PATIENT SAFETY

in the
OPERATING ROOM
Joy E. Luat-Inciong, MD
St. Lukes Medical Center
Philippines

Effective Communication
in the OR
sophisticated instruments
transfer of critical information
changing nature of patients
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 PatientAssociated Risks

Preventing Wrong-Site, WrongProcedure, Wrong-Person Surgery
Preventing Medication Errors

Wrong-Site, WrongProcedure, Wrong-Person

Procedure Surgery

Causes of Wrong-Site, WrongProcedure, 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, WrongPerson 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, WrongPerson Procedure
More than one surgeon
Multiple procedures
Time pressure
Unusual patient characteristics

Universal
Protocol
for Preventing Wrong-Site,
Wrong-Procedure, WrongPerson 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 ORAssociated 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
Patients 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 staffs 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.