PATIENT SAFETY

in the
OPERATING ROOM

Joy E. Luat-Inciong, MD
St. Luke’s Medical Center
Philippines
Effective Communication
in the OR
sophisticated instruments
transfer of critical information
changing nature of patient’s
condition
uncertainty inherent in surgery
Communication failure is
the root cause of nearly
70% of sentinel events.
Ways to Establish
Communication
Providing the staff access to
leadership
Eliminating hierarchy
Encouraging a team approach to
care
 Addressing Patient-
Associated Risks

Preventing Wrong-Site, Wrong-

Procedure, Wrong-Person Surgery
Preventing Medication Errors
 Wrong-Site, Wrong-
Procedure, Wrong-Person
Procedure Surgery
Causes of Wrong-Site, Wrong-
Procedure, Wrong-Person
Surgery
Ineffective/Inadequate communication among
members of the surgical team
Lack of patient involvement in site marking
Lack of procedures for verifying operative site
Inadequate patient assessment
 Causes of Wrong-Site,
Wrong-Procedure, Wrong-
Person Surgery
Inadequate medical record review
Exclusion of certain surgical team members
in verification process
Illegible handwriting
Use of abbreviations related to surgical
procedure, site or laterality
 Causes of Wrong-Site,
Wrong-Procedure, Wrong-
Person Procedure

More than one surgeon

Multiple procedures
Time pressure
Unusual patient characteristics
 Universal
Protocol
for Preventing Wrong-Site,
Wrong-Procedure, Wrong-
Person Surgery

Preoperative verification process

Marking of the surgical site

Time-out before start of procedure

Preoperative Verification
Process
at time procedure is scheduled
at time of admission into facility
anytime responsibility for care of patient
is transferred to another caregiver
before patient leaves preoperative area
or enters procedure room
 Marking the
Surgical Site
Write “Left” or “Right” or “Yes”
Mark should be visible after
patient has been prepped and
draped
Do not mark any non-operative site
Do not write “X”
Mark all cases involving:

Laterality
Multiple structures
Multiple levels
 Sites Exempt from
Surgical Site Marking

Single organ
Interventional cases
Teeth
Premature infants
 Time-Out

Correct patient identity

Correct side and site

Agreement on procedure to be performed

Correct patient position

Availability of correct implants, special
equipment or requirements
 Addressing OR-
Associated Risks
Ensuring Fire Safety
Ensuring Infection Control and
Prevention
Maintaining Proper Hand Hygiene in
the OR
Ensuring Sharps Safety
Preventing Overbooking of ORs
Ensuring Fire Safety
The Fire Triangle

Fuel source
Ignition source
Oxygen source
Minimizing Risks Associated
w/ Fire Triangle
Preparing patients appropriately
Using equipment safely
Maintaining equipment
Controlling excess oxygen
Engaging staff in fire prevention
Responding to OR Fire

Shut down medical gases

Pour saline into surgical site
Remove burning material
Ventilate with air instead of
oxygen
 Ensuring Infection
Control and Prevention

Air quality and ventilation

Effective OR cleaning
Effective medical equipment cleaning
Effective laundry cleaning
Air Quality and Ventilation
Centers for Disease Control and
Prevention Guidelines

Maintain positive pressure ventilation

Maintain 15 air changes per hour
Filter air
Introduce air from ceiling and exhaust
near floor
Keep OR doors closed
Reducing Risk of TB

Patient should be intubated in AII room

or in OR
Use surgical N95 respirator or a PAPR
Use bacterial filter with anesthesia
equipment
Reducing Risk of TB

Extubate and allow recovery in AII

room
Schedule as last surgical case of
the day
Cleaning the OR Effectively

Terminal cleaning once

every 24 hours
Use wet vacuum or
single use mop
Cleaning Equipment
Effectively
Which?
When?
How?
How often?
Classification to Determine
Cleaning Strategy for
Equipment
Critical Cleaning
Semicritical Decontamination
Noncritical Disinfection
Sterilization
 An antiseptic made up of a
combination of 2 antiseptics
with different mechanisms of
action can be better at
fighting bacteria than a
single antiseptic.
 Guidelines in
Selecting Protective
Apparel
Type of material
Safety
Performance characteristics
Appropriate care
Proper disposal
 Reducing Surgical
Site Infections
Amount of bacteria
Virulence of bacteria
Microenvironment of wound
Patient’s defenses
 Reducing Surgical Site
Infections
Using prophylactic antibiotics
Removing hair appropriately
Ensuring glycemic control
Preventing hypothermia
Providing supplemental O2 during surgery
Infection Control Emergency

Limit OR traffic
Designate specific rooms and routes
Monitor staff’s health
Use disposable equipment
Reducing Sharps
Injuries

Use a neutral zone

Practice double-gloving
Regularly change surgical gloves
Stay out of the way
Preventing Overbooking
of ORs

Managing block time effectively

Separating urgent and elective
cases
Improving on-time starts
 Managing Block
Time Effectively

Set clear rules

Consider utilization as a guideline
Regularly review block time
Add an urgent room
Emergent - 30 minutes
Priority - 30 minutes to an hour
Urgent - 4 to 24 hours
Nonurgent - after 24 hours
 Risk Factors for Retaining
Foreign Bodies After Surgery

Emergency surgeries
Complex procedures
Surgeries with unplanned
procedures
 Risk Factors for
Retaining Foreign Bodies
After Surgery
Surgeries on off hours
Sponges used for packing
or retractors
Patients with high body
mass index
 Strategies for Preventing
Retention of Foreign Bodies

Reviewing counting policy

Educating staff
Ensuring effective communication
 Strategies for Preventing
Retention of Foreign Bodies
Performing x-ray on all high-risk
patients
Minimizing rush
Minimizing distractions
 Nowhere, perhaps, is it
more important to
preserve the safety of
the patients than in the
OR.....
Lives often depend on it.