321 Genesee Street Oneida (315) 363-6000 www.oneidahealthcare.org

Oneida Healthcare CenterHospital Description

Level I medical centerLocated in rural OneidaApproximately 3,600 surgeries annuallyJoint Commission Accredited daVinci Robotic Surgery 2012EHR implemented in August 2012

Population ServedApproximately 24 communities in Madison

and western Oneida countiesPopulation 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 NursingSherry Willis, RN

OR Nurse ManagerKristy Russ, RN

Physician Leads:Dr. David Gordon MD,

Chief of Surgery

Dr. Sabhash DasAnethesiologist

Director of Patient Safety and Quality

William Griffiths, RN, MSHS,CPHQ

Quality Improvement Designee, Susan Smith, RN

Manager of Infection PreventionJeanne Miller, RN, BSN,CIC

Infection Prevention RNNancy Sheridan, RN, BSN

Circulating RNKristen Menard, RN

Surgical Scrub TechnicianChristine Bryson, ST

What do we do about it?Reviewed our current checklist/time outFormalized the team and viewed webinars Conducted observations in the ORMonthly regular meetings with

Quality/Infection Prevention/OR staffRegular attendance at Surgery Dept.

meetingsRevised checklist with input and assistance

from OR staff

“Hurdles” IdentifiedCurrent system failures and challenges

Communication breakdown

Distractions

Did we learn from past mistakes?

Sign In(Nurse & Anesthesia)

Time Out(Entire OR Team)

Sign Out(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 verbally confirm

□ Patient□ Site □ Procedure

□ Anticipated Critical Events □ Surgeon Review: What are the critical or

unexpected steps, anticipated blood loss, estimated case time length?

□ Anesthesia Team Review: Any patient-specific concerns?

□ Nursing Team Review: Has sterility been confirmed? Are there equipment issues or concerns? Correct equipment? 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

□ Nurse verbally confirms with the team: □ Name of procedure recorded□ Completion of instrument, sponge

and needle counts□ Specimen labeling: read specimen

label aloud, including patient name□ Whether there are any equipment

problems to be addressed□ Surgeon, anesthesia professional and nurse

review the key concerns for recovery and management of this patient.

□ Normothermia post-op (post-op temperature is documented before leaving OR)

*Based on the NYSPFP modified WHO Surgical Safety Checklist

Surgical Safety Checklist

OHC’s PROGRESS

Sep-12 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-130

1

2

3

4

5

A

B

C

D

OHC Surgical Adverse EventsA: IC and OR monthly meet-ings beganB: Checklist and Webinar with ORC: Checklist introduced to surgeonsD: Checklist fully imple-mented in OR