In considering how best to implement changes related to the Universal Protocol, the following issues are recognized:
- Failure to recognize risks in procedural settings other than the operating room.
- Lack of “agreement” by the procedure team and individuals performing the procedures surgeon regarding a standardized approach and the difficulty for changing local culture.
- Reluctance of nurses and other staff to question the individuals performing the procedures when a possible error is identified.
- Inadequate human resources and knowledge for facilitating processes to be challenged.
- “Automatic” behavior during the time-out process (“going through the motions” but without meaningful communication).
- Inconsistency of Universal Protocol procedures among several hospitals within a geographic area, staffed by the same surgeons operating at more than one of the hospitals.
- Permanent tattooing of immature skin (premature infants).
- Perception of increased workload by staff and decreased efficiencies.