- Email: [email protected]
When to perform the surgical time out
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Clinical Issues
JANUARY 2009, VOL 89, NO 1
REFERENCES 1. HR6111 Tax Relief and Health Care Act of 2006: Sec 101 Physician Payment and Quality Improvement. Centers for Medicare and Medicaid Services.
http://www.cms.hhs.gov/PQRI/Downloads/PQRI TaxReliefHealthCareAct.pdf. Accessed November 24, 2008. 2. ACS Quality Measures: Implementation Guide (Version 1.0). ASC Quality Collaboration. http:// www.ascquality.org/documents/ASCQualityCol laborationImplementationGuide.pdf. Accessed November 11, 2008. 3. National voluntary consensus standards as of October 29, 2008. National Quality Forum. http:// www.qualityforum.org/pdf/Btblendorsedmeasures current.xls. Accessed November 12, 2008. 4. Stanton C. New tools to promote ASC quality. AORN Management Connections. April 2008. http:// www.aorn.org/Managers/April2008Issue/NewTools ToPromoteASCQuality. Accessed November 11, 2008.
When to perform the surgical time out QUESTION: We know that in 2009, the Joint Commission Universal Protocol™ will be revised in the National Patient Safety Goals (NPSGs). Currently, we conduct the time out before starting the procedure, usually before the anesthesia process is initiated. In instances in which two or more procedures are being performed on the same patient, when is the time out performed for each procedure? ANSWER: The 2009 Joint Commission NPSG UP.01.03 elements of performance state that the time out should be performed immediately before the start of a procedure: The purpose of the time-out immediately before starting the procedure is to conduct a final assessment that the correct [patient], site, positioning, and procedure are identified and that, as applicable, all relevant documents, related information, and necessary equipment are available.1 The Universal Protocol for 2009 provides unambiguous guidance for when two or more procedures are performed on the same patient: a time out is performed to confirm each subsequent procedure before it is initiated.1 Additionally, safety can be enhanced when all team members suspend activities and focus their attention on confirmation of the correct patient, correct site, and other critical elements with the patient identifiers and consent. The Joint Commission’s Universal Protocol is applicable to every perioperative setting (eg,
office-based facilities, ambulatory surgery centers, dental/maxillofacial facilities, interventional radiology suites, endoscopy laboratories) where operative and other invasive procedures are performed, including facilities not accredited by the Joint Commission. The 2009 NPSGs delineate other recommendations to reduce the risk of errors during invasive procedures. Health care organizations in all settings should incorporate these recommendations into policies and practice together with other risk-reduction strategies. Example include • an interactive, team communication approach that eliminates complacency and rote execution of the time out; briefing checklists that foster thorough inclu• sion of critical items that must be verified; and • simulation training that hones the briefing process, aligns perceptions, and improves communication skills while promoting a team culture. A wealth of tools and guidelines are available for educating staff members and assisting with implementation of policies to promote perioperative patient safety, regardless of the accrediting agency used by the organization. The World Health Organization has published a practical implementation guide and one-page surgical safety checklist for implementing the time-out.2 The AORN Correct Site Surgery Tool Kit3 is available at no cost to members and can be used to implement the Joint Commission’s Universal Protocol. Successful patient outcomes can be achieved with deliberate education, knowledge, AORN JOURNAL •
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communication, and development of a functional team culture. Editor’s note: The Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery is a trademark of the Joint Commission, Oakbrook Terrace, IL. SHEILA MITCHELL RN, BSN, MS, CNOR PERIOPERATIVE NURSING SPECIALIST AORN CENTER FOR NURSING PRACTICE
REFERENCES 1. 2009 National Patient Safety Goals Hospital Program. Joint Commission. http://www.joint commission.org/PatientSafety/NationalPatient SafetyGoals/09_hap_npsgs.htm. Accessed November 11, 2008. 2. Surgical safety checklist. The World Health Organization. http://www.who.int/patientsafety /safesurgery/tools_resources/SSSL_Checklist _finalJun08.pdf. Accessed November 11, 2008. 3. Correct Site Surgery Tool Kit. AORN, Inc. http://www.aorn.org/PracticeResources/Tool Kits/CorrectSiteSurgeryToolKit. Accessed November 11, 2008.
Editor’s note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices from members and other interested individuals. When available, these proposed recommended practices appear online at http://www .aorn.org. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling the Center for Nursing Practice at (800) 755-2676 x 334. A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.
Future Congress Dates and Locations
M
ake plans now to attend AORN Congress in upcoming years. Following is a list of future Congress dates and locations: • 2009—March 15 to 19, Chicago, Illinois
• • • •
2010—March 2011—March 2012—March 2013—March
14 to 18, Denver, Colorado 19 to 24, Philadelphia, Pennsylvania 25 to 29, New Orleans, Louisiana 3 to 7, San Diego, California
Remembering Our AORN Colleagues
I
f you know of a colleague who has passed away since the March 2008 Congress, President Susan K. Banschbach, RN, MSN, CNOR, encourages you to submit his or her name to AORN headquarters. Names of those to be remembered will be displayed during the Opening Session at the 2009 Congress in Chicago, Illinois. Send names to the attention of Mary Lopez by fax at (303) 750-2927, by e-mail to [email protected], or
200 • AORN JOURNAL
by mail to 2170 S Parker Rd, Suite 300, Denver, CO 80231-5711. Please include the individual’s first name, middle initial, last name, city, and state. Be sure to verify that spelling is correct and that all handwritten submissions are legible. If you submit a name by e-mail, please type “Congress 2009 Project” in the subject line. To ensure inclusion, all names must be received by Mary no later than Monday, February 9, 2009.
