- Email: [email protected]
Patient Safety Requires a Team Approach
PATIENT SAFETY FIRST Patient Safety Requires a Team Approach SHARON A. MCNAMARA, RN, MS, CNOR
H
ealth care practitioners worldwide share a unified concern for patient safety and a desire to foster an environment of care that is characterized by communication and teamwork. Teamwork is an essential component of patient safety1; however, although the term surgical team is frequently used, it is often reflective of only the most basic definition by Webster: “a number of persons associated in work or activity.”2(p1209) This statement is not intended to minimize the importance of the team of practitioners who hold the surgical patient’s life in their hands, but to emphasize that team behavior is not always reflected in everyday practice. Historically, surgical team members have looked to their professional associations to guide their practice and, although practitioners strive to work collaboratively in the OR, their professional associations are not always in concert on select issues that govern practice (eg, oversight, shared role responsibilities, delegation of duties). In July 2003, AORN was the catalyst for initiating the organization of national surgical associations to advance a common goal—safety. The AORN Executive Symposium “Envisioning the Future of Surgery” brought together representatives from AORN and the six other principal surgical patient care provider associations:
the American Association of Nurse Anesthetists, the American Association of Physician Assistants, the American College of Surgeons, the American Society of Anesthesiologists, the American Society of Perianesthesia Nurses, and the Association of Surgical Technologists.
The symposium promoted discussion among participants who held executive positions in their respective health care facilities, professional and regulatory organizations, and industry on issues that they thought would be most prevalent in the future of health care. Impassioned debate ensued as the participants considered what issues they could agree on and what issues they could agree to disagree on. The outcome was that the group decided to collaborate on that issue on which they could all agree: perioperative safety. This was the foundation from which the Council on Surgical and Perioperative Safety (CSPS) was formed. TARGETING PATIENT SAFETY The CSPS is a unique, multidisciplinary coalition composed of two representatives from each of the seven professional associations that represent key members of the surgical team. The CSPS “envisions a world in which all patients receive the safest surgical care provided by an integrated
The AORN Journal is seeking contributors for the Patient Safety First column. Interested authors can contact Sharon A. McNamara, column coordinator, by sending topic ideas to [email protected]. doi: 10.1016/j.aorn.2010.06.013
466
AORN Journal ●
October 2010
Vol 92
No 4
© AORN, Inc, 2010
PATIENT SAFETY FIRST
www.aornjournal.org
team of dedicated professionals.”3 With a mission to promote excellence in patient safety in the perioperative environment, the members created the following guiding principles and values:
DEVELOPING COMMON PRINCIPLES AND STANDARDS The group worked collaboratively to define safe surgery principles that each organization could support as part of the perioperative care team. We are committed to implementation of all These principles are generalized statements that strategies that support safe surgery for all direct the user to standards, recommended pracpatients. tices, policies, guidelines, resources, and research We treat everyone with respect and appreciate from each of the seven organizations, other paindividual and organizational differences. tient safety organizations, and regulatory agencies. We value the diversity of our membership and For example, the CSPS fifth safe surgery princitheir unique roles in the delivery of care. ple on sharps safety states that “The CSPS en We are committed to collaboration and effecdorses sharps safety measures to prevent injury tive communication among all team members during perioperative care. Sharps safety measures involved in perioperative care. should include double-gloving, blunt suture nee We are committed to partnerships (regulatory, dles for fascial closure, and the neutral zone when public, private, research agencies) that imappropriate to avoid hand passage of sharps.”4 prove patient safety. This principle can be accessed on the CSPS web We value a culture of patient safety and a carsite along with links to statements on sharps ing perioperative workplace environment.3 safety from AORN, the American College of SurThe CSPS team is committed to providing collabgeons, the Association of Surgical Technologists, orative resources to advance perioperative practiand the Emergency Nurses Association, as well as tioners and organizalinks to the Centers tions in their quest for Disease Control for a culture of and Prevention and The CSPS team is committed to providing safety for both pacollaborative resources to advance perioperative National Institute for practitioners and organizations in their quest for tients and practitioOccupational Safety a culture of safety for both patients and health ners. Team members and Health sites, care providers. spent many hours where a plethora of identifying the plethresources are housed ora of resources that on sharps injury, each organization had for its members, including including the current Occupational Safety and standards, policies, guidelines, and tool kits for Health Administration regulations. professional practice. The group agreed that these In March 2009, the CSPS disseminated its first resources did not need to be duplicated by the statement on violence in the health care workCSPS but that information could be effectively place.5 The responsibility for ensuring a violencefree environment is shared by all stakeholders in shared. From these efforts, they developed a dythe perioperative setting. The CSPS advocates for namic web site (http://www.cspsteam.org) that implementation of workplace violence prevention offers valuable information to support teamprograms in all health care organizations. Free driven, patient-centered programs; free educaresources available through CSPS including a tional resources; access to professional speakers PowerPoint® presentation entitled “Violence for a moderate fee; and links to each professional in the OR: A Never Tolerated Event.”6 The association’s resources to support individual pracpresentation addresses all perioperative health titioners with patient safety initiatives. AORN Journal
467
October 2010
Vol 92
PATIENT SAFETY FIRST
No 4
care workers and features multiple references, examples supported by research of behaviors that undermine a culture of safety and affect both the provider and patient, and an example of a program implemented by a major northeastern cancer center that demonstrates policies and innovative preventive measures to address inappropriate behavior. Transitions in care will be the next major topic addressed by the CSPS in the fall of 2010. Supporting documentation will include a PowerPoint presentation examining areas of risk for breakdown in communication as the patient traverses the surgical continuum of care. The goal is to address each practitioner’s vulnerability in the communication chain and to provide tools that can help in preventing errors that could harm patients.
