Transcript The Count Revisited

The Count
Revisited
VPNG
Strategies for Success
Cathy Dean
Clinical Support & Development
Nurse Alfred Hospital
Latrobe Perioperative Course
Coordinator
Objective:
Elimination of the RSI
Session outline
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Identify strategies to improve count practices and
eliminate RSIs and to explore ways that current
count practices can be further improved
An overview of current count practices
Discuss current available studies on counts and RSI
Identify future directions in using research to
prevent RSIs
Improved team communication as a tool in RSI
prevention
Technological adjuncts and their role in
preventing RSIs
Data collection as a tool to identify trends and
emerging patterns in RSIs
Using research findings on trends and patterns to
inform practice
Toward the future
Current count practices
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ACORN standards: detail the minimum
standards for management of accountable
items
Standardized system designed to reduce risk
of RSI
ACORN standards; Local guidelines and
State/Territory policies and guidelines
Apply to all members of the surgical team
Scrub & Scouts have the primary responsibility
for the management of the count procedure
but the surgeon has a significant role.
Count practices
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Well established formalised process
Core responsibility of the perioperative nurse
Consumables are counted but ACORN do provide
leeway on individual facility requirements in the
counting of some items.
ACORN standards do require all instruments are
counted and reconciled against the tray lists
Variations in what is counted
Variations in process documentation
Individual hospital guidelines on the counting of
instruments and instrument trays
Counting of all Instruments
So how do RSIs occur?
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Multiple cases
Multiple teams
Poor team communication – respect and
action; unknown to each other
Fatigue
Lack of handover process
Rushed or incomplete count practices
New equipment and procedures
Unfamiliar with procedure or instrument sets
Literature
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Case reports clinical series & opinions
Little quantative research insight into RSI risk
factors to date
What contributes to the RSI risk profile ?
Identification of clinically important
differences not agreed on within the
literature.
Surgeon perspective and circular in nature.
Limited findings or recommendations that
inform practice
Questions asked
 Body
mass index
 Emergency procedures
 Blood loss
 Nursing staff change over
 After hours
 Lack of counts or no counts
 ….what has been extracted?
 ….a surgical trainee in the OR ??
The Perioperative Nurse
 How
do we prevent RSIs?
 Asking the questions
 Collecting the data
Data
 Understanding
the issues through data
 Risk Watch – Victoria
 Global risk watch : data
 Transparent reporting
 Agreed terminology
 In form our practice in a clear way that
can be linked into our everyday practice.
Communication
 RSIs
are rare events …never events
 Team communication
 Human factors
 Surgical safety checklist & time out
 Achieving the level playing field with
equal and respectful communication
Risk watch 2004-2014
 Retained
curette laparoscopic surgery
 Disposable verres needle sheath
 A retained pack in a laparotomy case
 Raytec gauze hip replacement
 Retained pack – vaginally
 Artery forceps
 Measuring pins
 Fractured guide wires
Preventing RSIs
 Good
systems; good communication
 High functioning teams training programs
in communication
 Formal Human factors training
 Standardised practices
 Data informing practice quickly and
effectively
 Adoption of adjunct technologies that
seamlessly achieve high confidence
levels in reconciling the count.
Technological adjuncts
 Reducing
the incidence of RSIs
 Query an added layer of complexity
RFI for RSIs
 Packs
& Raytec
 Disposable trocars and sheaths
 Instrumentation
 Reliable detectors for all items
 Enjoying confidence that no thing is left
behind
Safety Programs
 National
Safety Standards
 Board to ward approach
 Strategies based on emerging trends
 Inform practice
 Adopt strategies quickly
Complex Surgery complex
counts Complex environment
Communication
 Complex
environment
 Knowing the team
 Pause & introduction
 WHO – white board
 Understand the plan
 All team members understanding the
count
 To hear and to act
Getting it Right together
Strategies for success
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Realising the RSI as a never event?
Teaching communication
Ongoing communication support within the
interdisciplinary team
Board to ward
Equal and respectful
Data to inform practice and practice change
Adjunct technological aids to enhance safety
and eliminates RSIs
References
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ACORN standards 2014-2015
Australian Institute of Health and welfare Canberra, Sentinel events in
Australian public hospitals 2004-05. July 2007.
Boyd, C., & Lottenberg, L., (2015) Preventing Retained Surgical Sponges:
clinical and Economic Considerations. General Surgery News (2015) .
http://www.globalpatientsafetyalerts.com/English/ContributingOrganizations/
Pages/default.aspx
Copeland, A., Retained surgical sponge (gossypimboma) and other retained
surgical items: Prevention and Management. www.uptodate.com (2015)
Feldman, D., Prevention of Retained Surgical Items ., Mount Sinai Journal of
Medicine (2011) 78: 865-871.
Hariharan, D., & Lobo, D., Retained surgical sponges, needles and instruments.
Ann R Coll Surg Engl (2013) 95: 87-92.
Hicks, C., Rosen, M., Hobson, D., Ko, C., & Wick, E., Improving safety and
Quality of Care With Enhanced Teamwork Through Operating Room Briefings,
JAMA Surg (2014) 149 (8): 863-868.
Ivory, K., Listen, hear, act: challenging medicine’s culture of bad behaviour.
MJA. (2015) 202 (11)
McDonald, I., Human Behavior behind most surgical errors (2015)
http://www.fiecehealthcare.com/story/johns-hopkins-mayo-clinic-causessurgical-errors-never-events/2015-06-09
Mehtsun, W., Ibrahim, A., Diener-West, M., Pronovost, P., & Makary, M.,
Surgical Never Events in the United States. Surgery (2013) volume 153 (4).
Moffatt-Bruce, S., Cook, C., Stienberg, S., & Stawicki, S., Risk factors for
retained surgical items: a meta-analysis and proposed risk stratification
system., Journal of Surgical Research 190 (2014) 429-436
References cont.
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Orosco, R., Talamini, J., Chang, D., & Talamini, M. Surgical Malpractice in the
United States. J Am Coll Surg (2012) 215: 480-488.
Pennsylvania Patient Safety Advisory, Beyond the Count: Preventing retention
of Foreign Objects. Vol 6 No 2 June 2009.
http://health.vic.gov.au/clinrisk/sentinel/index.htm : Risk Watch News letters
Rupp, C. et.al. Effectiveness of a Radiofrequency Detection System as an
Adjunct to Manual Handling Protocols for Tracking Surgical Sponges: A
Prospective Trial of 2,285 Patients. J Am Coll Surg (2012;215:524-533
State Government Victoria, Department of Health, Supporting patient safety
Sentinel event program Annual report 2011-12 and 2012-13.
Stawicki, S., et.al., Natural history of retained surgical items support the need
for team training, early recognition, and prompt retrieval. The American
Journal of Surgery (2014) 208, 65-72.
Stawicki, S., et.al. Retained Surgical Items: A Problem Yet to be Solved. J Am
Coll Surg (2013) 15-22.
Steelman, V., Graling, P., & Perkhounkova, Y., Priority Patient Safety Issues
Identified by Perioperative Nurses. AORN Journal (2013) Vol 97 No 4.
The Joint Commission Sentinel Event Alert, Preventing unintended retained
foreign objects. Issue 51 October 17, 2013.
Williams, T., Tung, D., Steelman, V., Chang, P., & Szekendi, M., Retained
Surgical Sponges: Findings from Incident Reports and a Cost-Benefit Analysis
of Radiofrequency Technology. J Am Coll Surg (2014) 219:354-364.