. The cross-fingered pink glove hand image is a trademark
of Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:24 PM Page 73
Introducing Deb!
Starring in “The Pink Glove Dance”
Introduced in 2005, the Medline Doll Collection was created to recognize the caring and dedicated
healthcare professionals in our industry. Since then, Medline has introduced seven dolls, including Deb,
who made her debut in March 2010.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:24 PM Page 74
74 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/14/10 5:27 PM Page 75
Win-Win
Negotiation
Wolf J. Rinke, PhD, RD, CSP
Times are tough, and virtually all of us have a need to get more “bang for our
How to buck,” whether it’s when we want to make a purchase, attempt to get a promo-
tion or talk our children out of getting that expensive “must-have” new toy. And
get more yet most of us consider negotiating or “haggling” a distasteful activity that should
be avoided at all costs. That is especially true if you are a woman. Research
shows that women are far less likely to negotiate than men, and when they do,
of what they do it in a way that is less assertive. One study found that 20 percent of
women do not negotiate at all. To help you overcome the distaste for negotiation,
you want master the following strategies, and you will get more of what you want.
Similarly, how many times have you interviewed for a job and felt the prospective
employer had all the power because you really needed the job while the employer
appeared to have all the applicants in the world? Having been in both roles—
interviewer and applicant—let me assure you nothing could be further from the
truth. The employer almost always needs you just as much as you need him (as-
suming of course you have the right skill set), even during these tough times.
These biases come about because you are committing an “attribution error.” For
example, because the employer has certain visible attributes of power you
assume she has more power than you do which, right or wrong, becomes
your “reality.”
76 The OR Connection
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Putting those unanticipated outcomes aside, all of these Separate Option Generation from Decision-Making
approaches will likely end up in either Win-Lose or Lose-Lose As you learned from the previous example, most of us tend to
outcomes, which neither the father nor his daughter are going focus on two mutually exclusive outcomes: either you get
to be particularly happy with. what you want and I lose, or I get what I want and you lose.
(Win-Lose.) If instead we learn to get in the habit of engaging
Now let’s take a look at how this might work if we focus on the brain power of both parties, many not-so-obvious ideas
interests, needs or wants instead of positions. can be generated that will meet or even exceed both parties’
Father: “I understand you don’t like milk. So please needs (Win-Win.). In other words, if we separate option gen-
tell me what you really want.” eration from decision-making, we can almost always make
Daughter: “I want food that tastes good, and milk just the pie bigger, and if we can’t, then we can establish objec-
doesn’t taste good to me.” tive criteria before attempting to reach an agreement (see the
Father: “I appreciate that. Now let tell you what I want. next section). Unfortunately, we tend to fall into the trap of
I would like you to get food that is nutritious and skipping the option generation step because most of us want
high in calcium. Why don’t we take a moment to get the negotiation process over with, and one way to do
and come up with a list of foods that meet both that is to come up with the answer
of our needs.” (This is separating option genera- both of us can agree on as fast
tion from decision-making. See the next section). as possible.
78 The OR Connection
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At this point you might be saying: “That just doesn’t make any If All Else Fails Resort to Objective Criteria
sense.” Going back to the used car selling example, the only You will of course encounter real “fixed pie” scenarios. For
thing both parties are concerned with is price! Not necessar- example, if you have only one vacancy in your department
ily! It’s likely that both parties had other things that factored and there are three people applying, even after all the best ne-
into the sale. For example, if the buyer had said to the seller: gotiations in the world, there will still be two losers and only
“Before we talk about price, tell me what you want out of this one winner. To improve negotiation whenever you are involved
deal.” The seller might have said, “I’m interested in selling the in a true distributive negotiation process, where one party
car now, but keeping it for another two weeks because my must lose and the other win, it is wise to resort to objective
daughter’s new car won’t be delivered until then.” She might criteria such as standards, rules, independent mediators,
also have said, “I would like to get cash so I don’t have to arbitration, flipping a coin, drawing straws or other forms of
worry about a bounced check.” Or she might have said, “I chance, or any other criteria that produces a perceived fair
love this car like my own child and I would really like to sell it outcome. The classical example of this is the challenge of
to someone who will take really great care of it.” dividing one piece of cake between two siblings. If you have
children, I’m sure you can identify with this dilemma, and you
The buyer, on the other hand, might have said: “I would like to may remember how much potential bickering can ensue.
make sure I’m not buying a lemon; I would like a car that has There is of course a very elegant solution to that problem,
been well taken care of; I would like to drive it away today; I which dates back to biblical times. Have one child cut the
would like to deal with someone I can trust”…and the list goes cake and the other choose the piece she wants.
on. All of these may have economic value to either the seller
or the buyer and hence could have been used not only to in-
fluence the purchase price of the car, but could have resulted
in both parties getting far more than just a good price, i.e.,
getting a Win-Win outcome.
