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Oneida Healthcare CenterHospital Description
Level I medical centerLocated in rural OneidaApproximately 3,600 surgeries annuallyJoint Commission Accredited daVinci Robotic Surgery 2012EHR implemented in August 2012
Population ServedApproximately 24 communities in Madison
and western Oneida countiesPopulation approximately 80,000
Nearly 50% patients insured by Medicaid
General, Orthopedic, Ob/Gyn, Urology, Thoracic, ENT surgeries performed
OHC’s Surgical Safety Team
Director of NursingSherry Willis, RN
OR Nurse ManagerKristy Russ, RN
Physician Leads:Dr. David Gordon MD,
Chief of Surgery
Dr. Sabhash DasAnethesiologist
Director of Patient Safety and Quality
William Griffiths, RN, MSHS,CPHQ
Quality Improvement Designee, Susan Smith, RN
Manager of Infection PreventionJeanne Miller, RN, BSN,CIC
Infection Prevention RNNancy Sheridan, RN, BSN
Circulating RNKristen Menard, RN
Surgical Scrub TechnicianChristine Bryson, ST
What do we do about it?Reviewed our current checklist/time outFormalized the team and viewed webinars Conducted observations in the ORMonthly regular meetings with
Quality/Infection Prevention/OR staffRegular attendance at Surgery Dept.
meetingsRevised checklist with input and assistance
from OR staff
“Hurdles” IdentifiedCurrent system failures and challenges
Communication breakdown
Distractions
Did we learn from past mistakes?
Sign In(Nurse & Anesthesia)
Time Out(Entire OR Team)
Sign Out(Nurse, Anesthesia & Surgeon)
□ Patient has confirmed □ Identity□ Site□ Procedure□ Consent
□ Site marked/ Not applicable □ Anesthesia safety check completed □ Pulse oximeter on and functioning □ Thermometer available and functioning □ Does patient have a: □ Known allergy
□ Yes□ No
□ Difficult airway/aspiration risk□ No□ Yes, equipment/assistance available□ Risk of >500ml blood loss (7mg/kg children)□ No□ Yes□ Normoglycemia status□ Yes□ No, initiate protocol to achieve normoglycemia
□ Surgeon, anesthesia professional and nurse verbally confirm
□ Patient□ Site □ Procedure
□ Anticipated Critical Events □ Surgeon Review: What are the critical or
unexpected steps, anticipated blood loss, estimated case time length?
□ Anesthesia Team Review: Any patient-specific concerns?
□ Nursing Team Review: Has sterility been confirmed? Are there equipment issues or concerns? Correct equipment? Sufficient supplies?
□ Has antibiotic prophylaxis been given in last 60 minutes?
□ Yes□ Not applicable□ Redosing available for cases >3 hours
□ Hair removal using clippers or depilators? □ Yes□ Not applicable
□ Glycemic monitoring in place? □ Yes□ No
□ Is essential imaging displayed?□ Yes□ No
□ Nurse verbally confirms with the team: □ Name of procedure recorded□ Completion of instrument, sponge
and needle counts□ Specimen labeling: read specimen
label aloud, including patient name□ Whether there are any equipment
problems to be addressed□ Surgeon, anesthesia professional and nurse
review the key concerns for recovery and management of this patient.
□ Normothermia post-op (post-op temperature is documented before leaving OR)
*Based on the NYSPFP modified WHO Surgical Safety Checklist
Surgical Safety Checklist
OHC’s PROGRESS
Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-130
1
2
3
4
5
A
B
C
D
OHC Surgical Adverse EventsA: IC and OR monthly meet-ings beganB: Checklist and Webinar with ORC: Checklist introduced to surgeonsD: Checklist fully imple-mented in OR