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Communication Your keys to safe patient care Objectives O Understand the role of communication in providing safe care of the surgical patient. O Demonstrate the use of SBAR communication tool O Describe the elements of the surgical safety checklist and when to perform them. “We have learnt over the last decade that adverse events occur not because bad people intentionally hurt patients but rather that the system of health care today is so complex that the successful treatment and outcome for each patient depends on a range of factors, not just the competence of an individual health-care provider. “ - World Health Organization O In 2010 a Joint Comission study analying over 4800 medical errors over 15 years found that communication was the #1 top contributing factor and handoffs were involved in 80% of serious preventable adverse events. Handoffs associated with surgical procedures O PreOp Nurse Circulator O Circulator Circulator O Circulator PACU That’s a lot of handoffs in a day Elements of Effective Communication: SBAR O Situation O Background O Assessment O Recommendations Situation O Who is the patient? O What’s their diagnosis/procedure to be performed? O Where is the patient? Ex: John Doe is a 34 year-old male with a rightsided tibial plateau fracture. He is in the ER awaiting ORIF surgery on his fracture. Background O Pt medical history pertinent to procedure (NOT HIS ENTIRE HISTORY) O Medications taken daily/so far today O Allergies O Lab values (HCG for women, EKG for pts over 65) O Vitals O Code status Ex: Fracture sustained snowboarding, pt has a PCN allergy, he last ate breakfast at 7am, so far has had 2 g of morphine in the ER for pain control, CBC was normal, Type and Screen sent to lab 20 minutes ago. He is a full code. Assessment O Patient’s understanding of procedure O Specific needs or precautions O Pain control O Cultural needs Ex: He is able to transfer himself from one bed to another with minimal assistance. He is nervous about going under and has a lot of questions. Recommendations O Patient’s readiness for surgery. O Orders completed. O Equipment/Implants available O Opportunity for questions. Ex: “The patient was seen and marked by the surgeon. The surgeon is concerned about blood loss please have 2 units of RBCs on standby, he did not order antibiotics. Do you think he will ask for preop antibiotics?” SBAR exercise 1 A 53 y/o woman is admitted to the ER with RUQ abdominal pain which began last night after dinner, she has been unable to eat anything since but has been keeping down water. Her last PO intake was 4 hours ago. She is evaluated by the general surgeon and scheduled for a Laparoscopic Cholecystecomy this evening. She rates her pain at 4/10. The following info obtained by the ER is in her chart: Diagnosis: Acute Cholecystitis Ht 65in; Wt 160lbs HR: 93, BP:148/92, temp: 98.5 O2 sat 98% RA Hg 11, Hct 34, WBC 9,000, HCG neg. Meds at home: Lipitor, HCTZ Meds in ER: 50mg fentanyl IV, LR 120ml/hr IV. Medical History: HTN, hyperlipidemia, preterm delivery at 32 weeks in 2007 Surgical History: Appendectomy at age 21. SBAR exercise #2 You are 45 minutes into an ORIF on a 67 y/o woman with a right-sided femoral neck fracture resulting from a fall from standing. A type and screen was done prior to surgery but no blood products are ordered. Pre-op her H&H was 10&34, a recent repeat H&H has just come back 8.2 and 33.1. Her vital signs are stable but the anesthesia provider has requested you turn up the temperature in OR, twice. History significant for 1ppd smoker x 38y and ORIF ankle 3 years ago. A relief nurse comes along to offer you a much needed lunch break. Sign in, Time Out, Sign out Sign in /Debriefing O Pt confirms Identity procedure & consent. Introduce pt to people in the room. O State allergies O Pt specific surgical risks (airway, aspiration, blood loss). The goal is to prevent errors not scare the patient. O Anesthesia machine functioning. Time Out O All team members are present have a role O Confirm patient identity with 2 identifiers O Confirm procedure and side O Antibiotic prophylaxis O Equipment/implants/images O Length of procedure, anticipated EBL O Patient specific safety concerns. ***various facilities may add to this list Sign Out As the case is closing confirm: O Procedure done, it may not be the one you set out to do. O Counts O Any specimens for lab or pathology O Problems with equipment to be addressed? CMS Never Events O Objects left behind during surgery O Mediastinitis after CABG O DVT/Pulmonary Embolism O CAUTI O Use of incompatible blood products And many more Who Else Should be “In the Loop”? O Surgeon(s) and assistant(s) O Anesthesia Providers O Charge Nurse O House Supervisor? O Lab? O Radiology? O Equipment/Implant Reps O Anyone else associated with patient specific procedure. Documentation as Communication Documentation is more than just CYB in case you get sued… O It is a reminder if the elements of good patient care. O It fills in gaps left by person to person report. … and yes, it proves you did your job correctly so don’t just blow through it. Make sure it is accurate, complete, and accessible to others. Listening is Communication too O Surgeons HATE being asked the same question again and again (everyone does) O Read the H&P, read the consent O Write it down!! O Having your eyes on the chart and your ears on the surgical case is hard at first, but you will get there. Close the Loop Patient Communication O Don’t be fooled, patients are nervous, their families are nervous. O You don’t have to know all the answers but you must be willing to find them out. O It is your job to make sure they know what is on their consent. O Talk to kids about their surgery when appropriate. Sources O Berry & Kohn's Operating Room Technique._11th edition, by N. Phillips O Alexander’s Care of the Patient in Surgery 14th edition by Jane C. Rothrock O Debbie Popovich (2011)Cultivating Safety in Handoff Communication, Pediatric Nursing, 37(2):55-60. retrieved from http://www.medscape.com/viewarticle/746 070_2