Improving Team Members' Attention During the OR Briefing or Time Out.

Effective coordination among health care professionals is crucial to achieving optimal outcomes. In the OR, even minor errors can have catastrophic consequences. To mitigate the risk of error, health care professionals have adopted a briefing culture like that used in the aviation industry. Briefings are essential to ensure that everyone involved in a procedure knows the plan and potential risks and is prepared to perform their duties safely and effectively. The fundamental human sense involved in briefings is auditory perception; although important, hearing alone does not equate to focused attention. To enhance the efficacy of briefings, engaging the use of a second sense by adding a visual checklist may increase attentiveness and the chances of early error detection and prevention. Using a projection device may enhance all team members' engagement and participation during the briefing or time-out process and can be an effective tool for improving communication and reducing errors.

Using a Tibetan Gong to Increase Staff Member Engagement During Time Outs.

Perioperative and procedure area nurses can encounter barriers during the time-out process. In March 2016, a mock regulatory agency surveyor identified a gap during a time out in our cardiac catheterization laboratory. We worked with our facility's holistic nursing group to identify a solution to gain the full attention of all procedure area team members during each time out. Historically, ceremonial leaders used a gong to begin events because they thought that the sound helped participants focus on the ceremony. Because we wanted staff members to participate in a mindful practice during time outs, we decided to use a Tibetan gong to draw attention to the process. After implementing this change, staff members were more engaged during the time-out process than they were before the change. In addition, facility leaders requested that we share our process with the staff members in the perioperative and endoscopic areas.

Improving Preprocedure Time Out Compliance Using Remote Audiovisual Observation.

Health care organization leaders can help prevent surgical errors by ensuring compliance with standardized preprocedure time outs that require the active participation and engagement of the entire surgical team. Some surgical department leaders have used remote video observation without audio to monitor compliance with the time out. After a sentinel event occurred, leaders at our large academic medical center initiated a quality improvement project to audit compliance with the standardized preprocedure time out. We used remote audiovisual observation to ensure that all members of the procedure team were adhering strictly to the elements of the preprocedure time out in all invasive procedure areas. Since the beginning of this remote auditing process, team member compliance with the standardized preprocedure time out has improved.

Using Hourly Time-Outs and a Standardized Tool to Promote Team Communication, Medical Record Documentation, and Patient Satisfaction During Second-Stage Labor.

BACKGROUND: During labor, effective communication and collaboration among the healthcare team is critical for patient safety; however, there is currently no standard for communication and documentation of the plan of care as agreed upon by healthcare team members and the woman in labor. OBJECTIVES: The goal of this project was to increase consistency in communication and collaboration between clinicians and laboring women during second-stage labor. METHODS: An hourly "time-out" meeting of all healthcare team members was initiated for all women during second-stage labor. A documentation tool was implemented to ensure regular and clear communication between the clinical team and laboring women. Data were collected via medical review of cases of second-stage labor lasting more than 2 hours (n = 21 in the pre-implementation group; n = 39 for 3 months postimplementation; and n = 468 patients for 2 years post-implementation). Surveys were conducted of the clinical team (n = 40) and patients (n = 28). RESULTS: Following implementation, documented agreement of the plan of care increased from 14.3% before the project to 82.1% 3 months after implementation and remained at 81.6% 2 years after implementation. All nurses who participated in the survey reported a clear understanding of how and when to complete necessary medical record documentation during second-stage labor. The providers viewed the project favorably. Most women (92.9%) reported satisfaction with their experience. This project enhanced collaborative communication between members of the clinical team and laboring women and improved patient satisfaction. The improvements were sustainable over a 2-year period.