patient safety in the surgical and perioperative environment. Editor’s note: PowerPoint is a registered trademark of Microsoft Corp, Redmond, WA. References 1.
2. 3.
4.
5.
6.
CONTINUED COLLABORATION Surgery is a complex, high-risk event that requires strong leadership, teamwork, and communication in a safe environment. The CSPS representatives collectively epitomize the idealized perioperative team, and they strive to further advance patient safety by modeling partnering behaviors, addressing complex issues in team dynamics, and creating environments that positively affect patient outcomes. The CSPS members will continue their efforts to promote excellence in
Sammer CE, Lykens K, Singh KP, et al. What is patient safety culture? A review of the literature. J Nurs Scholarship. 2010;42(2):156-165. Merriam Webster’s Collegiate Dictionary. 10th ed. Springfield, MA: Merriam-Webster, Inc; 1993:1209. One team. One goal. Surgical patient safety. Council on Surgical and Perioperative Safety. http://www.cspsteam .org/missionvisionvalues/missionvisionvalues.html. Accessed July 8, 2010. CSPS Safe Surgery Principles: Sharps Safety #5. Council on Surgical and Perioperative Safety. http://www .cspsteam.org/sharpssafety/sharpssafety.html. Accessed July 9, 2010. Statement on violence in the workplace. Council on Surgical and Perioperative Safety. http://www.cspsteam.org/ StatementViolenceWorkplace.doc. Accessed July 9, 2010. Violence in the OR: a never tolerated event. Council on Surgical and Perioperative Safety. http://www.cspsteam .org/Violence_-_JCR-CSPS_3-31-2009.pdf. Accessed July 29, 2010.
Sharon A. McNamara, RN, MS, CNOR, is chair of the Council on Surgical and Perioperative Safety, Chicago, IL, and an independent perioperative consultant. Ms McNamara has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
This column was funded through a grant from the AORN Foundation.
468
AORN Journal
H
ealth care practitioners worldwide share a unified concern for patient safety and a desire to foster an environment of care that is characterized by communication and teamwork. Teamwork is an essential component of patient safety1; however, although the term surgical team is frequently used, it is often reflective of only the most basic definition by Webster: “a number of persons associated in work or activity.”2(p1209) This statement is not intended to minimize the importance of the team of practitioners who hold the surgical patient’s life in their hands, but to emphasize that team behavior is not always reflected in everyday practice. Historically, surgical team members have looked to their professional associations to guide their practice and, although practitioners strive to work collaboratively in the OR, their professional associations are not always in concert on select issues that govern practice (eg, oversight, shared role responsibilities, delegation of duties). In July 2003, AORN was the catalyst for initiating the organization of national surgical associations to advance a common goal—safety. The AORN Executive Symposium “Envisioning the Future of Surgery” brought together representatives from AORN and the six other principal surgical patient care provider associations:
the American Association of Nurse Anesthetists, the American Association of Physician Assistants, the American College of Surgeons, the American Society of Anesthesiologists, the American Society of Perianesthesia Nurses, and the Association of Surgical Technologists.
