The Red Line Safety Program: Here's Where We Draw the Line Hermelita 'Lit' May, MEd, BA, RN Callie S. Craig, MS, BSN, RN, CNOR Angela D.

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1 SESSION NAME SPEAKERS SESSION NUMBER 0056 DATE/TIME REPEAT SESSIONS 0189, 0133 REPEAT DATES/TIMES CONTACT HOURS (CH) 1.0 SESSION OVERVIEW: The Red Line Safety Program: Here's Where We Draw the Line Hermelita 'Lit' May, MEd, BA, RN Callie S. Craig, MS, BSN, RN, CNOR Angela D. Harris, RN Tuesday, April 1, 2014, 4:15-5:15pm Wednesday, April 2, 2014, 7-8am Wednesday, April 2, 2014, 8-9am Recognizing the importance of proactive patient advocacy amidst a myriad of policies, protocols, and practices, a Comprehensive Red Line Safety Program was designed and implemented in the surgical unit at a large tertiary transplant facility. The program highlights six key patient safety practices and provides the appropriate structure, innovative education and training, and comprehensive support network that are essential to its implementation, maintenance, and success. Attendees will be able to recognize the importance of staff participation, creative planning, and organizational support in the development and implementation of a successful perioperative safety program. OBJECTIVES: 1. Identify three components to effective education. 2. Recognize three barriers to success and creative solutions for them. 3. Identify six critical safety practices in the perioperative environment. 4. Identify five implementation strategies for a successful safety program. SPEAKER BIOGRAPHIES: Callie S. Craig, MS, BSN, RN, CNOR, is the clinical director for surgical services at INTEGRIS Baptist Medical Center in Oklahoma City. She manages 16 ORs as well as the anesthesia services department at this Magnet facility in central Oklahoma. She received her BSN from the University of Arkansas and her MS in nursing administration and management from the University of Oklahoma. Ms. Craig has been a member of AORN since She has served on the AORN National Nominating and Leadership Development Committee, National Membership Committee, Next Generation Task Force, and is a former chair of the International Activities Committee. She is the current co-chair of the AORN young professionals task force and a member of AORN of Central Oklahoma Chapter, and the Oklahoma State Council of Perioperative Nurses. She received the 2008 AORN Next Generation Achievement Award and the 2006 Oklahoma Nurses' Association Nursing Impact on Public Policy Award. She has presented numerous programs throughout the US on evidence-based practice and leadership. Her international speaking engagements include programs in Singapore and Austria. Callie currently serves as the national AORN Secretary.

2 AORN Surgical Conference & Expo 2014 P a g e 2 o f 3 Hermelita 'Lit' May, MEd, BA, RN, is the perioperative safety coordinator for surgical services at INTEGRIS Baptist Medical Center in Oklahoma City. She was a circulating nurse for 10 years prior to becoming the safety coordinator at this Magnet facility in central Oklahoma. Lit received a Master's of Education in Community Counseling and a Bachelor of Arts in Psychology from the University of Oklahoma before receiving her Associate Degree in Nursing from Oklahoma State University. Lit currently serves on the Patient & Staff Satisfaction Committee Governance Board, the Patient Safety & Infection Control Committee Governance Board, and the Surginet Core Group Council. She is a member of AORN and has been a member of the Oklahoma Philippine Medical Association for 11 years. Angela D. Harris, BSN, RN, is the clinical educator coordinator and clinical nurse manager for surgical services at INTEGRIS Baptist Medical Center in Oklahoma City. She received an AAS in nursing from Redlands Community College and a BSN from Oklahoma City University. Angie currently serves on numerous boards, including the Patient & Staff Satisfaction Committee Governance Board, the Patient Safety & Infection Control Committee Governance Board, and the Surginet Core Group Council, the SCIP Measures Board, the Hyperglycemia Board, and the Metro Nursing Education Board. She is a member and delegate of AORN. Angie was named Surgery Nurse of the Year in 2010 and received a Guardian Angel Award in SPEAKER CONTACT INFORMATION: Callie S. Craig, MS, BSN, RN, CNOR Surgery Clinical Director Integris Baptist Medical Center Oklahoma City, Oklahoma Callie.Craig@integrisok.com Angela D. Harris, BSN, RN Clinical Educator Coordinator and Clinical Nurse Manager INTEGRIS Baptist Medical Center Oklahoma City, Oklahoma angela.harris@integrisok.com Lit May, MEd, BA, RN Periop Safety Coordinator Integris Baptist Medical Center Oklahoma City, Oklahoma hermelita.may@integrisok.com

