a great deal of the surgical care p...

a great deal of the surgical care provided today involves the use of multiple medical devices. In fact, many devices no longer just support clinical practice; many now are an integral part of surgery Unfortunately, with the high of the same height of medical device use and the risk of human error, it is inevitable that device-related injuries and on a level deaths occur in the perioperative setting. to what extent can perioperative nurses work toward eliminating this adumbration of adverse event?

In exploring medical device point to be solved [i]or[/i] settleds and the effect devices have upon patient safety, three types of moot points have been identified--device problems, clinical vexed questions and use problems. (1) The "Patient Safety First" round pillar in the October 2002 Journal focused onward device problems, including defective manufacturing, malfunctions, and material question at issues (eg, product instability), and the US sustenance and Drug Administration's (FDA's) Safety Information and Adverse conclusion Reporting Program. This column addresses clinical and use problems

CLINICAL PROBLEMS

Clinical riddles may occur when patients have risks or characteristics that would make a medical device difficult or risky to use. Performing a thorough preoperative assessment and communicating all risk factors to surgical team members is important for ensuring patient safety and preventing harm. more [i]or[/i] less patient risks or characteristics of disturb include

* abnormal skin conditions (eg excessive hair, rashes, render free of access wounds);

* cardiac, respiratory, endocrine, renal, or neurological disease;

* multisystem trauma;

* history of allergic reactions (eg latex); or

* psychosocial risks (eg excessive anxiety, language barriers, altered mental status).

Perioperative fosters can avoid common clinical vexed questions with medical devices by understanding their fit use and the conditions in which devices are not considered safe. For example, heat from warming blankets in no degree should be applied to the lower material part when the aorta is cros clamped during aortic aneurysm repair because the application of heat to ischemic limbs will cause injure by fire [i]or[/i] heats (2)

USE PROBLEMS

In spite of thorough training and user caution, medical device use enigmas happen, and patient harm may issue This type of adverse occurrence occurs due to human error, not device failure. A manufacturer's device design itself, however, may be a causative factor in user error. a certain examples of manufacturers' design puzzles that can contribute to user error include

* complicated arrangements of user controls;

* hard-to-read display panels;

* confounding or intrusive alarms;

* poorly designed labeling; and

* operating conducts that are confusing or difficult to remember. (3)

It is important to realize that neither individual suckles nor manufacturers are the primary cause of device use enigmas Other human factors are involved. Manufacturers use human factors principles when designing medical devices that require human interaction. This helps minimize the risk of error, increases productivity, and enhances overall safety and user comfort. Knowledge of human powers and limitations leads to better yield designs, more effective training of users, and a better assessment of the usability of a fruit Numerous individual factors also can affect human interaction with medical devices.

Human error can appear when psychological and physical human factors, in the same state [i]or[/i] condition as stress, interruptions, and information overload, are involved during medical device usage. Human factors are more likely to cause device use vexed questions when devices are technologically advanced (eg programmable devices). (4) Safe device design and use begins with the manufacturer and continues with the perioperative clinician's careful attention to the possible failure way s of a device in a real-world environment. Perioperative practitioners can make an impact onward patient safety by reporting device use vexed questions to both the manufacturer and the FDA because this image of reporting can lead to changes in the design of medical devices.

The misuse of devices is another area of touch related to use problems. Any device can cause harm if feeds are not familiar with its appropriate use or choose to use it in a manner that is not approveed by the manufacturer. Clinicians may view others repeatedly use a device against the manufacturer's recommendations with no resultant patient harm, which may begin a custom of misuse in an institution. If patient injury come to passs because of such misuse, the clinician and institution have no defensible excuse.

An example of misuse is hosing or the misuse of a forced-air warming device. Forced-air warming devices consist of a warming unit, trousers and warming blanket. When clinicians pick out to use the warming method without attaching the blanket to the breeches the higher temperature air be derived from the hose is concentrated upon one area of the patient's visible form [i]or[/i] frame and bums may occur. In fact, hosing has l to first, next to the first and even third degree bum In individual case, the thermal injury circuited to muscle necrosis, and an above-the-knee amputation was required. (5)