OR Manager August 2022 - 19

Patient Safety
geon " in the below Q&A, is one of
the researchers and authors of the
Patient Safety in Surgery article. His
work is centered on patient safety.
* An OR specialty team manager from
an academic hospital who prefers
to remain anonymous, identified as
" OR manager " below, was a circulating
nurse for over 10 years before
stepping into a leadership role. She
has recent first-hand experience with
the causes and prevention methods
for better communication in the OR.
Q: Based on your research, surgical
miscounts are frequently encountered
in all ORs. What are some of the
contributing factors to this?
Surgeon: These events are caused by a
constellation of factors, including time
pressures, a distracting and often loud
environment, a large number of instruments
and needles, and OR staff shift
changes.
OR manager: In addition, when there
are multiple tables set up, that adds
another level of confusion. If we walk
into a case that we are not very familiar
with but we are supporting, that adds
another level of stress. From a staffing
standpoint, having travel nurses who
are not familiar with the hospital or the
team could create unecessary complexities
along with multiple hand-offs. A very
long case or an open case could also
increase the chance of miscounts.
Q: Can you elaborate on the concept
of " recall bias " ? How did you confirm
the data?
Surgeon: The surgeon plays the primary
role in the OR and bears the bulk of the
responsibility and any potential negative
consequences. We assume that might
lead them to have a bias towards recalling
a more positive outcome.
To verify that, we obtained an odd
ratio comparing surgeons to the rest
of the surgical staff (anesthesiologists,
nurses, and technologists) to see if
there is a difference in the perception
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of the number of lost sharp events. Surgeons
were found to be almost 3 times
more likely to report zero lost events
and 2.5 times more likely to say all
lost sharps were recovered prior to the
completion of a surgery.
I want to emphasize that this does
not imply that surgeons are trying to
hide something. It is more likely due to
them not being directly involved in the
instrument counting process.
OR manager: I agree. It is basically
unawareness, which is why a survey
like this creates a neutral platform for
dialogue.
Here is how I think about perception
in an OR: Imagine the patient lying on
the table. The anesthesiologist sits next
to the patient by the airway. Therefore,
he or she is completely aware of what
is happening in that area. The surgeons,
on the other hand, are operating over
the patient. They are concentrating on
the inside of the body. The nurses and
technologists care for the operation of
the OR, from the use of instruments
and equipment, to movement around
the room, to the patient's vital signs,
and the overall environment. There is a
clear division of labor, and that leads to
different perceptions of events.
Q: What can we do to help prevent
adverse events?
Surgeon: When I started researching
on this, part of my intention was to use
data to drive meaningful conversation.
Many institutions now utilize an " end "
time-out procedure to review what was
done during the course of the operation
and to review any key or important
events. The more conversation and dialogue
teams implement, confusion and
ambiguity are less likely. OR leaders
should strive for everyone to be on the
same page before, during, and after
each surgical procedure.
OR manager: I also suggest a few strategies
that can help prevent miscounts:
➊ During both the initial count and
final count, turn down the noise
level and do not distract the person
counting. Do not rush.
➋ Repeat back the initial count and
final count to a second person.
➌ Articulate the motion of handing
off the needles (such as 'one-in,
one-out') verbally.
➍ Have a whiteboard inside the room
when dealing with a large number
of needles so the surgical technician
can both hear and visualize
the number of needles.
➎ And of course, the use of adjunct
technologies in recent years has
made things easier.
Recognizing that there are multiple
perspectives in the OR is the first step
to begin the conversation on patient
safety. Only after the differing perspectives
are considered, will the appropriate
processes and protocols put in
place to improve patient safety and increase
OR efficiency be followed.
The more stressful the situation is,
the more important the above is as well.
When people are under stress, most
will default to what is easier and more
streamlined to resolve said stress,
which might not include newly established
protocols. Leaders should ensure
that all patient safety protocols are
" user friendly, " meaning all members
from a surgical team are being represented.
The adoption rate will increase
when the effort is there to show all angles.
A protocol is good only when it is
properly adopted. ORM
-Ivy Montgomery is a Go-To-Market
executive who is passionate about improving
patient outcomes, especially in
the areas of diagnosis, treatment, and
prevention of diseases.
Reference
Weprin S, Meyer D, Li R, et al. Incidence
and OR team awareness of
" near-miss " and retained surgical
sharps: a national survey on United
States operating rooms. Patient Saf
Surg. 2021; 15: 14.
OR Manager | August 2022 19
https://pssjournal.biomedcentral.com/articles/10.1186/s13037-021-00287-5 http://www.ormanager.com
OR Manager August 2022

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