3 AORN Surgical Conference & Expo 2014 P a g e 3 o f 3 FACULTY DISCLOSURE: Callie Craig: 7. No conflict. Angie Harris: 7. No conflict. Lit May: 7. No conflict. COMMERCIAL SUPPORT: Corporate support provided by Aspen Surgical, a Hill-Rom Company

4 Mandatory Compliance Written directive from the hospital Board of Directors All staff, physicians, and hospital personnel will be held accountable in following the mandatory Universal Protocol. 1 Hospital Policy Development The Joint Commission 2 1

5 WHO Safe Surgery Checklist 3 AORN Comprehensive Surgical Checklist 4 2

6 INTEGRIS Universal Protocol 5 Alternative Marking of the Operative Site 6 3

7 Annual Staff Training 7 Annual Staff Training 8 4

8 Annual Staff Training 9 Hand-Off Communication Tool 10 5

9 Preoperative Checklist 11 The Road to Red Line Ongoing Education with staff regarding: Surgery fire prevention Patient fall prevention Prevention of retained foreign objects Universal protocol Labeling of medications on the sterile field Reduction of immediate use sterilization Staff Feedback: A standardized comprehensive safety protocol was needed! 12 6

10 Red Line Safety Every staff member is accountable for patient safety. Questions or concerns about responsibilities should be directed to the team manager/supervisor. Safety concerns should be reported to the team manager/supervisor immediately. Failure to follow these critical practices will result in automatic disciplinary action. 13 Red Line Safety Accounting Surgical Counts Medication Immediate Use Sterilization Fire & Laser Safety Fall Safety Universal Protocol 14 7

11 Accounting: Surgical Counts Sponges must be completely separated and viewed by the surgical technician and nurse when counting IN or OUT All sponges must be scanned IN and OUT using the electronic sponge counter system. If sharps are present, they must be counted. 15 Medication Label medications, including saline and other irrigation, on the back table. Label all syringes, medication cups, fluid warmers, and basins. 16 8

12 Immediate Use Sterilization Documentation must be completed on the Autoclave Log Sheet for each use. Permission from a team manager/supervisor and the surgeon must be obtained before processing any implants via Immediate Use Sterilization. The early release verification form must be completed and a biological indicator must be ran with each implant tray. 17 Laser & Fire Safety Utilize risk appropriate interventions as outlined in the AORN Fire Safety Tool Kit. 18 9

13 Fall Safety Whenever possible, two safety straps must be utilized when the surgical table is tilted laterally, in Trendelenburg or in reverse-trendelenburg. Use as many safety straps or positioning aides as needed to ensure that the patient is adequately secured. If unable to adequately secure the patient, contact a team manager/supervisor for assistance. 19 Universal Protocol The Universal Protocol is mandatory on EVERY procedure. A Preprocedure Checklist, Sign-In, Time Out/Pause, and a Sign-Out must be conducted on every patient. 1. Preprocedure Checklist 2. Surgery Board Completion 3. Sign-In 4. Time-Out/Surgical Pause 5. Sign-Out 20 10

14 Universal Protocol 1.PreProcedure Checklist Complete a Preprocedure Checklist before patient transport to OR. 2. Surgery Board Completed RN or Tech fills out staff names Tech fills out patient name, procedure and site. RN fills out additional Sign-In elements 3. Sign-In RN verifies info on White Board with patient ID band (name & DOB) RN verifies info on White Board with surgery permit RN verifies the patient name, DOB and orientation of radiologic films Fire Risk Assessment is complete 21 Universal Protocol 4. Time- Out/Surgical Pause If needed, Scrub Tech asks surgeon to initiate Time-Out Surgeon initiates Time-Out Circulator: 1) states the patient name 2) verifies antibiotics administration 3) reads the surgical permit Anesthesiologist verifies correct patient, procedure, and surgical site If a Vendor is present, he/she verifies implants Surgeon 1) verifies correct patient, procedure, and surgical site 2) asks each member of the surgical team to confirm correct patient, procedure, and surgical site 22 11

