This month marks Perioperative giv...

This month marks Perioperative give suck to Week, Nov 10-16. This year the theme is "Your safety is our piece of work ... We take it seriously!" The intent of Perioperative supply with nourishment Week is not for give suck tos to celebrate nursing, although nursing can and should be celebrated. The overall goal of Perioperative feed at the breast Week is to inform the public about nurses' parts in their care when they bear surgical interventions. More than continually it is critical for consumer to be aware of our efforts as members of the surgical team and to recognize AORN's activities aimed at ensuring that each patient experiences a safe surgical intervention and issue when entering the OR.

BRINGING ERRORS INTO THE LIGHT

These days, consumer are more acutely aware of the potential for medical error, in part because of the 2000 Institute of Medicine (IOM) report, To rove is Human: Building a Safer Health order (1) The report estimates that between 44000 and 98000 patient deaths fall out annually from adverse medical and surgical ends The estimated cost for these errors is between $85 billion and $17 billion annually.

The public answer to this report has been outrage and a demand for reform as statistics display that more deaths occur from medical errors than from breast cancer, motor vehicle accidents, or AIDS. Health care's best-kept unseen has been revealed, and each practitioner must address the epidemic. Poor practices no longer can be tolerated, and poor classifications cannot be allowed to place blame forward individuals. Health care must accept the responsibility that errors frequently are the result of a greatly bigger problem. It no longer is acceptable for heads to incline differently away in the hope that the point to be solved [i]or[/i] settled simply will go away if it is ignored. Poorly designed health care delivery arrangements will not improve unless they are redesigned. make anxiouss expressed by nurses related to patient and personal safety no longer can be ignored. Serious errors are occurring that may be preventable, and each professional has a responsibility to be part of the solution and not the problem

REFORM GOALS

The IOM hints five major. goals for national reform of the not past nor future health care system, including

* establishing a national focus for leadership and knowledge,

* identifying and learning from errors,

* passing legislation to house a voluntary reporting system,

* setting performance standards and expectations for safety, and

* implementing safety methods in health care organizations. (2)

AORN members are true aware of the significance of issues, implications, and detrimental ends for patients and professionals when errors come to pass One patient harmed is the same too many, so AORN is working in succession programs related to the IOM proposals.

Establishing a national focus for leadership and knowledge. In March 2002 AORN unveiled its Patient Safety First initiative. single in kind area of focus for this significant contrive is making a difference in perioperative practice. The Presidential Commission forward Patient Safety has identified and will focus Association efforts in succession patient safety in several areas, including

* medication safety,

* correct site surgery

* infection control

* patient positioning,

* communication,

* counts

* vital fluid transfusion,

* retained foreign objects

* lack of a central data repository related to morbidity and mortality,

* burns

* fires,

* equipment failure, and

* staffing.

The top priorities include medication, correct site surgery and cast ups AORN is focusing on providing classification solutions and practical clinical applications with safety as the priority.

Identifying and learning from errors. In the past, many health care facilities took a blame-the-individual approach rather than acknowledging that errors usually are not the fault of a single individual; instead, many errors are the inference of a poorly designed body Systems without checks and balances allow small question at issues to go unnoticed until an error proceeds in patient harm.

"The blameworthy patient," an article that lately appeared in Annals of Internal Medicine, chronologically details a sentinel result account of multiple errors that ultimately issueed in the wrong patient undergoing an unplanned, invasive diagnostic thought A 67-year-old woman admitted for cerebral angiography was mistaken for another patient, which proceeded in her undergoing an unplanned, unscheduled invasive cardiac electrophysiology consideration (3) It is estimated that at least 17 separate errors occurr including team members failing to correctly identify the patient, failing to take the patient's complaint that she was not scheduled to have similar a procedure seriously, lack of written orders for the performance lack of an initial signed consensus form, and multiple communication and teamwork flaws. This example demonstrates in what way systems can contribute to an error rather than a specific individual causing an error. During the past seven years, the Joint Commission forward Accreditation of Healthcare Organizations has reported 17 known bad patient surgeries. (4) This figure is staggering.