Clinical Issues
JANUARY 2009, VOL 89, NO 1
REFERENCES 1. HR6111 Tax Relief and Health Care Act of 2006: Sec 101 Physician Payment and Quality Improvement. Centers for Medicare and Medicaid Services.
http://www.cms.hhs.gov/PQRI/Downloads/PQRI TaxReliefHealthCareAct.pdf. Accessed November 24, 2008. 2. ACS Quality Measures: Implementation Guide (Version 1.0). ASC Quality Collaboration. http:// www.ascquality.org/documents/ASCQualityCol laborationImplementationGuide.pdf. Accessed November 11, 2008. 3. National voluntary consensus standards as of October 29, 2008. National Quality Forum. http:// www.qualityforum.org/pdf/Btblendorsedmeasures current.xls. Accessed November 12, 2008. 4. Stanton C. New tools to promote ASC quality. AORN Management Connections. April 2008. http:// www.aorn.org/Managers/April2008Issue/NewTools ToPromoteASCQuality. Accessed November 11, 2008.
When to perform the surgical time out QUESTION: We know that in 2009, the Joint Commission Universal Protocol™ will be revised in the National Patient Safety Goals (NPSGs). Currently, we conduct the time out before starting the procedure, usually before the anesthesia process is initiated. In instances in which two or more procedures are being performed on the same patient, when is the time out performed for each procedure? ANSWER: The 2009 Joint Commission NPSG UP.01.03 elements of performance state that the time out should be performed immediately before the start of a procedure: The purpose of the time-out immediately before starting the procedure is to conduct a final assessment that the correct [patient], site, positioning, and procedure are identified and that, as applicable, all relevant documents, related information, and necessary equipment are available.1 The Universal Protocol for 2009 provides unambiguous guidance for when two or more procedures are performed on the same patient: a time out is performed to confirm each subsequent procedure before it is initiated.1 Additionally, safety can be enhanced when all team members suspend activities and focus their attention on confirmation of the correct patient, correct site, and other critical elements with the patient identifiers and consent. The Joint Commission’s Universal Protocol is applicable to every perioperative setting (eg,
office-based facilities, ambulatory surgery centers, dental/maxillofacial facilities, interventional radiology suites, endoscopy laboratories) where operative and other invasive procedures are performed, including facilities not accredited by the Joint Commission. The 2009 NPSGs delineate other recommendations to reduce the risk of errors during invasive procedures. Health care organizations in all settings should incorporate these recommendations into policies and practice together with other risk-reduction strategies. Example include • an interactive, team communication approach that eliminates complacency and rote execution of the time out; briefing checklists that foster thorough inclu• sion of critical items that must be verified; and • simulation training that hones the briefing process, aligns perceptions, and improves communication skills while promoting a team culture. A wealth of tools and guidelines are available for educating staff members and assisting with implementation of policies to promote perioperative patient safety, regardless of the accrediting agency used by the organization. The World Health Organization has published a practical implementation guide and one-page surgical safety checklist for implementing the time-out.2 The AORN Correct Site Surgery Tool Kit3 is available at no cost to members and can be used to implement the Joint Commission’s Universal Protocol. Successful patient outcomes can be achieved with deliberate education, knowledge, AORN JOURNAL •
199
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Clinical Issues
JANUARY 2009, VOL 89, NO 1
communication, and development of a functional team culture. Editor’s note: The Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery is a trademark of the Joint Commission, Oakbrook Terrace, IL. SHEILA MITCHELL RN, BSN, MS, CNOR PERIOPERATIVE NURSING SPECIALIST AORN CENTER FOR NURSING PRACTICE
REFERENCES 1. 2009 National Patient Safety Goals Hospital Program. Joint Commission. http://www.joint commission.org/PatientSafety/NationalPatient SafetyGoals/09_hap_npsgs.htm. Accessed November 11, 2008. 2. Surgical safety checklist. The World Health Organization. http://www.who.int/patientsafety /safesurgery/tools_resources/SSSL_Checklist _finalJun08.pdf. Accessed November 11, 2008. 3. Correct Site Surgery Tool Kit. AORN, Inc. http://www.aorn.org/PracticeResources/Tool Kits/CorrectSiteSurgeryToolKit. Accessed November 11, 2008.
Editor’s note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices from members and other interested individuals. When available, these proposed recommended practices appear online at http://www .aorn.org. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling the Center for Nursing Practice at (800) 755-2676 x 334. A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.
Future Congress Dates and Locations
M
ake plans now to attend AORN Congress in upcoming years. Following is a list of future Congress dates and locations: • 2009—March 15 to 19, Chicago, Illinois
• • • •
2010—March 2011—March 2012—March 2013—March
14 to 18, Denver, Colorado 19 to 24, Philadelphia, Pennsylvania 25 to 29, New Orleans, Louisiana 3 to 7, San Diego, California
Remembering Our AORN Colleagues
I
f you know of a colleague who has passed away since the March 2008 Congress, President Susan K. Banschbach, RN, MSN, CNOR, encourages you to submit his or her name to AORN headquarters. Names of those to be remembered will be displayed during the Opening Session at the 2009 Congress in Chicago, Illinois. Send names to the attention of Mary Lopez by fax at (303) 750-2927, by e-mail to [email protected], or
200 • AORN JOURNAL
by mail to 2170 S Parker Rd, Suite 300, Denver, CO 80231-5711. Please include the individual’s first name, middle initial, last name, city, and state. Be sure to verify that spelling is correct and that all handwritten submissions are legible. If you submit a name by e-mail, please type “Congress 2009 Project” in the subject line. To ensure inclusion, all names must be received by Mary no later than Monday, February 9, 2009.