321 Genesee Street Oneida (315) 363-6000 www.oneidahealthcare.org Oneida Healthcare Center Hospital Description Level I medical center Located in rural Oneida Approximately 3,600 surgeries annually Joint Commission Accredited daVinci Robotic Surgery 2012 EHR implemented in August 2012 Population Served Approximately 24 communities in Madison and western Oneida counties Population approximately 80,000 Nearly 50% patients insured by Medicaid General, Orthopedic, Ob/Gyn, Urology, Thoracic, ENT surgeries performed OHC’s Surgical Safety Team Director of Nursing Sherry Willis, RN OR Nurse Manager Kristy Russ, RN Physician Leads: Dr. David Gordon MD, Chief of Surgery Director of Patient Safety and Quality William Griffiths, RN, MSHS,CPHQ Dr. Sabhash Das Anethesiologist Quality Improvement Designee, Susan Smith, RN Manager of Infection Prevention Jeanne Miller, RN, BSN,CIC Circulating RN Kristen Menard, RN Infection Prevention RN Nancy Sheridan, RN, BSN Surgical Scrub Technician Christine Bryson, ST What do we do about it? Reviewed our current checklist/time out Formalized the team and viewed webinars Conducted observations in the OR Monthly regular meetings with Quality/Infection Prevention/OR staff Regular attendance at Surgery Dept. meetings Revised checklist with input and assistance from OR staff “Hurdles” Identified Current system failures and challenges Communication breakdown Distractions Did we learn from past mistakes? Surgical Safety Checklist □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ Sign In Time Out Sign Out (Nurse & Anesthesia) (Entire OR Team) (Nurse, Anesthesia & Surgeon) Patient has confirmed □ Identity □ Site □ Procedure □ Consent Site marked/ Not applicable Anesthesia safety check completed Pulse oximeter on and functioning Thermometer available and functioning Does patient have a: Known allergy □ Yes □ No Difficult airway/aspiration risk No Yes, equipment/assistance available Risk of >500ml blood loss (7mg/kg children) No Yes Normoglycemia status Yes No, initiate protocol to achieve normoglycemia □ □ □ □ □ □ Surgeon, anesthesia professional and nurse □ Nurse verbally confirms with the team: verbally confirm □ Name of procedure recorded □ Patient □ Completion of instrument, sponge □ Site and needle counts □ Procedure □ Specimen labeling: read specimen Anticipated Critical Events label aloud, including patient name □ Surgeon Review: What are the critical or □ Whether there are any equipment unexpected steps, anticipated blood problems to be addressed loss, estimated case time length? □ Surgeon, anesthesia professional and nurse □ Anesthesia Team Review: Any patientreview the key concerns for recovery and specific concerns? management of this patient. □ Nursing Team Review: Has sterility been □ Normothermia post-op (post-op confirmed? Are there equipment issues temperature is documented before leaving or concerns? Correct equipment? OR) *Based on the NYSPFP modified WHO Surgical Safety Checklist Sufficient supplies? Has antibiotic prophylaxis been given in last 60 minutes? □ Yes □ Not applicable □ Redosing available for cases >3 hours Hair removal using clippers or depilators? □ Yes □ Not applicable Glycemic monitoring in place? □ Yes □ No Is essential imaging displayed? □ Yes □ No OHC’s PROGRESS OHC Surgical Adverse Events 5 A: IC and OR monthly meetings began B: Checklist and Webinar with OR C: Checklist introduced to surgeons D: Checklist fully 4 3 2 C A D 1 0 Sep-12 B Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13