Safety Huddles in the PACU: When a Patient Self-MedicatesThe implementation of safety huddles in the PACU has been effective in enhancing and promoting patient safety during the recovery period. The case scenario presented in this article demonstrates how the safety huddle can be used to examine nursing care in the PACU. Allotting time each day to address patient-related issues that arise during patient care allows the team to troubleshoot and resolve clinical issues. Through examination of nursing practices in the recovery period, PACU nurses are able to support the best perianesthesia care possible.
Creating a Safer Perioperative Environment With an Obstructive Sleep Apnea Screening ToolObstructive sleep apnea (OSA) is a common condition that increases the risk of complications for patients undergoing sedation and/or general anesthesia. The purpose of this quality improvement project was to promote evidence-based practice for nurses to screen patients with OSA in the perioperative setting. A step-by-step team process was implemented using the Iowa Model of Evidence-Based Practice in a shared leadership environment at an acute care facility to educate staff and evaluate the practice change.
Noise in the Operating Room—What Do We Know? A Review of the LiteratureBecause noise is a general stressor, noise in the OR should be avoided whenever possible. This article presents the results of a review of the research literature on the topic of noise in the OR. A systematic literature search was conducted. Eighteen relevant articles were identified and categorized as follows: noise levels, noise sources, staff performances, and patient’s perception of noise. Each study was assessed according to the strength of the evidence and the quality of the study. Noise levels in the OR in general exceed recommended levels, and the noise sources are related to equipment and staff behavior.
Patient Safety—Ten Years LaterDecember 1, 2009 was the tenth anniversary of To Err is Human,1 the Institute of Medicine (IOM) report on medical errors in the health care system. Dr. Wachter notes that this report “arguably launched the modern patient-safety movement.”2 In an updated analysis, Wachter looks at the progress that has been made since that initial report and also gives an in-depth description of the gaps that are still present.
Pre-printed Opioid Medication OrdersPRE-PRINTED ORDERS are often used in the PACU setting to allow for timely intervention in treating postoperative pain. These orders are intended to provide safe and efficient care in a specialty unit by providing specific orders from physicians to the nursing staff who are appropriately assessing patients' needs for management and treatment of pain.
Handoff Communication: Opportunities for ImprovementTHERE IS NO PAUCITY of information related to the problems that arise when communication between health care workers is poor, minimized, ignored, or absent. The literature abounds with scenarios, true stories, and real incidents where incomplete communication played a significant part in an untoward patient outcome. Multiple medical and nursing reports, journal articles, and media portrayals tell the story. In fact, nurse managers can simply review incident reports and listen to concerns related to poor handoff of care to find unit-specific evidence that there are numerous opportunities for improvement.
Improving Patient Safety by Understanding Past Experiences in Day Surgery and PACUPatient safety is a priority, yet little is understood regarding the nature of errors in the perianesthesia settings. The purpose of this claims analysis was to examine patient safety issues in the day surgery and PACU. A retrospective, exploratory design was used. Ninety-three patient safety cases were identified. Differences emerged between PACU and day surgery in regard to allegations and risk management issues. Thirty-nine percent of PACU and 25% of day surgery cases involved nurses as the primary responsible party.
Understanding Never EventsTHE NATIONAL Quality Forum (NQF) is a nonprofit organization comprised of policy makers, physicians, hospitals, and businesses that was created to develop and implement a national strategy for health care quality reporting and measurement. One of the leading causes of death and injury in the United States is adverse events occurring in the hospital setting.1 Based on this finding, the NQF developed a list of 27 adverse events, also referred to as never events, in 2002. These events were considered serious enough to be reported publically.
2009 National Patient Safety GoalsThe Joint Commission (TJC) established its National Patient Safety Goals (NPSGs) program in 2002 and the first set of Goals was effective January 1, 2003. The NPSGs were established to help accredited organizations address specific areas of concern regarding patient safety. The development and annual updating of the NPSGs is overseen by a panel of patient safety experts, including nurses, physicians, pharmacists, risk managers, and other professionals who have hands-on experience in addressing patient safety issues in a variety of health care settings.
Statement on Violence in the Workplace The Council on Surgical & Perioperative Safety (Approved October 9, 2007)The Council on Surgical & Perioperative Safety (CSPS) has agreed on many safe surgery principles concerning the safe care of surgical patients and the promotion of a caring workplace environment for the entire perioperative team. One of these principles is that violence in the workplace must not be tolerated under any circumstances. Thus, the CSPS proposed a Statement on Violence in the Workplace that was approved in October 2007.
Perianesthesia Nursing Advocacy: An Influential Voice for Patient SafetyPerianesthesia nurses are called to advocate for their patients, promote a safe work environment, and contribute to the continued advancement of the nursing profession. Nurses must demonstrate vigilance in their nursing care to protect patients from harm. It is an ethical and legal responsibility to request physicians to review with patients their informed consents when they report they do not understand or have questions about the surgical procedure. Likewise, nurses need to alert managers and administrators when they experience unsafe work environments, such as actual or potential nurse staffing issues, unsafe nurse-to-patient ratios, medication errors, and nurse fatigue.
Fatigue: Do You Understand the Risks to Safety?A LANDMARK publication from the Institute of Medicine (IOM), To Err is Human: Building a Safer Health System, highlighted the importance of patient safety in the hospital and ambulatory settings.1 This report spurred health care organizations to begin examining their systems and move from a culture of blame to a culture of safety.1 Health care systems, like hospitals, are complex and highly interdependent. It is important, therefore, to emphasize that most errors occur because of system, rather than human-related errors.
Medication Errors in the PACUA collaborative research group examined seven years of PACU medication errors from the MEDMARX database. Descriptive statistics showed a comparison of medication errors in all ages from pediatric to adult to geriatric groups. Nine categories of medication errors were noted and a total of 3,023 errors were attributed to errors in prescribing, transcribing, dispensing, administering, and monitoring. Harmful errors were present in 5.8% of the sample, which included two patient deaths. Results indicated that errors can occur in any age group.
American Society of PeriAnesthesia Nurses: A Position Statement on Perianesthesia SafetyASPAN has the responsibility of defining the principles of safe, quality nursing practice in the perianesthesia setting. ASPAN, therefore, sets forth this position to define the scope of perianesthesia safety.
Patient Safety: Perianesthesia Nursing's Essential Role in Safe PracticeA safety culture that promotes best practices and best outcomes is important in today's healthcare environment. The perianesthesia environment of care is constantly challenged with the introduction of new technologies, improved medications, and advances in surgical and nonsurgical procedures. This practice is also marked by fast turnover, increasing volume, and, often, high-acuity patients. The integration of principles of safety and evidence-based principles is a core value of perianesthesia practice.
Surgical Site Verification: A Through ZPerforming the correct procedure on the correct patient has always been of prime importance to all health care providers. For the past six years, it has been a patient safety initiative priority of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Before JCAHO took the lead in this arena, however, health care facilities handled this issue with individualized policies and procedures. This became problematic because physicians practice in multiple institutions that could have conflicting policies, which could confuse the issue.