Body_65488_MedCal.qxp:Layout 1 4/14/10 5:29 PM Page 80
80 The OR Connection
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:25 PM Page 81
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82 The OR Connection
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Infection Control
2009 AAAHC/CMS Crosswalk for Infection Control . . . . . . . . . . . .85
Surgical Safety
WHO Surgical Safety Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . .93
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2009 AAAHC/CMS
A Cr
Crosswalk
ossw
walk for
Infection
Infec
ction Contr
Control
ol 416.51
416
6 51
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AAAHC Standards/Additional
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Condition
dition for AAAHC
CMS Requirements
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re
equ
uirements
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age (CfC) # Number
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Federral Regulations)
416.51 The ASC must maintain an Ch. 8. The ASC must maintain an infection
n contr
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o program
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ol that seeks to minimize
m infec- NEW
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comm
municable
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416.51(a) Standard:
S The ASC must provide
provide Ch. 10.I.M A safe environment
environment for treating
treating surgical
surgical patients, including
Sanitary en
environment
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d sanitary adequate safeguards
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NEW ST
STANDARD
TA
ANNDARD environment
environment forr the provi-
provi- is assured
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provision of adequate
a space, equipment,
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adhering to professionally
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Provisions have been made for the
th
he isolation or immediate
acceptable standards
stan
ndards of transfer of patients with a communicable
communicable disease.
practice. 2. All persons entering operating rooms
rooms
o are
are properly
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3. Acceptable aseptic techniques are
a e used by all persons in the
ar
surgical are
are and all such personss must decontaminate hands
either by using a hygienic hand scrub
s or by washing with a
disinfectant soap prior to and after
after direct
direct contact with each
patient.
4. Only authorized persons are
are all in
n the surgical or treatment
treatment
area,
area,
ea including laser rooms.
rooms.
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5. Suitable equipment for rapid and
d routine
routine sterilization is avail-
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ensure that operating room
roo
om materials are
are sterile.
6. Sterilized materials are
are packaged
d and labeled in a consistent
manner to maintain sterility and identify
id
dentify sterility dates.
7. Environmental
Environmental controls
controls are
are implemented
imple
emented to ensure
ensure a safe
and sanitary environment.
environment.
8. Suitable equipment is provided
provided for
fo
or the regular
regular cleaning of all
interior surfaces.
9. Operating/procedure
Operating/procedure rooms
rooms are
are appropriately
a opriately cleaned before
appr before
each procedure.
procedure.
The Accreditation
Acc
creditation Association for Ambulatory
Ambulatorry Hea
Health
alth Care 2009 | Effective 5-18-09
AAAHC Standards/Additional
Standarrds/Additional
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Condition
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quirements Medicare
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req
quirements
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416.51(b)
416.51(b
b) The ASC mustt maintain and Ch. 8. The ASC must maintain an ongoin
ongoing
g nggppr
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and for im
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The Accreditation
Accredita
ation Association for Ambulatory
Ambulatorry Health Care
C 2009 | Effective 5-18-09
86 The OR Connection
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Reference
1
AORN. Recommended practices for positioning the patient in the perioperative practice setting. Perioperative
Standards and Recommended Practices. 2008 Edition. Denver, Colo.: AORN Publications; 2008.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:25 PM Page 88
PERIOPERATIVE
PRESSURE ULCER EDUCATION
“
Prevention Programs and FREE webinars for
I have seen an increase in the number of legal issues
acute care and perioperative services, call
linking facility-acquired pressure ulcers to post-surgical
your Medline representative or visit
patients. A pressure ulcer program for the OR is more
www.medline.com/pupp-webinar.
critical than ever.”
Diane Krasner, PhD, RN, CWCN, CWS, BCLNC, FAAN
The AORN Seal of Recognition has been awarded to Pressure Ulcer Prevention for Perioperative Services
in June 2009 and does not imply that AORN approves or endorses any product or service mentioned in
any presentation, format or content. The AORN Recognition program is separate from the AORN, ANCC
Accredited Provider Unit and therefore does not include any CE credit for programs.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
The AORN Seal of Recognition is a trademark of AORN, Inc., All rights reserved.
