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Archive July 2020 XXI, No. 7

Communication and Cooperation Prevent Avoidable Errors

Structure, checklists and pre-op time outs protect patients from harm.

Danielle Bouchat-Friedman, Associate Editor

BIO

HUDDLE UP
Megan Nolan, BSN, RN, CNOR, CSSM
HUDDLE UP The interdisciplinary pediatric cardiac surgical team at Boston Children's Hospital engages in preoperative briefings to ask questions and raise concerns regarding the care of the patient.

When the Joint Commission looked at the most commonly reported sentinel events from ambulatory care organizations in 2018 and the first half of 2019, wrong-site surgeries and retained objects topped the list. Never events? Hardly. How should surgical teams respond to the continuing occurrence of avoidable errors? For one, they can prioritize clear communication about safe patient care.

Regularly scheduled pre-op huddles have been paramount in improving the surgical team's communication skills at Boston Children's Hospital, according to Megan Nolan, BSN, RN, CNOR, CSSM, clinical coordinator in the cardiac operating room. An interdisciplinary team meets 30 minutes before patients are wheeled in for surgery.

"We decided to establish a consistent place to meet, and always huddle in the OR so perfusionists and scrub nurses can join the briefing," says Ms. Nolan. "Before we even think about going to get the patient, we go over all aspects of the case. Confirming the patient's weight is a big part of the discussion because it determines the size of the bypass circuit we use and how much blood we give the patient. All of our drug calculations are also based on weight."

Typically, perfusionists set up their pumps the day before a case based on the patient's most current weight, which is noted in the medical records. The nursing staff also has the patient's weight in their records and compares it to the weight recorded in pre-op on the day of surgery. If the updated weight is different than what's been noted in the medical record, even by only 1 kg, a nurse informs the rest of the care team during the regularly scheduled pre-op huddle.

Ms. Nolan recalls a few instances where discrepancies in a patient's weight were caught during the pre-op check and says the briefings have enhanced patient safety. She also acknowledges there's room for improving the process. A scrub nurse, circulating nurse, perfusionist, anesthesia fellow and anesthesia attending are all present during the huddles, but many surgeons have not been able to attend. The scheduled times — 7 a.m. on Mondays, Thursdays and Fridays and 8 a.m. on Tuesdays and Wednesdays — are not ideal for them due to their workflow.

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