Patient safety in operating room

Introduction

Patient safety in the operating room is one of the core areas of the nursing professionalism. In order to ensure safety, many of the activities in the Operating Room are designed, planned and progressed to ascertain the achievement of this core objective. There are however numerous issues in the pursuance of this objective that may affect the nursing profession in general. The sole objective of patient safety in operating room shapes the nursing response fueled by a combination of training, behavior, various cultural backgrounds and leadership.  Krause, John & Diane (14) states, “It is more often the human element—leadership, culture and behavior—rather than the science that proves to be the weak link in the chain of health-care delivery and patient safety.” In fact, patient’s safety in the operating room has been studied to have a direct impact on nursing. Therefore, the procedures, policies and methodologies used to ensure the ultimate objective of patient safety should be studied and evaluated for the possible effects on nursing behavior and practices with respect to the Operating Room as well as patient safety.

Problem Definition and Literature Review

Throughout the history of healthcare in recent decades, the operating room nursing practices have been primarily influenced by patient safety.  Operating Room (OR) nursing is gauged by the safe handling of the patient through all phases of the surgical environment. The Operating room safe handling of every patient scheduled to have a procedure is closely monitored. In case of any negligence, the consequences normally lead to most devastating results.

Lack of safety measures have led to the natural outcomes of pressures and stress through the OR nursing practices.  “Focusing on the structure, processing and outcomes of care, a behavioral health patient safety program continually emphasizes changing the system to make treatment safer for consumers through evolution of the evidence.” (Fowler & Susan, n. page 65). This focus and monitoring at all levels demand more vigilance and strict compliance with facility procedures and standing orders to ensure patient safety.   However, despite the fact that it ensures patient safety, it can also reduce the margin of decisions, which is a major instrument for safety management in operating rooms. The ability to have to make numerous decisions often at the same time can lead to preventable errors and the importance and sensitivity of decision in operating rooms.  Prioritizing which tasks need to be performed in order of importance can place and extreme burden on the shoulders of that operating room nurse.  Pikaar, Ernst &, Paul  (239) states, “The surgical domain is a fragile and a complex web of experts with constant decision making and uncertainties linked to patient safety.  Any unwanted technological interference in key treatment strategies or surgical tasks can lead to fatalities.”  The complexities of decision-making are not limited to technological domains, but the psychological pressures and debilitating stress can be equally distressing for the nursing staff.  As an OR nurse, I can definitely attest to the fact that the surgical environment can be one of great amazement but at the same time can also be an intense, physiological and psychological stressful environment.

Patient Safety precautions have been shown to possibly affect the operating room communications which are crucially important in most if not all of the cases. The nursing staff often has to take special care with reference to in operating room communications, especially in cases where patients can hear and share communication. JCR-I (37) observes, “The flow of communication is crucial in Operating Room.” Lack of communication may affect the performance and quality of care nursing staff is expected to deliver to the patient in the operating room. The operating room nurses may be exposed to some personal injuries, infections, skin damages and other safety hazards while providing care to patients or assisting surgeons. These injuries can be primarily considered a managerial as well as an administrative issue and is usually covered through the policy guidelines of the institution.

Many steps have been taken to avoid the above mentioned effects to operating room nurses, and numerous efforts are required to be carried out in this direction to reduce the effects of patient’s safety on OR nurses. These effects often include but not limited to stress in the operating room; lack of decision power directly related to extreme stress and fatigue; lack of communication due to patient safety considerations and physical safety of nurses serving in the operating room.  These affects are widely discussed in nursing literature as Flin & Lucy (372) states, “As a consequence, clinical guidelines in acute medicine aim to reduce stress to increase patient safety.” Similarly, Roussel (3) stresses the need of decision power in these words, “Sound nursing and management theories, along with evidence-based management practices equip the nurse administrator with the tools to foster a culture of collaborative decision making and positive patient and staff outcomes.” There is a consensus that lack of communication can cause perilous sentinel incidents. (JCR-II, 6).

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A remedial possible solution could include administrative orders, institutional policy guidelines and the promulgation of best practices, special training programs for operating room nurses.  However, this process is far from a finite entity but instead is an ongoing process that is ever changing and patient’s safety requirements will continue to assert newer affects on nurses in operating rooms. To avoid patient safety affects on operating room nurses Kneedler & Gwen (134) suggests, “Every operating room should have standing policy for equipment and instrument inspection.”

In conclusion, as previously mentioned in this paper I am an Operating Room nurse at a Level 1 trauma center located in the Bronx.  I can truly sympathize with other OR nurses in regards to constantly monitoring the safety of each patient since they are often intubated and cannot care for themselves.  This very desire to do no harm is always expected, as well as it should be, but its undertones can place a significant amount of stress both physiological and psychological on the operating room nurse.  It is not always easily apparent to identify or recognize the effects of stress on the nurse until it is too late.  In as much as we have to be concerned about patient safety, the nurses’ safety is equivalently important. Self -preservation is very important to providing high quality care to patients. This maximizes the chances of compromising patient safety in any environment.

