Download "Time out" immediately before starting the procedure JCAHO

"Time out" immediately before starting the procedure
General Information Sheet
JCAHO Requirements:
A time out should be conducted in the room before the
procedure/incision for any procedure where instruments will be inserted
in to a body orifice or the integrity of the skin will be compromised.
Pre-Procedure Time-Out
Patient safety during invasive procedures is of utmost importance in the medical center. This
includes pre-procedure protocols to help ensure that all members of a procedural team, including
the patient if applicable and able, are in agreement as to what is to occur. This is known as a
“Time-Out” and should be performed prior to the start of any invasive or consent-necessary
procedure. This should be viewed as an integral final safety stop before a procedure is to begin.
Invasive Procedure- any procedure requiring insertion of an instrument or device into the body
through the skin or a body orifice for diagnosis or treatment.
• All of these procedures should also require a written consent from the patient or
surrogate
Time-Out Protocol
• All members of the team present during the procedure should participate and
verbally acknowledge each component
• Patient identity should be confirmed using a minimum of two identifiers
• Procedure to be performed confirmed
• Patient positioning verified
• Procedure location, including correct side
• Applicable pre-procedure medications, equipment, imaging set and confirmed
• Time-out should be documented
• If patient needs to be repositioned, procedure altered, or any other factor that
leads in anyway to a gap in the planned procedure, a new Time-out should be
performed
• Protocol may be abbreviated or by-passed in emergent situations providing
appropriate documentation of such
Review the Checklist on the Following page. The checklist will be used for
all appropriate procedures during training sessions and assessments.
Procedural Skills Instruction
Time-Out Checklist
ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
All steps must be verbalized for all applicable procedures.
Please rate the examinee on the following items:
1. Written consent from patient or surrogate obtained.
2. All team members participated in time out. (Must
verbalize if specific procedure may involve more
than
one caregiver.)
3. Patient identity confirmed w/minimum of two
identifiers.
4. Procedure to be performed confirmed.
5. Patient positioning verified.
6. Procedure location, including correct side (or side
being
di
bpre-procedure
li d
i imedications,
h
l f equipment,
i
)
7. Applicable
imaging set and confirmed.
8. Time Out documented
9. If any change in plan – time-out is performed again.
10. If protocol is abbreviated or by-passed for an
emergent
i
i
i d
i i
id d
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___Done
__Not Done
___N/A
___N/A
___N/A
___N/A
Procedural Skills Instruction
Arterial Blood Gas (ABG) Checklist
ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
Please rate the examinee on the following items:
1. Washed hands.
2. Check that all necessary equipment is available and ready to
use.
3. Perform “Time Out” immediately before beginning procedure
4. Put on examination gloves.
___Done
__Not Done
___Done
__Not Done
__Correct
Technique
__Incorrect
Technique
___Done
__Not Done
__Not Done
5. Identified location of radial artery (palpated pulse lateral to
flexor
i diand
li demonstrate
d
Th the
b steps inbthe Allen
d i test”
l i )
“Describe
__Correct
Technique
__Incorrect
Technique
6. Hold patient’s hand up and have patient clench and unclench
hand
l i the radial
d i and
bl ulnar
d f arteries
h hwhile
d patient is
7. Compress
clenching the
d hand and have patient relax the arm and hand to
8. hLower
alleviate
i pressure
hi h on the ulnar
i
(M for brisk
b li )
9. Release
artery and lobserve
return of
l
h potential
d (M
b li )
10. “Describe
results”
Participant answer need not be verbatim but must be
complete:
“Positive Test: Color returns to hand in 14 seconds or less
and
procedure can be done; Negative Test: Color returns to hand
in 15
seconds or greater and procedure must be aborted. Assess the
other hand.”
11. Prepared area with alcohol wipe to simulate CHG
(chlorhexidine
gluconate) or idophor. Must state that solution stays on site
for 2
minutes until dry before puncturing the skin.
