Surgical teams should follow 13 key safety strategies to manage the number and severity of underlying medical problems among geriatric patients, according to joint guidelines issued by the American College of Surgeons and the American Geriatrics Society.

The guidelines, published in the October issue of the Journal of the American College of Surgeons, aim at optimizing surgical care for patients 65 years or older — a dramatically growing population, notes the ACS — who present for surgery with specific and complex problems. Addressed in the guidelines are such issues as cognitive impairment and dementia, cardiac and pulmonary evaluation, fall risk, medication management, pre-op testing, and patient-family and social support systems.

There's no "magic bullet" for improving surgical care for the elderly, says Clifford Y. Ko, MD, FACS, director of the ACS's National Surgical Quality Improvement Program and Research and Optimal Patient Care division. For example, he points out, a surgical team could accurately assess a patient's cognitive functioning, but fall short in gauging how many medications the patient is taking at the time of surgery. For that surgical team, perioperative medication management becomes the biggest concern, says Dr. Ko.

The bottom line: Guiding elderly patients safely through surgery generally requires a team approach, says Dr Ko, adding, "We want everyone on the same page of providing good, quality care."

Daniel Cook

The federal Agency for Healthcare Research and Quality has developed a prototype system that would let patients report medical errors, and is waiting for approval from the White House's Office of Management and Budget to begin consumer testing, according to the New York Times.

According to the newspaper, the online system involves a questionnaire that asks patients whether they have recently experienced a medical mistake and whether they are generally concerned about the safety of their health care. Based on the answers to those questions, it prompts them to proceed with "a new consumer reporting system for patient safety." This asks patients to report, among other things, provider and facility information; the what, when and where of an event and whether it resulted in harm; and why they think the mistake occurred.

Patients who report will also be asked for permission to share information with the healthcare providers and facilities named. The government will work with the RAND Corporation and the ECRI Institute to analyze the reports, says the New York Times, and will use the resulting data to develop healthcare safety efforts.

Stephanie Wasek

Looking to beef up your facility's culture of safety? Follow these 2 pieces of advice: always practice what you preach, and make sure your staff knows you've got their backs.

An international team of academics recently examined the psychological conflict that nurses may feel when reporting clinical errors in the strictly controlled environment in which they operate.

Surveying 54 nursing teams at 4 Belgian hospitals, they saw the highest-functioning safety cultures as continuing circles. In short, nursing supervisors whose safety actions closely reflect the instructions they impose will lead nurses who are less hesitant to speak up if they see something going wrong.

Also, nurses made confident by their supervisors' support in safety matters will be more inclined to report the patient care mistakes they've committed if they occur, which leads to overall improvements, says study co-author Deirdre McCaughey, an assistant professor of health policy and administration at Penn State University. "Work environments in which error is identified offer employees the opportunity to learn from those errors and, ultimately, prevent similar errors from occurring."

"A climate of safety requires both prioritizing existing safety protocols and constructive responses to errors," says lead author Hannes Leroy of Katholieke Universiteit Leuven in Belgium. "Achieving this balance highlights the importance of leadership to foster team priority of safety."

The study appears in the Journal of Applied Psychology.

David Bernard

Besides being a testament of the great job you're doing, salary increases are a good barometer of economic health. Tell us when you last received a raise in Outpatient Surgery Magazine's InstaPoll.

Last week we asked: Which statement best describes your feelings about aromatherapy for treating PONV? The results, based on 198 responses:

• Steroids OK before tonsillectomy Giving corticosteroids to pediatric tonsillectomy patients in order to reduce PONV will not increase serious bleeding events during or after surgery, as has been previously feared, according to a study in the Journal of the American Medical Association. Bleeding risks did not increase at 14 days post-op in 314 children who received dexamethasone, notes the study, allaying fears of a rare but potentially serious complication in the procedure performed on approximately 500,000 children per year.
• Dr. Makary speaks out "Medical mistakes kill enough people each week to fill 4 jumbo jets," writes Martin Makary, MD, MPH, FAC, an associate professor of surgery and public health at the Johns Hopkins University School of Medicine, and full transparency within and between healthcare facilities is necessary to reduce this track record of error. In a recent column appearing in the Wall Street Journal, he notes that wrong-site and -procedure surgeries happen as often as 40 times a week, but at hospitals where clinical staff report good teamwork, infection rates and patient outcomes correlate positively. Dr. Makary, whose book Unaccountable was published last month, will be sharing his insights at Outpatient Surgery Magazine's OR Excellence conference on Oct. 18 in Fort Lauderdale, Fla.
• Splitting dose improves bowel prep Instructing colonoscopy patients to split their doses of bowel prep solution — drinking 2 or 3 liters the night before, and 1 or 2 liters the morning of — increases the quality of the prep, polyp and adenoma detection rates and colonoscopy completions, according to a study by Mayo Clinic Arizona researchers, published in the September issue of the journal Gastrointestinal Endoscopy.
• Anesthesia machine component discontinued GE Healthcare has recently announced it is ending sales of the 1503-3855-000 flow transducer for the 7900 ventilator, which directly affects owners of its "workhorse" Datex-Ohmeda Modulus SE and Excel 210 SE anesthesia machines, both of which contain that ventilator.