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:25 PM Page 89
Do you have a policy and procedure for skin and risk assessment that addresses:
a. How and when a patient is considered at risk for
development of a pressure ulcer and in need of
prevention intervention(s)?
b. Who is responsible for developing, implementing
and monitoring the prevention care plan?
Do you have prevention protocols for staff to
implement when specific pressure ulcer risk factors
are identified?
Do you have a policy and procedure for positioning patients at risk for pressure ulcer that addresses:
a. Pressure redistribution OR table pads for
procedures lasting longer than two hours?
b. The use of gel table pads when indicated?
Do you warm your patients 30 minutes prior to the
surgical procedure to maintain core body
temperature intraoperatively?
Does the individualized care plan for each patient at
risk for pressure ulcers address the following
prevention interventions:
a. Pressure, friction and shear reduction
1. Pressure redistribution OR table pads or
overlays (foam, gel)?
2. Positioning/repositioning techniques?
3. Positioning devices (foam, gel, wedges, etc.)
to prevent pressure on bony prominences?
4. Mechanical aids (lifts, slide boards, sliding
sheets) for lifting, moving and
positioning/repositioning?
5. Protection for head, elbows and heels?
6. OR tables of sufficient sizes to fit your
patient population?
b. Skin care
1. Does skin inspection occur prior to and
immediately following the surgical procedure?
2. Is skin is kept dry during the surgical
procedure with minimal exposure to moisture,
perspiration and drainage?
3. Is it ensured that warming blankets are not
placed between the pressure redistribution
table pad and the patient in high-risk patients?
90 The OR Connection
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©2010 Medline Industries, Inc. Medline® is a registered trademark of Medline Industries, Inc.
Sterillium® is a registered trademark of BODE Chemie GmbH.
NIVEA and Eucerin are registered trademarks of Beiersdorf AG.
Sterillium® Comfort Gel® is a registered trademark of Bode Chemie GmbH. References 1. Data on file
Body_65488_MedCal.qxp:Layout 1 4/13/10 8:26 PM Page 92
Setting
a new
standard
in patient
safety.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Surgical Safety Checklist
Body_65488_MedCal.qxp:Layout 1
Before induction of anaesthesia Before skin incision Before patient leaves operating room
(with at least nurse and anaesthetist) (with nurse, anaesthetist and surgeon) (with nurse, anaesthetist and surgeon)
4/14/10
Has the patient confirmed his/her identity, Confirm all team members have Nurse Verbally Confirms:
site, procedure, and consent? introduced themselves by name and role. The name of the procedure
Yes
5:30 PM
Confirm the patient’s name, procedure, Completion of instrument, sponge and needle
Is the site marked? and where the incision will be made. counts
Yes Has antibiotic prophylaxis been given within Specimen labelling (read specimen labels aloud,
the last 60 minutes? including patient name)
Not applicable
Page 93
To Nursing Team:
Difficult airway or aspiration risk? Has sterility (including indicator results)
No been confirmed?
Yes, and equipment/assistance available Are there equipment issues or any concerns?
This checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged. Revised 1 / 2009 © WHO, 2009
Forms & Tools
Sterillium® Rub
Your hands will
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©2010 Medline Industries, Inc. Medline® is a registered trademark of Medline Industries, Inc.
Sterillium® is a registered trademark of BODE Chemie GmbH.
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VOLUME 5, ISSUE 2
Free Webinars
New Techniques for Pressure Ulcer Prevention,
Hand Hygiene and CAUTI Prevention
Learn about pressure ulcer prevention in the perioperative arena and the implications
of the 2008 CMS inpatient hospital care “Present on Admission (POA)” indicator.
M AY JUNE J U LY AUGUST
4th 12:00 pm - 1:00 pm 3rd 11:00 am - 12:00 pm 7th 11:00 am - 12:00 pm 12th 1:00 pm - 2:00 pm
19th 1:00 pm - 2:00 pm 22nd 1:00 pm - 2:00 pm 20th 12:00 pm - 1:00 pm 17th 12:00 pm - 1:00 pm
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Sign up at www.medline.com/PUPP-webinar
As the number one defense against healthcare-acquired conditions, hand hygiene plays
an important role in the prevention of infections. Learn how hospitals and healthcare
facilities are combining best-in-class products and education to achieve hand hygiene
THE OR CONNECTION
compliance while dramatically improving the skin condition of healthcare workers.
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