How Inconsistent Surgical Staff Compliance Effect The Quality Of Health Care Delivery?

In accordance with the World Health Organisation (WHO 2008) checklist and Local trust policies, a team briefing was held before the day’s list started. The checklist is part of a second Global Patient Safety Challenge initiative entitled ‘Safe Surgery Saves Lives’, aimed at reducing the number of surgical deaths worldwide and was launched in June 2008. This not

Surgical site infections (SSI) occur in 2 – 5% of ‘clean’ non-abdominal surgical procedures (Rothrock, 2007). Staphylococcus epidermidis is the most common cause for SSI in Orthopaedic surgery (NICE, 2008). Guidelines were produced by the National Institute for Health and Clinical Excellence (NICE) to try and reduce this infection rate and include a preoperative phase, (including hair removal and antibiotic prophylaxis), an intra-operative phase and postoperative phase.

In 2003, as an outcome of all the sentinel events reported to the Joint commission lead to the creation of the “The Universal protocol for preventing wrong site, wrong procedures, and wrong person surgery” (Mulloy & Hughes 2008). So, one of the ways that could have potentially prevented the situation from happening at the first place was implementing the universal protocol procedure. According to the protocol the conduction of proper pre as well as post-operating procedures are extremely mandatory. Therefore, by enforcing a standardized routine pre-operating procedure such as verifying the patient as well as the correct site for the procedure, by having the medical staff or preferably the physician marking the operating site with his or her initials before the surgery will be an effective preventive measure (Mulloy & Hughes 2008).

If all patients were bathed/showered preoperatively with an antiseptic, it would reduce the risk of SSIs. This would benefit the patient with shorter time spent on a critical care unit, would reduce the mortality rate and can reduce the readmission rate . Bathing/showering would mean an extra step for the patient and the nurse with added cost for the antiseptic chlorhexidine wash but it serves as added protection in the prevention of post surgical infection.

The Safe Surgery Save Lives initiative undertaken by the World Health Organization (WHO) in 2008 focused on implementation of a surgical checklist. The safety checklist requires the surgical site be checked during the check in process as well as during the surgical time out.

According to the Hospital National Patient Safety Goals, Goal 7 is to reduce the risk of health-care associated infections. NPSG.07.0.01 deals with surgical-site infections. The question to be asked is, “Why are surgical site infections a problem?” The prevention of surgical site infections can occur before and during surgery, with certain actions of the nurse, and when the patient is healthy. One way surgical site infections can occur is during surgery, or intra-operation. Sources of bacteria, exogenously, include the airborne route as a significant source of infection. Endogenously, infections can occur from the normal flora of a patient (Edmiston & Spencer, 2014a). Surgical site infections are a problem intra-operatively because of operating room temperatures not being controlled, misuse of sterile procedure, and improper hand hygiene. Operating room temperatures should be kept between 68 to 75 degrees Fahrenheit or 20 to 24 degrees Celsius. There also needs to be positive

2. Verbal Order / Read Back elements: Goal is 100%. • This is so important to minimize any wrong information or orders misunderstanding, or even misinterpretation. The lack of full compliance increase the risk of wrong treatments, medications and the consequences could be major. Our institution compliance varied between departments, and was noticed that surgical and in specific orthopedic department was the least compliant with verbal order policy. The compliance in this department was 62%. Reasons for this non compliance include: a. Lack of pathways for specific medical problems, where standard orders are the acceptable route to minimize inappropriate orders. b. Timing of the verbal orders, specifically during the night, where most of non-compliance documented. c. Surgical and specifically orthopedic department have a significant trust between surgeon and staff, which lead to non-compliance. These elements should be addressed aggressively to avoid harm.