Goals to Correct Problem

In order to come up with success in the patient safety campaign, various goals and strategies have to be put in place. Some of the goals set to be achieved include;

1. Stress Management Training for OR nurses.
2. Pre-operation meetings and discussions.
3. Enforcement of precautionary measures.

It has been noted that stress on Operating Nurses can be enormous to an extent of causing physical and psychological distress.  Many institutions do not have Stress Management Training programs in place to help nurses cope with the stress relating to patient safety or other stressors that they come in contact with on a daily basis. It is for this reason why I have begun to offer such a training program at my institution. Stress management program will be presenting the idea to the Administrative staff for their review by the end of the month.  One of the major goals put in place is to ensure that workers are motivated. A successful institution is characterized with people who feel appreciated and valued for without that you just have a building with a bunch of people in it.

Another possible goal that can be implemented in the nursing fraternity is arranging pre-operation meetings and discussions with the surgical team. Through such meetings, stress experienced by Operating Nurses can be reduced. These meetings can help in identifying any potential issues with regards to patient safety during the procedure as well as afterwards.  Identifying these potential issues at the beginning of a case can help reduce the amount of stress circulating nurse encounters.  My institution is more of a reactive and stressful environment instead of a proactive and relaxed one.  Hopefully my plan to minimize stress in the OR will help to eradicate this negative and often toxic culture.  There is an old saying that I find particularly appropriate with reference to this issue: “an ounce of prevention is worth a pound of cure”.  This phrase captures how important it is to try and avoid potential problems before they escalate into more complex issues in turn requiring more time energy and money to correct.

Lastly, an institution can have an enforcement of the precautionary measures in place. Through these precautionary measures, it can be possible to help minimize stressors incurrence affecting nurses in the operating room. I have found over the few years of being a nurse that being precautionary can help to avoid mistakes before they can happen since you will be better equipped to handle an issue either before or during an incident, and respond in a timely and safe manner.

Action Plan and Implementation

This section elaborates more about the action plan designed to help implement the goals of correcting the patient safety problem. The first course of action would be to induce a change in the administrative staff of units by the end of the month.  As a result of many changes within an institution, they are usually driven from a financial standpoint or a response to a negative situation that had occurred.   It is my contention that in order to bring about change, you have to identify a need for it.  The need for this change is that nurses are being neglected in terms of their own well being. In the end the impact is felt through the compromising of patient safety.

When I present my proposal to the managers of my department I plan on having some coworkers present in order to get some feedback on the urgency for a change in culture.  In order to have change evolve we must create a sense of urgency and develop a change vision and strategy.  It is also important to present nurses with information about change and how it can be beneficial to their overall well being and translate into better care for their patients.  As with most people, some feel that change for a good cause is beyond their ability but I will hopefully present myself in a manner that will show them that they are what can and will make change happen.  Communication is also important for change to occur since it is often difficult to convince others of the need to change unless you convey what issues are concerning you.    Since my plan involves various aspects, it is important to celebrate small short term goals and not overlook them because in order to achieve a major change you need to start with small attainable goals and work your way up to your ultimate goal.  It will probably start off slow but over time it will hopefully gain more momentum.

Now that I have identified the action plan the next step is to formulate a way in order to implement my idea for change.  Since nurses are often inundated with work while they are caring for patients I will try to organize stress relieving and team building exercises outside of work.  I am sure that there will be some resistance but am confident that in the long run people will be coming up with different activities of their own.  One such activity I thought of was organizing a trip to a cooking class studio and break into groups.  This in my opinion is a fun event since I have done it before and it creates a sense of teamwork and definitely releases stress since it is a relaxing non pressured environment.  My next challenge will be to get my managers to sponsor this event, and although they might say no initially I believe that if we present a strong enough argument they might be persuaded to participate.  I have reviewed some statistics from the nursing department and have determined that the average nurse in my department calls in sick on average 3-4 days a month.  I have yet to figure out how much that translates into financially but I am sure that it is something that can be offset with some culture change within the department.  As I previously mentioned usually change is either driven by financial situations or responses to an event and this plan will hopefully respond accordingly.

In conclusion, I have also drafted up a questionnaire that I plan on giving my fellow colleagues during my presentation in order to get some feedback and input that will help me to fuel the need for change.  I have been an operating room nurse for two years and within three months of being in my department I knew that things had to change.  The main reason for putting up this proposal is because I consider myself to be a

Realist and not a conformist like some of my coworkers. I feel that nurses must embrace change for our own benefit and well being.  I plan on submitting the responses to the questionnaires in Part IV of this project.

Evaluation

In order to correctly achieve an evaluation of the entire whole proposal, the questionnaires would be filled. The questionnaires would then be counter checked against the objective goals to verify the appraisal. The questionnaire sheet for data collection of the responses is shown below.

Questionnaire

1. What does change mean to you?
2. How do you think change can be brought about?
3. Give a specific item that you would like to change in the department and describe how you might go about doing it?
4. Are you resistant to changes even if they might be beneficial to the nursing staff? If so why? Please explain.