Conducting a "time-out" before beginning a surgical procedure is essential for preventing wrong-site, wrong-side, wrong-procedure or wrong-person surgery. Time-outs are short meetings with the entire operating team immediately before an incision to verify the patient's identity, the procedure and the site, along with other pertinent information. To celebrate this important process, The Joint Commission and the Association of periOperative Registered Nurses promoted National Time Out Day June 12. However, time-outs are not always conducted correctly, and surgical errors continue to occur.
Coleen Smith, RN, High Reliability Initiatives director for The Joint Commission's Center for Transforming Healthcare, shared common time-out mistakes and offered solutions in the podcast episode "Take 5 With The Joint Commission: The Latest on Time-Outs and Wrong-Site Surgery."
Common time-out errors
One of the most common time-out errors is that the entire team does not stop and participate in the time-out, according to Ms. Smith. Another common error is due to leadership's tolerance of unapproved pens for marking the site of surgery, which typically wash off during prepping. "The team is not used to seeing the mark once the patient is draped, so they're not missing the mark," Ms. Smith said.
Time-out solutions
Although a time-out occurs only just before incision, the success of the process relies on safe practices beginning at the time of scheduling, according to Ms. Smith.
1. Identify risks. Ms. Smith suggested using The Joint Commission's Targeted Solutions Tool to identify risks in the surgical process and develop strategies to reduce the risks. Taking the time to evaluate the entire perioperative process is imperative for all organizations, even those that have not had wrong-site surgeries. "Organizations may assume because they haven't had a wrong-site surgery that they don't have a high risk of having one. But, without understanding all the risk points that might be built into their processes, it might be that it's not a matter of good processes, they might just have luck," Ms. Smith said.
2. Standardize the booking process. The process for scheduling surgeries should be standardized to prevent errors. For example, there should be one method of scheduling instead of a mix of faxing, emailing and calling, Ms. Smith said. Schedulers should also eliminate acceptance of unapproved abbreviations so the documentation for the site and side of operation is clearly identifiable by all involved in scheduling a procedure.
3. Assign roles. To ensure every team member actively participates in the time-out, Ms. Smith suggested assigning people specific roles. For example, the circulating nurse could be responsible for announcing the time-out; the scrub tech for detailing special equipment and implants needed and on-hand; the surgeon for identifying specific risks and naming the site of the procedure; and the anesthesiologist for identifying anesthesia concerns.
4. Reference the site mark. One person's role during the time-out should be to point to the site mark and verify with the entire team looking at that site that it is the correct site for the procedure.
5. Don't rush. Many organizations identify time constraint as a challenge to conducting a complete time-out, according to Ms. Smith. OR leaders need to prioritize patient safety and ensure nurses are willing to "stop the line" when they have concerns. "When you accept production pressure over patient safety, you're putting the patient at a huge risk," she said.
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