The symposium promoted discussion among participants who held executive positions in their respective health care facilities, professional and regulatory organizations, and industry on issues that they thought would be most prevalent in the future of health care. Impassioned debate ensued as the participants considered what issues they could agree on and what issues they could agree to disagree on. The outcome was that the group decided to collaborate on that issue on which they could all agree: perioperative safety. This was the foundation from which the Council on Surgical and Perioperative Safety (CSPS) was formed. TARGETING PATIENT SAFETY The CSPS is a unique, multidisciplinary coalition composed of two representatives from each of the seven professional associations that represent key members of the surgical team. The CSPS “envisions a world in which all patients receive the safest surgical care provided by an integrated
The AORN Journal is seeking contributors for the Patient Safety First column. Interested authors can contact Sharon A. McNamara, column coordinator, by sending topic ideas to [email protected]. doi: 10.1016/j.aorn.2010.06.013
466
AORN Journal ●
October 2010
Vol 92
No 4
© AORN, Inc, 2010
PATIENT SAFETY FIRST
www.aornjournal.org
team of dedicated professionals.”3 With a mission to promote excellence in patient safety in the perioperative environment, the members created the following guiding principles and values:
DEVELOPING COMMON PRINCIPLES AND STANDARDS The group worked collaboratively to define safe surgery principles that each organization could support as part of the perioperative care team. We are committed to implementation of all These principles are generalized statements that strategies that support safe surgery for all direct the user to standards, recommended pracpatients. tices, policies, guidelines, resources, and research We treat everyone with respect and appreciate from each of the seven organizations, other paindividual and organizational differences. tient safety organizations, and regulatory agencies. We value the diversity of our membership and For example, the CSPS fifth safe surgery princitheir unique roles in the delivery of care. ple on sharps safety states that “The CSPS en We are committed to collaboration and effecdorses sharps safety measures to prevent injury tive communication among all team members during perioperative care. Sharps safety measures involved in perioperative care. should include double-gloving, blunt suture nee We are committed to partnerships (regulatory, dles for fascial closure, and the neutral zone when public, private, research agencies) that imappropriate to avoid hand passage of sharps.”4 prove patient safety. This principle can be accessed on the CSPS web We value a culture of patient safety and a carsite along with links to statements on sharps ing perioperative workplace environment.3 safety from AORN, the American College of SurThe CSPS team is committed to providing collabgeons, the Association of Surgical Technologists, orative resources to advance perioperative practiand the Emergency Nurses Association, as well as tioners and organizalinks to the Centers tions in their quest for Disease Control for a culture of and Prevention and The CSPS team is committed to providing safety for both pacollaborative resources to advance perioperative National Institute for practitioners and organizations in their quest for tients and practitioOccupational Safety a culture of safety for both patients and health ners. Team members and Health sites, care providers. spent many hours where a plethora of identifying the plethresources are housed ora of resources that on sharps injury, each organization had for its members, including including the current Occupational Safety and standards, policies, guidelines, and tool kits for Health Administration regulations. professional practice. The group agreed that these In March 2009, the CSPS disseminated its first resources did not need to be duplicated by the statement on violence in the health care workCSPS but that information could be effectively place.5 The responsibility for ensuring a violencefree environment is shared by all stakeholders in shared. From these efforts, they developed a dythe perioperative setting. The CSPS advocates for namic web site (http://www.cspsteam.org) that implementation of workplace violence prevention offers valuable information to support teamprograms in all health care organizations. Free driven, patient-centered programs; free educaresources available through CSPS including a tional resources; access to professional speakers PowerPoint® presentation entitled “Violence for a moderate fee; and links to each professional in the OR: A Never Tolerated Event.”6 The association’s resources to support individual pracpresentation addresses all perioperative health titioners with patient safety initiatives. AORN Journal
467
October 2010
Vol 92
PATIENT SAFETY FIRST
No 4
care workers and features multiple references, examples supported by research of behaviors that undermine a culture of safety and affect both the provider and patient, and an example of a program implemented by a major northeastern cancer center that demonstrates policies and innovative preventive measures to address inappropriate behavior. Transitions in care will be the next major topic addressed by the CSPS in the fall of 2010. Supporting documentation will include a PowerPoint presentation examining areas of risk for breakdown in communication as the patient traverses the surgical continuum of care. The goal is to address each practitioner’s vulnerability in the communication chain and to provide tools that can help in preventing errors that could harm patients.
patient safety in the surgical and perioperative environment. Editor’s note: PowerPoint is a registered trademark of Microsoft Corp, Redmond, WA. References 1.
2. 3.
4.
5.
6.
CONTINUED COLLABORATION Surgery is a complex, high-risk event that requires strong leadership, teamwork, and communication in a safe environment. The CSPS representatives collectively epitomize the idealized perioperative team, and they strive to further advance patient safety by modeling partnering behaviors, addressing complex issues in team dynamics, and creating environments that positively affect patient outcomes. The CSPS members will continue their efforts to promote excellence in
Sammer CE, Lykens K, Singh KP, et al. What is patient safety culture? A review of the literature. J Nurs Scholarship. 2010;42(2):156-165. Merriam Webster’s Collegiate Dictionary. 10th ed. Springfield, MA: Merriam-Webster, Inc; 1993:1209. One team. One goal. Surgical patient safety. Council on Surgical and Perioperative Safety. http://www.cspsteam .org/missionvisionvalues/missionvisionvalues.html. Accessed July 8, 2010. CSPS Safe Surgery Principles: Sharps Safety #5. Council on Surgical and Perioperative Safety. http://www .cspsteam.org/sharpssafety/sharpssafety.html. Accessed July 9, 2010. Statement on violence in the workplace. Council on Surgical and Perioperative Safety. http://www.cspsteam.org/ StatementViolenceWorkplace.doc. Accessed July 9, 2010. Violence in the OR: a never tolerated event. Council on Surgical and Perioperative Safety. http://www.cspsteam .org/Violence_-_JCR-CSPS_3-31-2009.pdf. Accessed July 29, 2010.
Sharon A. McNamara, RN, MS, CNOR, is chair of the Council on Surgical and Perioperative Safety, Chicago, IL, and an independent perioperative consultant. Ms McNamara has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
This column was funded through a grant from the AORN Foundation.
468
AORN Journal