12. Using a Heparinized syringe, removed residual air from
syringe.
F
di
b
d A h
dl
i
__Correct
Technique
__Correct
Technique
__Correct
Technique
__Correct
Technique
__Incorrect
Technique
__Incorrect
Technique
__Incorrect
Technique
__Incorrect
Technique
__Correct
Response
__Not Done
__Not Done
__Not Done
__Not Done
__Not Done
__Incorrect
Response
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
13. Palpated artery with index finger. of non-dominant hand
__Correct
proximal
Technique
(“ b adduct
”) l arm dand dorsiflex the wrist approximately 30o.
14. Slightly
Inserted needle at a 60° angle to the skin and advanced to the
__Correct
artery with bevel side up. (This must be done proximal to
Technique
model)
*Prompt participant to verbalize proper positioning.
15. Assessed for flashback of blood into the syringe, then allowed
syringe to fill. (about 1 cc - assessor should tell examinee
__Correct
that a
Technique
smaller amount is sufficient for the purpose of the exam.
Assessor may prompt for aspiration.)
16. Placed 2x2 gauze pad over puncture site and withdrew needle
__Correct
and
Technique
i
N
dl
f
d
i
i
d
17. Upon SI’s question, “How long should pressure be applied
___Correct
to
puncture site?” Answered, “At least five minutes” or “Five
Response
Minutes.”
18. Slowly inverts the syringe 10 times, and then roll between
__Correct
palms
Technique
19. In thei patient’s presence, labels the specimen and places in a
__Correct
biohazard bag. (NO ICE)
Technique
20. Ask: “What must you do once the procedure is
___Correct
completed?”
Answer: “Document in the patient chart including location of
Response
puncture site, results of Allen test, and any complications”.”
21. Patient comfort was a priority.
___Yes
__Incorrect
Technique
__Not Done
__Incorrect
Technique
__Not Done
__Incorrect
Technique
__Not Done
__Incorrect
Technique
__Not Done
___Incorrect
Response
__Incorrect
Technique
__Incorrect
Technique
__Not Done
__Not Done
___Incorrect
Response
___No
Procedural Skills Instruction
Basic Airway #1: Bag-Valve-Mask Ventilation
ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
Please rate the examinee on the following items:
1. Assessor Prompt: “What equipment should be set out and
checked for the procedure?”
Correct Response: “Oxygen, ambu bag, Oral & Nasal Airways,
Suction, stethoscope.”
2. Washed Hands
3. Put on Gloves
4. Chooses appropriate sized mask and attaches to ambu bag..
5. Checks patients’ mouth for foreign material and/or small or illfitting dental devices. (Good-fitting full dentures may be left in
place to get a better seal.)
6. Oral or Nasal airways properly measured (Tip of lip to angle of
jaw/Tip of nare to angle of jaw) and inserted. (If oral, curve up
towards hard palate first, then rotated at soft palate - or used
tongue blade; if nasal, lubricated generously and initially inserted
with bevel tip toward the septum.)
Ask: “When is a(n) oral/nasal airway used.”
Answer: Indicates gag reflex uses nasal vs. no gag reflex uses
oral.
**Oral and Nasal Airways can be done in conjunction with BVM
or as a separate task.**
7. Attaches Oxygen with tubing and adjusts regulator to at least 15
liters.
8. Head-tilt, Chin-lift performed.
9. Hand positioned– one-handed technique to fit and seal the bag
against the face. (Proper hand placement: Thumb & Index finger
on body of mask, 3rd & 4th digits on jawbone, 5th digit at the angle
of the jaw. Little or NO pressure to the sub-mandibular soft
tissue.)
10. Hand positioned– two-handed technique to fit and seal the bag
against the face. Assessor should squeeze the bag for the
participant. (Proper hand placements: Thumbs & Index fingers
on body of mask, 3rd & 4th digits on jawbone, 5th digit at the
angle of the jaw. Little or NO pressure to the sub-mandibular
soft tissue.)
