Monthly Archives: January 2024

Patient Safety, Policies

Costs of staff ‘running’ for supplies outside of the OR, could cost up to $1,500.00.

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A hospitals operating room, store room, can be overwhelming, lots of surgical trays, equipment & supplies everywhere, most of the time in an order that make sense to a supply administrator but not to the surgical team..argh and with limited details to find what you actually need, quickly.

 

This impacts on costs, why, because there are many times when a surgeon may need additional supplies, unexpectedly, intra-operatively. When equipment can not be easily found this builds tension in the OR, in addition to prolonging surgical time, which can also impact on patient outcomes.

 

Research suggests that nurses spend 26% of intra-operative time outside of the OR, attending to additional needs of the surgeon, which would involve collecting additional equipment and supplies to support an optimized surgical outcome.

 

If the equipment required is necessary this can bring the entire operating room to a stand still, costing approximately $1,500.00 for the loss of 15minutes, waiting for the nurse to find the equipment.

 

Research also suggests that nurses ‘spend 21minutes per shift looking for lost equipment, taking them away from direct patient care’.

 

Hospitals need to provide the infrastructure for clinicians to optimize patient safety and to support them in their roles which would remove unnecessary stress, that wastes critical time. Improving clinical resources to streamline practices will improve efficiency and productivity, which will impact on staff and patients.

 

https://www.sciencedirect.com/science/article/pii/S1743919118305338

 

 

https://www.himss.org/resources/applying-rtls-technology-improve-nurse-efficiency-and-patient-care#:~:text=Time%20spent%20looking%20for%20equipment%20certainly%20takes%20them%20away%20from,shift%20searching%20for%20lost%20equipment.

Patient Safety, Policies, Technology

Implications of Equipment Failure During Surgery

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Research states that, ‘Implications of equipment failure during surgery’, occurred in 92% of surgical cases.

According to research,’equipment failures occurred in 76.9% of surgical cases. Equipment availability was impacted by 37.3% of surgical cases.

Unfortunately this is not surprising to those in the industry. I have witnessed first hand the lack of operating room checks, due to, time poor staff, who are already overloaded with paperwork and surgical setups.

When I first started working in the operating room as an instrument and circulating nurse, one of the first things I was taught, was to check the OR environment. This involved turning wall switches on and off, increasing/decreasing hardware settings.

Fast forward twenty plus years and there is more equipment to check, that is more technical and complex.

Staff are not given time to check equipment and the environment, which leads to intra-operative delays, stress and tension. Surgical time is impacted, patient safety is impacted, the waitlist is impacted and costs increase.

I hope that as we engage in more specialised practices that time is spent on checking the surgical environment and hard ware prior to the start of a surgical case load, or that specialised technical support is available to take the load off our already time poor health care professionals.

If you are a facility that provides your staff with additional time to setup and check equipment or has a technical support person. I would love to hear from you.

Contact Us

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685966/

 

https://qualitysafety.bmj.com/content/22/9/710

 

 

Patient Safety, Uncategorized

Intra-Operative Pressure Injuries (PI)

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A patient has surgery to address a disease, illness, or trauma. They are vulnerable and anxious and surgery maybe the final option.

Surgery can be costly and a patient does not need another complication, such as a Pressure Injury (PI).

According to the Agency for Healthcare Research & Quality, pressure ulcers cost $9.1-$11.6 billion per year in the US. Cost of individual patient care ranges from $20,900 to 151,700 per pressure ulcer.

https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu1.html#:~:text=Cost%3A%20Pressure%20ulcers%20cost%20%249.1-%2411.6%20billion%20per%20year,ranges%20from%20%2420%2C900%20to%20151%2C700%20per%20pressure%20ulcer.

As healthcare professionals it is our role and responsibility to provide the best care we can, to our patients.

This is why pressure area care should be assessed and addressed.

There are a number factors that impact on intra-operative pressure care and what equipment should be used to support blood circulation and minimise pressure on vessels and tissue.

A patients own health and comorbidity can also impact on the predisposition for a postoperative PI.

Correct patient positioning, monitoring pressure sites and utilising equipment can aid in reducing PI. Moisture and heat sources such as a warming blankets can also play a role in the likelihood of skin breaking down.

It can be difficult to identify early stages of skin breakdown intra-operatively, which is why assessments and precautions should be undertaken preoperatively and postoperatively.

Research in identifying and educating health care workers is necessary to reduce the risks to patients. A 2019 study detected that 1 in 150 patients developed an intra-operative stage 1 PI. This study highlights the need for education and further research to assess a patients risk and implement strategies to reduce PI.

See more from AORN about how much a PI is costing your facility.

https://www.aorn.org/syntegrity/resources/tools-calculators/pressure-injury-calc#:~:text=Pressure%20ulcers%20costs%20hospitals%20up%20to%20%2426.8%20billion,first%2C%20calculate%20how%20much%20they%E2%80%99re%20costing%20your%20facility.

Patient Safety, Scrub

Communication in the OR & Valuing Senior OR Staff

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The operating room is an environment where the room for error is minimal and time is always critical.
Surgery is becoming more complex, technical & challenging, which is why, communication & experience should be valued, especially when it comes to operating room professionals.

Effective verbal, observation & listening skills are qualities all surgical team members must demonstrate. Rothrock (2011) states that, “ improved communication is imbedded in human factors, culture, and social systems, all of which are more complex than checklists, mnemonics, and acronyms”.

A senior and experienced OR nurse, ST or ODP is able to recognise a change in the environment, they are able to ‘read the room’ & assess where attention should be focused.

They are able to ask concise questions at pivotal moments.

Example, does the laparoscopic or robotic case need to be ‘opened’? If so what trays & equipment do I require? Is there a bleeding vessel, are more fluids required for irrigation, are additional clips, ties, endoloops required?

Senior staff are able to think ahead because of their experience and surgical exposure especially if they are skilled across multiple surgical specialties.

Time can be critical during these intense moments and cohesive teamwork is vital in reducing surgical time. Surgical errors and complications arise when there is tension.

Time and experience matter, and there is usually a higher cost for these skilled clinicians, is the money worth it? Yes indeed!

Experienced OR staff  bring a wealth of experience, they have trouble shooting skills & clinical knowledge, they are able to think quickly and prioritize the needs of the surgical team.

Surgical time can have a direct impact on a patient, leading to longer post-op recovery which can impact on reduced bed availability and increased hospital costs.

Thank you to all the senior operating room professionals who have a wealth of skills and experience. Never forget how valuable you are.