Administração segura de medicamentos via endovenosa: uma proposta para o hospital universitário / Safe intravenous drug administration: a proposal for the university hospital

Introdução: A assistência à saúde com qualidade e segurança é um tema atual e pertinente aos serviços de saúde, que tem se preocupado em aprimorar seus processos com base nos preceitos desta temática. Este estudo visa contribuir para qualidade e segurança na assistência aos pacientes no que concerne a administração de medicamentos. E também pretende contribuir com o ensino e pesquisa nesta área na medida em que trata um delineamento da realidade de uma Instituição de Ensino e busca propor uma uniformização do processo. Objetivos: Identificar a dinâmica de administração de medicamentos. Elaborar um Procedimento Operacional Padrão para administração de medicamentos via endovenosa. Elaborar Lista de Verificação (CheckList) com as etapas a serem seguidas para uma administração segura de medicamentos para avaliar adesão dos profissionais. Os produtos oriundos dessa pesquisa foram: Procedimento Operacional Padrão para administração de medicamentos via endovenosa e um CheckList com as etapas para administração segura de medicamentos.Método:Estudo descritivo com abordagem qualitativa para análise dos dados. Os participantes foram os membros da Equipe de Enfermagem da enfermaria de escolha, a coleta de dados foi realizada por meio da observação direta guiada por um roteiro de observação, no segundo semestre de 2015, de segunda a domingo, nos três turnos de trabalho após a assinatura do Termo de Consentimento Livre e Esclarecido, sendo a amostra não probabilística por conveniência. Este estudo foi aprovado pelo comitê de ética das instituições proponente e co-participante sob os pareceres n° 1.262.690 e 1.301.318. Resultados: Foi observado um total de 23 doses de medicamentos por via endovenosa. Foi observada adesão superior à 50% na maioria das etapas da administração de medicamentos. Porém ressaltou-se como pontos de atenção uma adesão de 17% ao uso de EPI durante a manipulação dos medicamentos, 17% à desinfecção das conexões antes da administração e 15% à higienização das mãos logo após o procedimento antes de retornar ao posto de enfermagem. Conclusão: Os achados desta pesquisa apontam para necessidade de intervenção em questões da prática dos profissionais como higienização das mãos e uso de EPI's. Esses dados corroboram a necessidade de uma uniformização da prática assistencial no que concerne a administração de medicamentos visando à qualidade e segurança da assistência de Enfermagem

Introduction: Health care with quality and safety is a current topic and pertinent to health services, which has been concerned with improving its processes based on the precepts of this theme. This study aims to contribute to quality and safety in patient care in drug administration. It also intends to contribute to teaching and research in this area insofar as it deals with a delineation of the reality of a teaching institution and seeks to propose a standardization of the process. Objectives: To identify the dynamics of drug administration. Elaborate a Standard Operating Procedure for intravenous drug administration. Elaborate Checklist with the steps to follow for safe administration of medications to assess adherence of professionals. The products that came from this research were: Standard Operating Procedure for intravenous drug administration and a CheckList with the steps for safe administration of drugs. Method: Descriptive study with qualitative approach for data analysis. Participants were members of the Nursing Team of the infirmary of choice, data collection was done through direct observation guided by an observation script, in the second half of 2015, from Monday to Sunday, in the three work shifts after the signature of the Free and Informed Consent Term, being the non-probabilistic sample for convenience. This study was approved by the ethics committee of the proposing institutions and co-participant under the reports no. 1,262,690 and 1,301,318. Results: A total of 23 intravenous drug doses were observed. Adherence was higher than 50% in most stages of drug administration. However, a 17% adherence to the use of PPE during the manipulation of medications, 17% to the disinfection of the connections before administration and 15% to the hygiene of the hands soon after the procedure before returning to the nursing station . Conclusion: The findings of this research point to the need for intervention in issues of professional practice such as hand hygiene and use of PPE. These data corroborate the need for a standardization of care practice regarding the administration of medicines aiming at the quality and safety of Nursing care

Reusing surgical instruments during Mohs micrographic surgery: safe from infection, but not free from risk.

We report several scenarios of compromise in patient safety owing to the re-use of mis-assigned patient's surgical instruments in Mohs micrographic surgery.We discuss the breaks in universal protocols that others may experience in their practices and describe corrective measures that our institutions employed to avoid such future events.There is a lack of publication in the literature on the topic of mis-assigned instrument use in Mohs surgery. We believe that the  practice of re-using instruments is cost-effective and therefore common. Based on our humbling experience, this publication may initiate important discussion among dermatologist regarding safety protocols at their respective institutions.