Features

Patient safety in the operating room is paramount and is top priority and a concern for hospitals. Numerous initiatives to improve OR care have had some impact, but problems persist.

To overcome these problems, hospitals must first assess the culture of the OR, address top priorities and build teamwork among clinicians and supporting departments.

 

A Safety Attitudes Questionnaire which was adapted from the airline industry, was developed to determine the staff’s outlook toward the work environment in the OR. “The questionnaire asks front-line providers how safe they feel their hospital is,” “Their response is the best predictor of risk that hospitals have.” It can provide a benchmark with other organizations and help develop safety programs.

Sample questions from the SAQ (OR version) include:

Sexton JB, & Thomas EJ. The Safety Climate Survey: Psychometric and Benchmarking Properties. Technical Report 03-03. The University of Texas Center of Excellence for Patient Safety Research and Practice (AHRQ grant  #1PO1HS1154401 and U18HS1116401), 2006.

 

 

Provides a framework for communication between members of the health care team about a patient’s condition. It allows an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.

Young GJ, Charns MP, Daley J, Forbes MG, Henderson W, Khuri SF. Best practices for managing surgical services: The role of coordination. 1997:22(4):72-81

Is a national quality improvement project designed to improve surgical care in hospitals.

SCIP is sponsored by the Centers for Medicare and Medicaid Services (CMS) in collaboration with a number of other national partners serving on the steering committee, including the American Hospital Association (AHA), Centers for Disease Control and Prevention (CDC), Institute for Healthcare Improvement (IHI), Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and others. SCIP is an extension of a previous CMS initiative called the Surgical Infection Prevention Project (SIPP).

The official Web site of SCIP is located on the:

 CMS QualityNet Web site

 

Among the most common complications that occur after surgery are surgical site infections and postoperative sepsis, cardiovascular complications, respiratory complications (including postoperative pneumonia), and thromboembolic complications. Patients who experience postoperative complications have dramatically increased hospital length of stay, hospital costs, and mortality rates. The Centers for Medicare & Medicaid Services, in collaboration with the Centers for Disease Control and Prevention, has implemented the Surgical Infection Prevention Project to decrease the morbidity and mortality associated with postoperative surgical site infections.

 

Mangram, A. J., T. C. Horan, M. L. Pearson et al. 1999. Guideline forPrevention of Surgical Site Infection, 1999. Centers for Disease Control andPrevention (CDC) Hospital Infection Control Practices Advisory Committee. American Journal of Infection Control 27 (2): 97–132.

Almost 50 percent of Joint Commission standards are directly related to safety, addressing such issues as medication use, infection control, surgery and anesthesia, transfusions, restraint and seclusion, staffing and staff competence, fire safety, medical equipment, emergency management, and security. These standards also include specific requirements for the response to adverse events; the prevention of accidental harm through the analysis and redesign of vulnerable patient systems (e.g. the ordering, preparation and dispensing of medications); and the organization’s responsibility to tell a patient about the outcomes of the care provided to the patient—whether good or bad.

 

Health care organizations are working hard to establish patient-safe cultures and implement integrated patient safety programs that aim to prevent harm to patients. Several strategies have been identified that both promote patient-safe cultures and serve to communicate issues associated with safety.

Organizations can significantly lower adverse drug events by using three strategies:
• Identifying high-risk processes
• Identifying errors before they reach the patient
• Developing systems that quickly mitigate the effect of any harm to a patient.

Joint Commission Resources, are dedicated to helping health care organizations improve patient safety, outcomes and satisfaction with products and services that address all three areas.

The National Patient Safety Goals program provides a significant focus on patient safety within health care and is designed to stimulate organizational improvement activities for several of the most pressing patient safety issues that all organizations are struggling to manage effectively.

 

The Joint Commission has shown proven ability to identify, test and specify standardized performance measures. It engages in cutting edge performance measurement research and development activities, and has established successful, ongoing, collaborative relationships with key performance measurement entities.

 

 

Quality improvement in the operating room (OR) is an important area in reducing health care costs and improving the efficiency of processing patients. The Centers for Medicare & Medicaid Services (CMS) published a rule instructing hospitals to develop and implement quality improvement programs in an effort to further reduce medical errors. Hospitals must develop and implement a quality assessment and performance improvement (QAPI) program that will identify patient safety issues and reduce medical errors in hospitals. This serves as another step towards improving patient safety, accountability and bringing quality to the forefront of medical practice.