11. Assessor prompt “What needs to be checked now?”
Correct Response: “Auscultation of chest.(By a second person)”
__Correct
Response
__Incorrect
Response
__Done
__Not Done
__Done
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Correct
Technique
__Incorrect
Technique
__Incorrect
Technique
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Response
__Not Done
__Not Done
__Incorrect
Response
12. Ask: “What must you do once the procedure is completed?”
Answer: “Document in the patient chart.”
__Correct
Response
__Incorrect
Response
Procedural Skills Instruction
Basic Airway #2: Oxygen Delivery (NC, Simple Mask, NRB) Checklist
ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
All Items MUST be done in the correct order per the checklist.
Participant MUST verbalize full range of oxygen liter flow for each device.
NASAL CANNULA
1. Connect end of tubing to Oxygen regulator
(flowmeter).
2. Turn on Oxygen from 2 to 6 liters. (states
range)
3. Place nasal cannula on patient w/prongs
correctly placed in nares and tubing gently
looped over ears.
4. Patient comfort was a priority.
___Not
Done
___Not
Done
___Done
___Done
___Correct
Technique
___Incorrect
Technique
___Yes
___Not
Done
___No
SIMPLE MASK
1. Connect end of tubing to Oxygen Regulator
(flowmeter)
2. Turn on Oxygen from 6 to 12 liters. (states
range)
3. Place mask over patients’ face and gently
place
l i comfort was
d ah priority.
b k f h h d
4. Patient
___Done
___Done
___Correct ___Incorrect
Technique
Technique
___Yes
___Not
Done
___Not
Done
___Not
Done
___No
NON-REBREATHER MASK
1. Connect end of tubing to Oxygen Regulator
(flowmeter)
2. Turn on Oxygen to 12 -15 liters. (states range)
___Done
___Done
___Not
Done
___Not
Done
3. Place thumb over vent until reservoir bag is
full.
4. Place mask over patients’ face and gently
place
l i comfort was
d ah priority.
b k f h h d
5. Patient
___Correct ___Incorrect
Technique
Technique
___Correct ___Incorrect
Technique
Technique
___Yes
___Not
Done
___Not
Done
___No
Procedural Skills Instruction
IV Insertion Checklist
ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
Please rate the examinee on the following items:
1. Checked that all necessary equipment is available and prepared
to use.
2. Washed hands
3. Perform “Time Out” immediately before beginning procedure
4. Put on gloves
5. Cleaned insertion point. Must use at least 3 wipes, as shown on
the training video, for credit.
6. Applied tourniquet (may be done prior to cleaning if necessary to
locate appropriate site.)
7. Inserted needle superficially with bevel side up; if blow-out
occurred, removed needle and starts procedure over in a different
vein with a clean needle
8. Removed tourniquet to release pressure in vein.
9. Using one finger to put pressure at the end of the catheter to stop
blood flow, removed the needle. (If using needleless device,
retracted needle first.)
10. Disposed of needle in Sharps container without recapping.
11. Attached IV tubing to hub of catheter and opened IV line to
ensure proper flow of fluids.
12. Thoroughly secured cannula and tubing with tagaderm & tape.
At least two pieces of tape must be used with the tagaderm for
credit.
13. Labeled work with the minimum of initials, date, and size of
needle. For credit, information must be recorded on piece of
tape or on the tagaderm before it is placed on patients’ hand.
14. Used proper removal technique: removed tape, applied 2x2
gauze pad with pressure at removal point, disposed of cannula
and attached one band-aid. Note: All steps required for credit;
if any are missing or incorrect, item is to be marked “incorrect
technique”
15. Placed biohazard materials in proper containers.
___Done
__Not Done
___Done
__Not Done
__Correct
Technique
__Incorrect
Technique
___Done
__Correct
Technique
__Not Done
__Incorrect
Technique
___Done
__Correct
Technique
__Not Done
__Not Done
__Not Done
__Incorrect
Technique
___Done
__Not Done
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Done
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Correct
Technique
__Incorrect
Technique
__Not Done
__Done
__Not Done
16. Patient comfort was a priority
17. Ask: “What must you do once the procedure is completed?”
Answer: “Document in the patient chart.”
