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PATIENT SAFETYPATIENT SAFETY• Protecting Patient’s RightProtecting Patient’s Right• General Patient Safety MeasuresGeneral Patient Safety Measures• Admission of the Patient to the Admission of the Patient to the
Operating RoomOperating Room
PRPD/DN/DM/2010PRPD/DN/DM/2010
PRPD/DN/DM/102
Protecting patient’s Protecting patient’s rightsrights
protection of patients’ personal moral and legal protection of patients’ personal moral and legal rights begins at the time of admission.rights begins at the time of admission.
The course of action involves correctly identifying The course of action involves correctly identifying patients, safeguarding their right to privacy and patients, safeguarding their right to privacy and their right to make choices regarding their care their right to make choices regarding their care and keeping confidential all records and reports.and keeping confidential all records and reports.
Personnel who obtain consents or witness them Personnel who obtain consents or witness them should be aware of the conditions that ensure should be aware of the conditions that ensure validity of the consent.validity of the consent.
PRPD/DN/DM/103
Cont..Cont..
A signed consent must also be an informed consent, A signed consent must also be an informed consent, which implies adequate communication with the which implies adequate communication with the patient regarding the procedure or procedures for patient regarding the procedure or procedures for which the consent is being signed.which the consent is being signed.
No surgical procedure should be performed without a No surgical procedure should be performed without a signed and witnessed informed consent.signed and witnessed informed consent.
The surgeon is ultimately responsible for informing The surgeon is ultimately responsible for informing the patient about the proposed operation or other the patient about the proposed operation or other invasive procedure, its inherent risks and invasive procedure, its inherent risks and complications, and for obtaining consent.complications, and for obtaining consent.
On the patient’s arrival in the operating room, the On the patient’s arrival in the operating room, the circulating nurse and anaesthesia provider are circulating nurse and anaesthesia provider are responsible for verifying that the consent is on the responsible for verifying that the consent is on the chart and is correct, properly signed and witnessed chart and is correct, properly signed and witnessed before the administration of anaesthesia.before the administration of anaesthesia.
PRPD/DN/DM/104
General patient safety measuresGeneral patient safety measures Minimizes human error helps eliminate hazardous Minimizes human error helps eliminate hazardous
conditions for the patient undergoing operative or conditions for the patient undergoing operative or other invasive procedures.other invasive procedures.
In all perioperative settings, where the patient is In all perioperative settings, where the patient is unable to protect himself or herself, nursing unable to protect himself or herself, nursing personnel must provide protection for the patient.personnel must provide protection for the patient.
Communication of vital medical information to Communication of vital medical information to surgical team members is essential to safe patient surgical team members is essential to safe patient care.care.
An allergy identification band is used to An allergy identification band is used to communicate a patient’s allergy to a given communicate a patient’s allergy to a given medication or substance. Patients should be queried medication or substance. Patients should be queried regarding allergies to medication or food products.regarding allergies to medication or food products.
PRPD/DN/DM/105
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All medication must be checked three times All medication must be checked three times before administration:before administration:
(1) When removed from the drug cabinet(1) When removed from the drug cabinet(2) Before being drawn up in the syringe(2) Before being drawn up in the syringe(3) Before being given to the patient(3) Before being given to the patient
Patients’ hearing tends to become more acute Patients’ hearing tends to become more acute after administration of the perioperative after administration of the perioperative medication and in the induction stage of medication and in the induction stage of anaesthesia. anaesthesia. A quiet environment is essential for all A quiet environment is essential for all patients awaiting surgery. Noise in the OR patients awaiting surgery. Noise in the OR should be controlled and conversation kept to should be controlled and conversation kept to a minimum.a minimum.
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Stretchers and operating room beds must be Stretchers and operating room beds must be stabilized with the wheels locked when a stabilized with the wheels locked when a patient is moving from one to another.patient is moving from one to another.
All safety devices on stretchers and All safety devices on stretchers and operating room beds must be in proper operating room beds must be in proper working order.working order.
