PATIENT SAFETY
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Protecting Patient’s Right
General Patient Safety Measures
Admission of the Patient to the
Operating Room
PRPD/DN/DM/2010
Protecting patient’s rights
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protection of patients’ personal moral and legal rights
begins at the time of admission.
The course of action involves correctly identifying
patients, safeguarding their right to privacy and
their right to make choices regarding their care and
keeping confidential all records and reports.
Personnel who obtain consents or witness them should
be aware of the conditions that ensure validity of the
consent.
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A signed consent must also be an informed consent, which
implies adequate communication with the patient
regarding the procedure or procedures for which the
consent is being signed.
No surgical procedure should be performed without a
signed and witnessed informed consent.
The surgeon is ultimately responsible for informing the
patient about the proposed operation or other invasive
procedure, its inherent risks and complications, and for
obtaining consent.
On the patient’s arrival in the operating room, the
circulating nurse and anaesthesia provider are
responsible for verifying that the consent is on the chart
and is correct, properly signed and witnessed before the
administration of anaesthesia.
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General patient safety measures
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Minimizes human error helps eliminate hazardous
conditions for the patient undergoing operative or other
invasive procedures.
In all perioperative settings, where the patient is unable
to protect himself or herself, nursing personnel must
provide protection for the patient.
Communication of vital medical information to surgical
team members is essential to safe patient care.
An allergy identification band is used to communicate a
patient’s allergy to a given medication or substance.
Patients should be queried regarding allergies to
medication or food products.
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All medication must be checked three times
before administration:
(1) When removed from the drug cabinet
(2) Before being drawn up in the syringe
(3) Before being given to the patient
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Patients’ hearing tends to become more acute
after administration of the perioperative
medication and in the induction stage of
anaesthesia.
A quiet environment is essential for all patients
awaiting surgery. Noise in the OR should be
controlled and conversation kept to a minimum.
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Stretchers and operating room beds must be
stabilized with the wheels locked when a patient
is moving from one to another.
All safety devices on stretchers and operating
room beds must be in proper working order.
Locking mechanisms, side rails, restraint straps,
intravenous standards, hydraulic controls,
armboards and other protective devices should
be used whenever necessary.
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Admission of the Patient to the Operating room
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Is a critical time for the perioperative nurse to
gather data and help plan for the patient’s care and
safety.
It is the opportunity to collaborate with the patient
by identifying and verifying his or her needs and
then planning care to meet those needs.
Empathic communication, good listening skills, being
alert to nonverbal communication, offering gentle
reassurance, providing explanations and utilizing
comforting behaviours are essential attributes of
perioperative nurses.
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Institutional policy and procedure for patient admission
Should include the following steps:
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The perioperative nurse verifies the patient’s identification orally
with the patient (if feasible) and compares the name on the
surgical schedule with the name on the patient‘s armband and
medical record.
The procedure to be performed (including the operative site, side,
and surgical approach) is verified by the patient and matched with
the surgical posting, medical record, and consent form.
The operative consent form, history and physical examination
record, laboratory results, and other examination or diagnostic
results should be complete before surgery and reviewed by the
perioperative nurse as part of patient assessment
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Cont….
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Allergies; previous unfavourable reactions to
anaesthesia or blood transfusion; previous reaction
to latex; religious; cultural, spiritual, or ethnic
preferences; and any advanced directive must be
carefully noted.
The patient should be queried about personal
effects, including clothing, money, jewelry, wigs,
religious symbols, and prosthesis such as dentures,
lenses, glass eyes and hearing aids. The nurse is
responsible for ensuring the safe handling and
proper disposition of patient property and
valuables.
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Cont….
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The perioperative nurse should review the orders
and results concerning pre-operative skin
preparation, medication administration, and
elimination, such as enema results and the amount
of urine voided or collected through a catheter.
It is important to determine whether preoperative
dietary and fluid restrictions (NPO status) have
been maintained, this is crucial in preventing the
aspiration of gastric contents during anaesthesia
induction.
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Cont ….
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The nurse should meticulously document any
medications, fluids, blood, or blood products
administered as ordered during the immediate
preoperative period.
The nursing staff should apply side rails, locking
devices, and safety straps on stretchers and
operating room beds to prevent falls and injury to
the patient during transport, transfer and
positioning.
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A Preoperative Checklist
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It is frequently used to prevent oversights,
omissions, and sentinel events, displays critical
items to be checked preoperatively.
Sentinel events defined as an “unexpected
occurrence involving death or serious physical
or psychological injury, or risk thereof.”
(JCAHO, 1997)
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Clinical Documentation
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A record should be kept of each operation,
including:
- the preoperative diagnosis
- the surgery performed
- a description of findings
- the specimens removed
- the postoperative diagnosis
- the names of all persons participating in
intraoperative care
This operative record is a permanent part of the
patient’s chart.
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Intraoperative Patient Care Record
Should include:
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Evidence of a patient assessment upon arrival in the
operating room which includes an assessment of patient’s
skin condition immediately before and after the
procedure.
Evidence of a plan of care individualized for the patient.
Any sensory aids or prosthetic devices worn by the
patient on admission to the operating room and their
subsequent disposition.
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Patient position, including supports or restraints used.
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Location of dispersive electrode pad placement and
identification of ESU and settings used.
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Cont….
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Location of temperature-control device placement,
with identification of unit used and recording of time
and temperature.
Placement of monitoring electrodes.
Medication administered or dispensed by the
perioperative nurse.
Presence of catheters, drains, packing and dressings.
Location of tourniquet cuff placement, identification
of unit, pressure setting and inflation and deflation
times.
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Cont….
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Fluid output, including blood loss estimates,
as appropriate.
Type, size and appropriate identifying
information (such as serial number) of
implants.
Skin-preparation solutions used, areas
prepped, and any reactions to prep.
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Cont ….
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Known allergies to medications, prep
solutions, tape, latex, etc.
Sponge, sharp, and instrument counts
taken and results obtained.
Wound classification.
Time of discharge and disposition of
patient from operating room, including
mode of transfer and patient status.
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In Conclusion
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Perioperative nursing document needs to
describe the assessment, planning and
implementation of perioperative care that
reflects individualization of care, as well as
the evaluation of patient outcomes.
The design format such as “Checklists”
will minimizes time needed for the
documentation process.
The End
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