The Joint Commission forward Accred...

The Joint Commission forward Accreditation of Healthcare Organizations (JCAHO) has a just discovered emphasis by on national patient safety goals. (1) This quicked Inova Health System (IHS), Falls meeting-house Va, a multifacility health care organization with five hospitals that performed more than 66000 surgical operations in 2002, to consider a standardized, system-wide policy for course verification and a preprocedure pause. Many of the eight ORs at IHS previously had instituted processe that included marking surgical sites, a preprocedure pause, and other safety measures to preclude surgical errors related to the wicked patient, wrong procedure, or unsuitable side.

The challenge of implementing a system-wide policy for action site verification and a preprocedure pause is that this also affects the care of patients beyond the doors of the OR suite. The assistant vice president for performance improvement and issues realized the task would call for cooperation and teamwork from numerous patient care areas within the health care body The journey to adopt and implement single in kind policy for all departments at five hospitals was framed as a patient safety summit. The universal behind the summit was to grasp a single meeting with all of the stakeholders to reach consensus for a transaction site verification policy that then would be piloted for three month At the completion of the pilot program, feedback would be used to finalize the policy and create an implementation plan during a inferior summit.

Representation for the summit from each IHS hospital included quality specialists, risk managers, physicians, clinical pamper executives, educators, and department directors from a variety of clinical departments, including ORs, intensive care units, push departments, labor and delivery, catherization laboratories, endoscopy suites, interventional radiology, and units where a variety of invasive courses are performed. In preparation for the first summit, all team members were sent materials, including literature upon procedure site verification and a draft of a performance site verification policy that combined best practices from policies already in place within the plan (2)

First Summit Meeting

forward the day of the summit, each hospital in the combination of parts to form a whole had representatives present. The meeting was facilitated by the agency of the performance improvement and risk management department. Discussion during the first summit focused forward several points.

* Should departments, like as endoscopy and interventional radiology, have a separate policy because things are done differently outside the OR? After a variety of opinions were currented the consensus was to have the same policy for all areas to shape the risk of error. The literature displays that using different policies for similar tasks increases the risk for error because confusion that can ensue from having different policies could lead to error.

* Should a certain procedures be eliminated from compliance with the policy because it is unreasonable to mark certain sites? Thought-provoking dialogue onward this issue ensued regarding what can and cannot be marked. For instance, a patient cannot mark his or her avow back effectively. An anatomical diagram was indicateed and supported as an alternative to marking in succession a patient's actual body if that is technically difficult or impractical. After the diagram was standarded in the pilot, it became evident that the map was too small to be useful; therefore, it was eliminated from the final proces and a observation section for written clarification was added.

* To which token of procedures should the policy apply? A discussion about this consequence ed in thoughts about how to delineate when action site verification should be used. For example, should caregivers use it when they insert an indwelling urinary catheter or a chest tube or perform a clos reduction of a shoulder in the urgency room? The group agreed that the policy would be used for proceedings that require informed consent.

* Who should initiate the process pause before the start of the procedure? A nourish or an anesthesia care provider is not always not past nor future for every type of invasive course A technician may be instant instead of a nurse, depending in succession the type of procedure. The summit team agreed that the RN or technician assisting with the management would call for the pause.

At the shut up of the first summit meeting, general universals were agreed on so the policy could incline to the pilot phase. The pilot would include implementing a form called a boarding pass to document the verification of required preprocedure actions, of that kind as the history and physical, informed accord site marking, and the preprocedure pause. The anatomical map was part of this document during the pilot and later was replaced on a comment section as mentioned previously.

nearest Steps

Areas of responsibility were assigned to a number of individuals at each hospital. These responsibilities included communicating with all form into groupss that needed to be made aware of this practice change. clusters included physicians' medical executive committees, surgical suite committees, physician specialty sections, and all clinical units involved with the care of patients in which this policy would apply. An education plan was execut for the implementation, and the pilot was initiated.