Locking mechanisms, side rails, restraint Locking mechanisms, side rails, restraint straps, intravenous standards, hydraulic straps, intravenous standards, hydraulic controls, armboards and other protective controls, armboards and other protective devices should be used whenever necessary.devices should be used whenever necessary.
Admission of the Patient to the Admission of the Patient to the Operating roomOperating room
Is a critical time for the perioperative nurse to Is a critical time for the perioperative nurse to gather data and help plan for the patient’s care gather data and help plan for the patient’s care and safety.and safety.
It is the opportunity to collaborate with the patient It is the opportunity to collaborate with the patient by identifying and verifying his or her needs and by identifying and verifying his or her needs and then planning care to meet those needs.then planning care to meet those needs.
Empathic communication, good listening skills, Empathic communication, good listening skills, being alert to nonverbal communication, offering being alert to nonverbal communication, offering gentle reassurance, providing explanations and gentle reassurance, providing explanations and utilizing comforting behaviours are essential utilizing comforting behaviours are essential attributes of perioperative nurses.attributes of perioperative nurses.
7PRPD/DN/DM/10
Institutional policy and procedure for patient Institutional policy and procedure for patient admissionadmission
Should include the following steps:Should include the following steps:
The perioperative nurse verifies the patient’s identification The perioperative nurse verifies the patient’s identification orally with the patient (if feasible) and compares the name orally with the patient (if feasible) and compares the name on the surgical schedule with the name on the patient‘s on the surgical schedule with the name on the patient‘s armband and medical record.armband and medical record.
The procedure to be performed (including the operative site, The procedure to be performed (including the operative site, side, and surgical approach) is verified by the patient and side, and surgical approach) is verified by the patient and matched with the surgical posting, medical record, and matched with the surgical posting, medical record, and consent form.consent form.
The operative consent form, history and physical The operative consent form, history and physical examination record, laboratory results, and other examination record, laboratory results, and other examination or diagnostic results should be complete before examination or diagnostic results should be complete before surgery and reviewed by the perioperative nurse as part of surgery and reviewed by the perioperative nurse as part of patient assessmentpatient assessment
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Cont….Cont…. Allergies; previous unfavourable reactions to Allergies; previous unfavourable reactions to
anaesthesia or blood transfusion; previous anaesthesia or blood transfusion; previous reaction to latex; religious; cultural, spiritual, or reaction to latex; religious; cultural, spiritual, or ethnic preferences; and any advanced directive ethnic preferences; and any advanced directive must be carefully noted.must be carefully noted.
The patient should be queried about personal The patient should be queried about personal effects, including clothing, money, jewelry, effects, including clothing, money, jewelry, wigs, religious symbols, and prosthesis such as wigs, religious symbols, and prosthesis such as dentures, lenses, glass eyes and hearing aids. dentures, lenses, glass eyes and hearing aids. The nurse is responsible for ensuring the safe The nurse is responsible for ensuring the safe handling and proper disposition of patient handling and proper disposition of patient property and valuables.property and valuables.
9PRPD/DN/DM/10
Cont….Cont…. The perioperative nurse should review the The perioperative nurse should review the
orders and results concerning pre-operative orders and results concerning pre-operative skin preparation, medication administration, skin preparation, medication administration, and elimination, such as enema results and the and elimination, such as enema results and the amount of urine voided or collected through a amount of urine voided or collected through a catheter.catheter.
It is important to determine whether It is important to determine whether preoperative dietary and fluid restrictions (NPO preoperative dietary and fluid restrictions (NPO status) have been maintained, this is crucial in status) have been maintained, this is crucial in preventing the aspiration of gastric contents preventing the aspiration of gastric contents during anaesthesia induction.during anaesthesia induction.
10PRPD/DN/DM/10
Cont ….Cont …. The nurse should meticulously document any The nurse should meticulously document any
medications, fluids, blood, or blood products medications, fluids, blood, or blood products administered as ordered during the immediate administered as ordered during the immediate preoperative period.preoperative period.
The nursing staff should apply side rails, The nursing staff should apply side rails, locking devices, and safety straps on stretchers locking devices, and safety straps on stretchers and operating room beds to prevent falls and and operating room beds to prevent falls and injury to the patient during transport, transfer injury to the patient during transport, transfer and positioning.and positioning.