___Yes
___No
___Correct
Response
___Incorrect
Response
Procedural Skills Instruction
Lumbar Puncture Checklist
ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
Instruct the Examinee: You are permitted to re-adjust by retracting the needle to the
subcutaneous tissue. If no fluid is present on the second attempt or if the needle is
completely removed while trying to readjust the angle, you must begin process over at a
new insertion site starting with sterilization.
Please rate the examinee on the following items:
1. Wash Hands.
2. Checked that all necessary equipment is available and
ready to use.
3. Perform “Time Out” immediately before beginning
procedure
4. Put on Mask.
5. Identified correct puncture site (midline at L4-L5-S1.
L4 is at the level of the iliac crest).
6. Open LP kit carefully to maintain sterility.
7. Open sterile glove package.
8. Put on sterile gloves maintaining sterile environment.
9. Prepped “skin” over proposed puncture site.
___Done
___Not Done
___Done
___Not Done
___Correct ___Incorrect
Technique
Technique
___Not Done
___Done
___Not Done
___Done
___Not Done
___Correct
Technique
___Correct
Technique
___Correct
Technique
___Correct
Technique
___Incorrect
Technique
___Incorrect
Technique
___Incorrect
Technique
___Incorrect
Technique
___Not Done
___Not Done
___Not Done
___Not Done
10. Place sterile drapes around site maintaining sterile
environment.
___Correct ___Incorrect
Technique
Technique
___Not Done
11. Properly administered a local anesthetic. Must
anesthetize four different tissue levels using smaller
needle for initial levels and larger needle for deeper
levels.
___Correct ___Incorrect
Technique
Technique
___Not Done
12. Verified proper fit of the stylette in the spinal needle.
13. Inserted the spinal needle with stylette into the
puncture site w/bevel toward the iliac crest and at the
proper angle. (10 degrees toward the umbilicus).
14. Advanced the needle into the subarachnoid space; if
___Done
___Not Done
___Correct ___Incorrect
Technique
Technique
___Not Done
___Correct ___Incorrect
___Not Done
bony resistance was felt, backed needle out to the
subcutaneous tissue, changed angle and re-advanced
the needle.
Ask: If boney tissue is felt, what would you do?
Response should be as stated above.
Technique
Technique
15. Tested for presence of spinal fluid. Note: Credit given
even if no fluid present.
Ask: “How much fluid is collected?”
Answer: “3 – 4 ml”
16. If no fluid seen, examinee states they would back
needle out to the subcutaneous tissue, changed angle
and re-advanced the needle.
17. Stylette placed into needle. Placed gauze over
puncture site and removed needle. (Must use gauze
every time needle is removed for credit and stylette
MUST be reinserted into needle before removal.)
18. Disposed of needle assembly in Sharps container
19. Disposed of soiled or bloodied gauze into biohazard
container.
20. When asked “What would you now advise the
patient to do?”
Correctly answered, “To stay supine/laying down flat
for at least several hours.”
21. Ask: “What must you do once the procedure is
completed?”
Answer: “Document in the patient chart.”
22. Patient comfort was a priority.
23. Maintained sterility appropriately throughout the
procedure.
___Correct ___Incorrect
Technique
Technique
___Not Done
___Correct ___Incorrect
Technique
Technique
___Not Done
___Correct ___Incorrect
Technique
Technique
___Not Done
___Done
___Not Done
___Done
___Not Done
___Correct
Response
___Incorrect
Response
____Correct
Response
____Incorrect
Response
___Yes
___No
____Done
___Not Done