Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP, CJCP, associate nurse executive, Accreditation and Certification Operations
Editor's Note: A version of this article appeared in Periop Insider.
This June 10, the perioperative community celebrates National Time Out Day—the 16th year that we recognize the value of taking a Time Out before any surgical procedure.
As surgical teams are focused on adhering to COVID-19 protocols to keep staff and patients safe from disease transmission, there have been some positive trends. Teams are:
- talking more
- collaborating more for safety
- recognizing the value of consistently taking time to ensure all details are confirmed for a safe surgical procedure
That’s why this year marks a unique opportunity to recognize the value of using safety tools such as the Time Out to connect as a team for safety.
Focus on Consistency
As a former hospital surveyor, I’ve witnessed a number of Time Outs. The best Time Out process I ever observed was at a large urban hospital in the Northeast. No matter what surgical procedure or setting, the Time Out was done consistently, whether for an orthopedic case, a scheduled C-section, or an interventional radiology procedure.
Three consistent practices made this hospital’s process stand out:
- The Time Outs were led by the same person—at this facility it happened to be the physician.
- Every team member stopped what they were doing to engage in the Time Out.
- Each team member introduced themselves and shared their role in the procedure.
What really set these Time Outs apart was the physicians’ request to each team member saying, “safety is important to me, I want you to stop me and tell me if I’m doing something that makes you uncomfortable or puts the patient or a team member at risk.”
This Time Out developed as a true conversation—it was the team coming together, everyone knew the purpose, everyone was empowered to speak up, and the physician looked to each member of the team to play an active role in safety.
Time Outs can look very different depending on the procedure, the team and setting, but every Time Out must have one common thread—team engagement. If every member of the team isn’t part of the conversation, mistakes can still happen, and they do.
Last year, 83 wrong implant, wrong patient, wrong site and wrong procedure surgeries were reported to The Joint Commission, and this number is projected to represent only 5% of these sentinel events that occur annually.
When we drill down further, we see that 52 of these sentinel events were the result of miscommunication or lack of communication leading to surgery at the incorrect surgical site—if teams focus on eliminating wrong site surgery alone, that would cut down these surgical error numbers considerably.
It’s important to look at these numbers because just one wrong surgery is too many and it’s up to every member of the surgical team to take actions that reduce these numbers.
Realizing Zero Wrong Site Surgeries
We have an arsenal of tools to protect patients from harm associated with wrong site surgery, and we have to use them, together.
Processes like the Universal Protocoll that require patient identification, site marking and the Time Out, as well as the Comprehensive Surgical Safety Checklist and other safe surgery tools and processes could significantly reduce the number of wrong site surgeries, if applied consistently and correctly.
As the patient’s advocate, nurses are often that team member who stands between the patient and a harmful event. This means nurses working on the frontline have to speak up when a member of the team needs to be called out for an unsafe action. Leaders have to support nurses and ensure they feel safe enough to speak up when their team is not following Time Out or other safety procedures.
Frontline nurses and nurse leaders also must connect with scheduling staff to ensure an error is caught upstream, long before the day of surgery. I’ve seen organizations put some innovative ideas in place, such as enforcing read-back strategies to ensure surgery site, side and procedure are correct from the moment surgery is scheduled.
Ready to refresh your team Time Out for better engagement? Check out these safe surgery resources to help your team improve the Time Out process:
- Review The Joint Commission’s Universal Protocol.
- Access the Association of perioperative Registered Nurses’ (AORN) Comprehensive Surgical Checklist to tailor a role-inclusive Time Out in your operating room (OR).
- Work with your team to review educational resources from AORN’s Correct Site Surgery Tool Kit.
This year, is a year like no other. Let’s take advantage of this opportunity when we’re talking and collaborating more than ever to really refine our Time Out process!
Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP, is the associate nurse executive in the Division of Accreditation and Certification Operations at The Joint Commission. Previously, Dr. DiBlasi Moorehead was a field director at The Joint Commission for the Hospital, Critical Access Hospital and Nursing Care Center accreditation programs. Since 2010, she has been a surveyor for the Hospital accreditation program. Prior to joining The Joint Commission, Dr. DiBlasi Moorehead was responsible for accreditation and regulatory compliance and related performance improvement activities for a five-hospital system in Louisville, Kentucky. She has also held leadership positions in nursing, quality and education during her more than 30 years in health care.