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Archive September 2020 XXI, No. 9

Patient Safety: Passionate About Advocating for Patients

The surgical teams at UPMC Horizon and Jameson prioritize protecting those in their care.

Daniel Cook

Daniel Cook, Editor-in-Chief


UPMC Jameson Hospital
HALL MONITORS The team at UPMC Jameson hold a socially distanced huddle to discuss patient care issues.

This isn’t the first time members of the surgical team within the University Pittsburgh Medical Center (UPMC) health system have been recognized for their efforts to protect patients from harm. A couple years ago, two nurses at UPMC Horizon hospital earned the Speak Up for Patient Safety Award — one nurse stepped in during a pre-op time out to avert a wrong-site surgery and the other discovered the wrong weight for a pediatric patient had been entered into the electronic health record, a good catch that prevented a potentially devastating dosing error. The actions of the nurses were rightfully recognized, but their willingness to speak up to protect patients was more commonplace than worthy of congratulations.

“I’ve always felt patient safety is extremely important in the surgical environment because patients can’t advocate for themselves,” says Rhonda Sebastian, MSN, RN, CNOR, clinical director of surgical services at UPMC Horizon and UPMC Jameson, sister hospitals and winners of the 2020 OR Excellence Award for Patient Safety. “Staff are empowered to speak up for patients. If they see something wrong, they say something. We’ll always stand behind them.”

The hospitals promote safe patient care in several other effective ways:

  • Communication and collaboration. The hospitals’ Professional Practice Council — comprised of nurses, surgical techs, central sterile techs and OR service techs — meets monthly and provides a forum in which staff members can address operational and clinical issues that impact safe patient care.

It took a lot of effort and education, but the tired trope of “what happens in the OR stays in the OR” has been replaced with a culture of open communication. “We conduct regular in-services and policy reviews to ensure frontline nurses understand patient safety is our number one priority,” says Ms. Sebastian. “It’s engrained in every member of the care team on a daily basis.”

  • Constant learning. All new surgical nurses are required to take the AORN Periop 101 course and must seek certified perioperative nurse (CNOR) status — the health system provides a prep course — after working in the OR for two years. In 2018, certification of the hospitals’ nurses increased from 18% to 88%. Overall, 92% of the care team — including central sterile techs and central sterile supply staff — achieved certification. “I’m big on continuing education,” says Ms. Sebastian. “It not only benefits staff, it also benefits patient care.”

She talks the talk and walks the walk. Ms. Sebastian is both a CNOR and a certified instrument specialist, which she obtained because she manages the central sterile department and wanted to understand the intricacies involved in working in that important aspect of safe surgical care.

Central sterile techs are told upon hire that they must become certified instrument specialists. “I look for people who want to make a career out of working in sterile processing,” says Ms. Sebastian. “I let them know they’re some of the most important members of our team, because we can’t provide safe care if they don’t properly sterilize instruments.”

  • Due diligence. The hospitals’ standardized policies and procedures are reviewed and updated annually to ensure staff always follow evidence-based practices, and AORN guidelines are posted on the health system’s intranet for staff to access. Members of the anesthesia and surgical teams conduct daily huddles at the beginning of each shift and again in the afternoon near the end of the day. They review the schedule, add-on cases, staffing and equipment needs, and discuss potential patient safety concerns that demand special attention throughout the day.

Surgical cases start late twice a month so the entire care team can participate in mock codes. “Emergency situations — such as malignant hyperthermia events — are rare in the OR, so we make sure staff practice the response protocols,” says Ms. Sebastian. “We want them to stay abreast on the latest techniques and fully understand their roles.”

  • Smoke-free ORs. Both hospitals have received AORN’s Gold Level Go Clear Award, which is given to facilities that achieve full compliance in the elimination of surgical smoke. “That was a big undertaking — it took close to a year to accomplish,” says Ms. Sebastian. “We received pushback from surgeons, but we educated and persisted. Evacuators are now used in 100% of cases. That was a huge win for us.”

In a recent Press Ganey survey, every member of the surgical services team said they view patients as individuals with specific care needs and treat patients with equal effort, even when circumstances make providing safe care difficult.

“We’re always staying current with safe perioperative practices and the latest trends and developments in safe practices,” says Ms. Sebastian. “The dedication and passion of our staff are worthy of recognition.” OSM

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