15 Universal Protocol Time- Out/Surgical Pause Requirements All team members required to stop all activity and pay attention Mark must be visible before and after patient is draped (or the drapes must be removed and the surgeon must re-verify and re-mark patient) RN reads from the surgical permit only (not from a pocket card, not from the surgery board, etc.) All team members verbally consent that mark is visible and that the correct site is prepped and draped All vendors, students, and observers must cease activity and pay attention during the surgical pause or they will be asked to leave the room until the pause is completed. 23 Universal Protocol 5. Sign- Out RN verifies the actual procedure with the surgeon RN verifies the name and test ordered on every specimen/culture RN verifies the number and type of implants used RN and tech verify that all counts are correct and informs the surgeon 24 12

16 Follow-Up More Monitoring Counseling Corrective Action Plan 25 Staff Participation Involve Medical Staff. Recruit Champions by utilizing Councils. Show Appreciation to Staff for goals accomplished. Have a strong knowledge base and set boundaries for goals

17 Creative Planning Utilize Unit Councils to facilitate planning. Utilize Education Department to assist with special training. 27 Remember: It is all about the presentation! 28 14

18 Organizational Support Letter from Medical Director to Medical Staff explaining the new policy and expectations of outcomes. Training hours budgeted by management to ensure compliance with required in-services. Audit system supported by Management. 29 Repeat, Repeat, Repeat Verbal Discussions during monthly Staff Meetings. Constant communication with OR teams. Encouraged to speak up about near misses and issues with process. Visual Videos Power Point slide shows Top 5 Board Pat on the Back Board Practice Simulation: each role has a part. Hands-on training

19 The importance of reporting sentinel events are detrimental to learning the obstacles of the Universal Protocol and helping to prevent Wrong Site Patient events. Before the embarrassment of reporting an incident is the trust of the circulating nurse. Must be able to step forward for your patient Speak up 31 True compliance may never be completely measured because currently there are no government regulations that require health care organizations to report sentinel events. The available data are limited to voluntary reporting (Carney, 2006, p. 1121). - Report Near Misses 32 16

20 The Education Series AROC/OROC yearly required training and simulation SIMULATION TRAINING Utilize AORN FIRE SAFETY TOOL KIT 33 Safety Audit Tool 34 17

21 Safety Audit Tool 35 Keys to Successful Implementation Solicit medical staff feedback during program development Conduct medical staff education in conjunction with staff education Management must be present in the operating rooms during protocol implementation to: Answer questions Clarify processes Educate and/or intervene with non-compliant physicians Verify compliance 36 18

22 Overcoming Compliance Barriers Ensure that staff understand that compliance is a condition of employment Written contract is reviewed annually and signed by employee Contract states that employee is responsible for reporting incidents of non-compliance by other staff and/or physicians. Provide ongoing education and practice discussions in EVERY staff meeting Conduct one-on-one counseling sessions with noncompliant employees 37 Overcoming Compliance Barriers Engage medical staff leadership to intervene with non-compliant physicians Standardize every step in the process so that staff are confident in their responsibilities and practice is consistent. Provide time in every staff meeting to debrief issues and clarify processes. Conduct ongoing audits and report results in department meetings Modify protocol and processing based on latest standards and recommended practices

23 Evidence-based References AORN. (2013). Retrieved from _Surgery_Tool_Kit/Comprehensive_checklist.aspx Blanco, M. C. (2009). Wrong Site Surgery Near Misses and Actual Occurrences. AORN Journal, Carney, B. (2006). Evolution of Wrong Site Surgery Prevention Strategies. AORN journal, The Joint Commission. (2013). Retrieved from Poster.pdf. The Joint Commission. (2013). Retrieved from aspx World Health Organization. (2013). Retrieved from s/ssslmanualfinaljun08.pdf. World Health Organization. (2013). Retrieved from 39 Questions & Answers Thank you. We appreciate your participation