A two-year program called On the CUSP: Stop BSI was formulated in 2008 to prevent CLABSIs in hospitals nationwide and was organized as a state or region-level collaborative with centralized education, data collection, and program management functions (AHRQ, 2012). More than 1,000 hospitals and 1,800 hospital units, representing a total of 44 states, the District of Columbia, and Puerto Rico, participated in the program (AHRQ, 2012). The program structure included three main components: (1) a model to translate evidence into practice at the bedside to prevent CLABSIs; (2) the CUSP to improve the safety culture; and (3) a system to measure and report infection data (Sawyer et al., 2010). Results of the program revealed success in reducing CLABSIs nationwide by 41% from a baseline of 1.915 infections per 1,000 line days to a rate of 1.133 infections (AHRQ, 2012). With the nationwide success of the On the CUSP: Stop BSI program (AHRQ, 2012), the state of Hawaii embarked on their own study to determine if a national ICU collaborative to reduce CLABSIs would succeed in the state (Lin et al., 2012). The study, which began in January 2009 and ended in December 2010, included the CUSP, a multifaceted intervention approach to CLABSI prevention, and infection rate monitoring (Lin et al., 2012). Data was collected and reported from 20 ICUs representing 16 hospitals across the state (Lin et al., 2012). The results revealed the overall mean 9statewide CLABSI rates decreased 61% from 1.5 infections per 1,000 catheter days at baseline to 0.6 at 16 to 18 months post-implementation of the project, reinforcing the evidence that the On the CUSP: Stop BSI program can succeed in other states and substantially reduce CLABSI rates in hospitals (Lin et al., 2012). The success of the initial Hawaii study was the catalyst to conduct a second study in the state. This cohort study continued the national On the CUSP: Stop BSI program interventions, extended

The unit utilizes an evidence-based testing and pre-surgical evaluation processes, thereby making it ideal to do the required assessment, testing, and treatment effectively. Although, there continues to be resistance from some surgeons, majority are taking notice of the major impacts of inadequate pre-operative patient preparation. The JC risk assessment recommendations dictate institutions are responsible to reduce infections caused by Multi Drug Resistant Organisms (MDRO) and the initial occurrence of an epidemiologically significant organism (2016).

This paper attempts to explain some areas of potential improvement for the Veteran Affairs (VA) organization in a surgical department. Describe the data that needs to be collected and the tools to be use. Also, it will be identified and compared the types of information collected based on the different tools used. Presenting the Quality Improvements (QI) tools needed to accomplish the goal and describe the information obtained from it. In addition, establish how are these tools helpful for the health care organizations.

At least half a million deaths per year could be prevented with effective implementation of systemic improvements in operating rooms. Specifically, multiple studies have found implementing the use of the WHO Surgical Safety Checklist would significantly reduce surgical morbidity and mortality due to surgical errors.

Surgical site infections are considered preventable. Because such infections are considered preventable, there are legal consequences directly connected to such a condition. In this paper, I will discuss what an SSI is and the reasons on why it is considered to be preventable. I will also discuss the role of disclosure and legal implications that are related to SSIs, accreditation expectations, and continuous quality monitoring as it relates to SSIs.

Research shows that Surgical site infections are preventable. According to the CDC, hand hygiene is the simplest approach to preventing the spread of infections and needs to be incorporated into the culture of the organization. Ensuring the use of infection control prevention is an important component of nursing care. Infection control prevention policies must be communicated undoubtedly to all employees. Staffers who do not comply must be re-educated to ensure that all are complying. Speaking up and pointing out that a nurse forgot to wash his or her hands, or notifying the surgical team that surgical instruments were not adequately cleaned may seem like small issues; but at the same time, not acknowledging a break in a sterile technique could mean the difference between life and death for a patient. One hospital that was struggling with high levels of infection related to surgical procedures, implemented a pre-procedure huddle as a team. This innovate way decreased the spread of infection and was a great way to improve the quality of care for patients. As mandated by the Joint commission, infection prevention personnel should provide multidisciplinary education on SSI prevention, to all team members, including

Ethical challenges are the most profound when dealing with patient safety; compliance with the prophylaxis antibiotic administration guidelines is paramount to a surgical patient in order to decrease the possibility of a post operative surgical site infection. Antibiotic timing requires

Those who incorporate the best practice standards can reduce the morbidity and mortality associated with surgical site infections.