11PRPD/DN/DM/10
A Preoperative ChecklistA Preoperative Checklist
It is frequently used to prevent oversights, It is frequently used to prevent oversights, omissions, and sentinel events, displays omissions, and sentinel events, displays critical items to be checked preoperatively.critical items to be checked preoperatively.
Sentinel events defined as an “unexpected Sentinel events defined as an “unexpected occurrence involving death or serious occurrence involving death or serious physical or psychological injury, or risk physical or psychological injury, or risk thereof.”thereof.”
(JCAHO, 1997) (JCAHO, 1997)
12PRPD/DN/DM/10
Clinical DocumentationClinical Documentation A record should be kept of each operation, A record should be kept of each operation,
including: including: - the preoperative diagnosis- the preoperative diagnosis - the surgery performed- the surgery performed - a description of findings- a description of findings - the specimens removed- the specimens removed - the postoperative diagnosis- the postoperative diagnosis - the names of all persons participating - the names of all persons participating
in in intraoperative careintraoperative care
This operative record is a permanent part of This operative record is a permanent part of the patient’s chart.the patient’s chart. 13PRPD/DN/DM/10
Intraoperative Patient Care Intraoperative Patient Care RecordRecord
Should include:Should include: Evidence of a patient assessment upon arrival in the Evidence of a patient assessment upon arrival in the
operating room which includes an assessment of operating room which includes an assessment of patient’s skin condition immediately before and after patient’s skin condition immediately before and after the procedure.the procedure.
Evidence of a plan of care individualized for the Evidence of a plan of care individualized for the patient.patient.
Any sensory aids or prosthetic devices worn by the Any sensory aids or prosthetic devices worn by the patient on admission to the operating room and their patient on admission to the operating room and their subsequent disposition.subsequent disposition.
Patient position, including supports or restraints used.Patient position, including supports or restraints used. Location of dispersive electrode pad placement and Location of dispersive electrode pad placement and
identification of ESU and settings used.identification of ESU and settings used.14PRPD/DN/DM/10
Cont….Cont….
Location of temperature-control device Location of temperature-control device placement, with identification of unit used and placement, with identification of unit used and recording of time and temperature.recording of time and temperature.
Placement of monitoring electrodes.Placement of monitoring electrodes.
Medication administered or dispensed by the Medication administered or dispensed by the perioperative nurse.perioperative nurse.
Presence of catheters, drains, packing and Presence of catheters, drains, packing and dressings.dressings.
Location of tourniquet cuff placement, Location of tourniquet cuff placement, identification of unit, pressure setting and identification of unit, pressure setting and inflation and deflation times.inflation and deflation times.
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Cont….Cont….
Fluid output, including blood loss Fluid output, including blood loss estimates, as appropriate.estimates, as appropriate.
Type, size and appropriate identifying Type, size and appropriate identifying information (such as serial number) of information (such as serial number) of implants.implants.
Skin-preparation solutions used, areas Skin-preparation solutions used, areas prepped, and any reactions to prep.prepped, and any reactions to prep.
16PRPD/DN/DM/10
Cont ….Cont ….
Known allergies to medications, prep Known allergies to medications, prep solutions, tape, latex, etc.solutions, tape, latex, etc.
Sponge, sharp, and instrument counts Sponge, sharp, and instrument counts taken and results obtained.taken and results obtained.
Wound classification.Wound classification.
Time of discharge and disposition of Time of discharge and disposition of patient from operating room, including patient from operating room, including mode of transfer and patient status.mode of transfer and patient status.
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In ConclusionIn Conclusion
Perioperative nursing document needs to Perioperative nursing document needs to describe the assessment, planning and describe the assessment, planning and implementation of perioperative care that implementation of perioperative care that reflects individualization of care, as well as reflects individualization of care, as well as
the evaluation of patient outcomes.the evaluation of patient outcomes.
The design format such as “Checklists”The design format such as “Checklists”will minimizes time needed for the will minimizes time needed for the documentation process.documentation process.
The EndThe End18PRPD/DN/DM/10
