Safe Surgery 2015: South Carolina Presentation – Circulating Nurses and Surgical Techs [ Insert Implementation Team Member Names] [ Insert Hospital Name] Insert Your Hospital’s Logo Here

Our Hospital’s Implementation Team [insert picture of your checklist implementation team]

Could This Happen Here?

The Time Out Time Out Led by circulator. Circulator stated procedure as booked “Percutaneous adductor tenotomy of the right and left groin”. Team not actively listening or engaged but stated that they agreed with Time Out. Attending surgeon made incision and proceeded to open and not do the procedure percutaneously as booked and as consented. Circulator observed large incision and questioned attending surgeon pointing out that the consent did not match the procedure.

More Facts Attending surgeon stated that he had previously talked to the family about the possibility of opening, but did not discuss with the team or write it on the consent. Circulator requested the consent to be corrected with the family and the consent was later amended. Team subsequently got into bleeding that required a general surgeon to assist with vascular repair.

What Could Have Helped? If the surgeon led the time out and actively participated. If a briefing was conducted where the operative plans and change in procedure would have been discussed.

Does anybody want to share something that has happened to them?

Safe Surgery 2015: South Carolina To use of the South Carolina Surgical Safety Checklist in every operating room for every patient in our state. To customize the checklist for our hospital’s unique needs. To be part of a larger goal in partnership with the South Carolina Hospital Association and Safe Surgery 2015 [Directed by Dr. Atul Gawande at the Harvard School of Public Health]. Our state will become the model for improving surgical safety throughout the United States.

What is the Evidence? Type of implementationScope of implementationImpact of implementation WHO Surgical Safety Checklist in OR8 diverse global hospitalsIn-hospital mortality rate 1 : 1.5%  0.8% Post-op complication rate 1 : 11.0%  7.0% Team training and use of briefing/ debriefing/checklists in OR 74 VA hospitals18% decline in annual rate of mortality vs. 7% decline in control group of hospitals Comprehensive set of surgery- related checklists in hospital including during surgery 6 'high-quality' Dutch hospitals In-hospital mortality rate: 1.5%  0.8% Post-op complication rate: 15.4%  10.6% 1. For 4 pilot sites located in developed countries (USA, Canada, UK, New Zealand), results were a decline in the in-hospital mortality rate from 0.9% to 0.6% and a statistically significant decline in post-op complication rate from 10.3% to 7.1% Source: Haynes, AB, et al, N Engl J Med 360:491-9, 29 Jan 2009; de Vries, EN, et al,N Engl J Med 363: , 11 Nov 2010; Neily, J, et al, J Amer Med Assn 304: , 20 Oct 2010; discussions with Safe Surgery Saves Lives team members

Virginia Mason Hospital, Seattle In order for the Checklist to work well it has to be used “right”. Improving communication between all members of the OR team is critical to successful implementation Annual Meeting of the American Society Anesthesiologists

South Carolina Checklist Template

Our Hospital’s Checklist [Insert your hospitals checklist]

How Did We Customize Our Checklist? Summarize items that you customized for your hospital.

Don’t We Already Do All of This? Encouraging a conversation at the beginning and end of surgery to improve communication. It empowers individuals to speak up when they see something that isn’t right. Gives an opportunity to review the equipment and supplies needed for the procedure that may be out of the ordinary.

Show Checklist Demonstration Video [Insert your hospital’s demonstration video or another video that you would like to show] If you do not have a video many hospitals have role-played using the checklist.

We are very good at what we do…. We can be even BETTER

How Can the Checklist Help Us Be Better? It makes sure that we do the things that our surgical patients need every time. It improves communication, teamwork and the culture of safety in our hospital. It can make surgical teams better prepared by reviewing necessary equipment and the operative plan.

Physician Acceptance and Leadership support is the Critical Factor in Successful and Meaningful Use of the Checklist

How Do We Feel in the OR as Nurses Before going into the OR I need to prepare my approach depending on surgeon or team. I know when there will be a battle and I need to prepare my response. Try to be positive during the surgical case, no matter what happens. Nursing carries the load to ensure that the safety checks are completed. I don’t want to be the enforcer but sometimes need to be for patient safety. I am not the right person to convince a surgeon who refuses to do this. Some frustration when team is not open and I feel shut down.

How Do We Feel in the OR as Scrub Techs I am part of the team and am responsible for patient safety as much as everyone else. I don’t want to waste time fighting about this- I wish we could just do it! Ready to change my approach, depending on who I am working with in the OR. The majority of the team will listen and participate, but I may need to help remind the surgeons to follow policies. Willing to back up circulator and to take on equal responsibility to ensure that this is completed for my patient. I think that it is the right thing to do. If I were the patient I would want it done for me.

We Can Make a Difference It is important to work as a team to improve the safety and outcomes of our patients. We are not powerless to make change. We are part of a surgical team and often in the position of leading that team – that is a privilege and an opportunity to make a difference.

Your Role In This You have the power to initiate and lead the checklist, if needed. Speak up when information is not shared or if you have questions. Become a leader in the OR when other team members do not. Initiate introductions. Set a professional tone. Encourage team members to speak up. Encourage the team to debrief before the patient leaves the OR.

What is This Really About? This isn’t just about you as an individual and what you need. Everyone is in the room for the patient and all of the people around you need your help, encouragement and leadership. Surgery is a team effort and the most effective and safe surgical teams recognize that.

This is About Teamwork Communication Coordination Team performance valued over individual performance Leadership

The Checklist Has Already Helped [insert examples of what the checklist has caught during the testing or how people feel about using the checklist.] Please see Talking to Your Colleagues – Presentation Guide and Tips Document.

Next Steps Culture of Safety Survey, many of you have already taken it. If you haven’t, please complete it. Room-by-room and team-by-team implementation. We are rolling the checklist out slowly over the next [insert #] weeks. Will talk to you and rehearse before we ask you to use it in your room with a live patient. After you start using the checklist we will assess teamwork in the OR using an observation tool.

Our Plan [Insert your timeline for checklist implementation].

How Can You Help? Work with us on putting the checklist into your rooms. Talk to your colleagues about this project. Give us feedback.

Contact Us with Questions & Feedback [Insert person to contact, and phone number]