Strategies for Preventing Distractions and Interruptions in the OR

Stakeholders in the automotive industry, airline industry, and anesthesia profession have identified critical periods of time in which distractions and interruptions of normal processes can have devastating effects. Just as reducing distractions improves safety in an automobile or airplane cockpit, limiting distractions and interruptions during critical times in the perioperative setting can increase patient safety. We assessed perioperative nurses and identified what they perceived as critical phases of nursing care. We also worked with our anesthesia partners to address their concerns about interruptions during the administration of nerve blocks. The perioperative nurses at our hospital initiated strategies to reduce distractions or interruptions to their practice at critical points, and, in collaboration with surgical committee members, we developed strategies to reduce or eliminate distractions for anesthesia professionals during the preoperative administration of nerve blocks and to eliminate distractions for the RN circulator and scrub person during the final counts.     

Introducing the editorial board

One of the most important contributions made to any medical journal is that of its board of editorial consultants. In the February issue we began to lntroduce the members of our Editorial Board. Each month we will publish brief profiles of a few more of these distinguished physicians so that ali of you may become a little more familiar with th ose whose dedicated labor does so much to make this journal possible.     

Hand Hygiene in Emergency Medical Services

Abstract

Background. Hospital-acquired infections (HAIs) affect millions of patients annually (World Health Organization. Guidelines on Hand Hygiene in Healthcare. Geneva: WHO Press; 2009). Hand hygiene compliance of clinical staff has been identified by numerous studies as a major contributing factor to HAIs around the world. Infection control and hand hygiene in the prehospital environment can also contribute to patient harm and spread of infections. Emergency medical services (EMS) practitioners are not monitored as closely as hospital personnel in terms of hand hygiene training and compliance. Their ever-changing work environment is less favorable to traditional hospital-based aseptic techniques and education. Methods. This study aimed to determine the current state of hand hygiene practices among EMS providers and to provide recommendations for improving practices in the emergency health services environment. This study was a prospective, observational prevalence study and survey, conducted over a 2-month period. We selected participants from visits to three selected hospital emergency departments in the mid-Atlantic region. There were two data components to the study: a participant survey and hand swabs for pathogenic cultures. Results. This study recruited a total sample of 62 participants. Overall, the study revealed that a significant number of EMS providers (77%) have a heavy bacterial load on their hands after patient care. All levels of providers had a similar distribution of bacterial load. Survey results revealed that few providers perform hand hygiene before (34%) or in between patients (24%), as recommended by the Centers for Disease Control and Prevention guidelines. Conclusion. This study demonstrates that EMS providers are potential vectors of microorganisms if proper hand hygiene is not performed properly. Since EMS providers treat a variety of patients and operate in a variety of environments, providers may be exposed to potentially pathogenic organisms, serving as vectors for the exposure of their patients to these same organisms. Proper application of accepted standards for hand hygiene can help reduce the presence of microbes on provider hands and subsequent transmission to patients and the environment.     

Abstracts for the 2008 NAEMSP Scientific Assembly

Abstract

Objectives. To date, most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting and data regarding emergency medical services (EMS)-related errors are limited. To address this gap, a study was conducted to gain an in-depth understanding of the views of highly experienced EMS practitioners, educators, administrators, and physicians on major issues pertaining to EMS patient safety. The intent of the study was to identify key issues to give direction to the development of best practices in education, policy, and fieldwork. Methods. A qualitative study was conducted using processes described by Lincoln and Guba (1985) to enhance the quality and credibility of data and analysis. Purposive sampling was used to identify informants with knowledge and expertise regarding policy, practice, and research who could speak to the issue of patient safety. Sixteen participants, the majority of whom were Canadian, participated in in-depth interviews. Results. Two major themes were identified under the category of key issues: clinical decision making and EMS's focus and relationship with health care. An education gap has developed in EMS, and there is tension between the traditional stabilize-and-transport role and the increasingly complex role that has come about through “scope creep.” If, as expected, EMS aligns increasingly with the health sector, then change is needed in the EMS educational structure and process to develop stronger clinical decision-making skills. Conclusion. The results of this study indicate that many individual organizations and health regions are addressing issues related to patient safety in EMS, and there are important lessons to be learned from these groups. The broader issues identified, however, are system-wide and best addressed through policy change from health regions and government.     

Functional Independence Measurement (FIM) of Patients Receiving Easy S treeta-A Retrospective Study

The objectives of this study were to (1) determine the types of patients who utilized the Easy Street facility and (2) compare the functional independence levels at discharge of patients who utilized Easy Street to that of patients who did not receive this treatment. This study utilized a retrospective chart review to collect data on a group of patients who were seen by physical therapy during a three-month period shortly after the introduction of Easy Street and on a second group of patients who were seen the previous year prior to its introduction. Controlling for length of stay, it was anticipated that patients who utilized Easy Street as part of their treatment protocol would demonstrate higher levels of independence upon discharge as measured by the Functional Independence Measure (FIM) than would patients who did not utilize Easy Street as part of a therapeutic protocol. A total functional ability-score was calculated from five FIM items dealing with transfers and locomotion at admission and discharge from Baptist Hospital for control and treatment groups. There were no statistically significant differences between the treatment and control groups in terms of age, gender and diagnosis. After controlling for age, length of hospital stay and baseline functional ability scores, the treatment group had a higher functional ability score than the control group (66.4 vs. 58.8) and this difference was statistically significant     

Entering a World with No Future: A phenomenological study describing the embodied experience of time when living with severe incurable disease

Scand J Caring Sci; 2013; 27; 165–174 A phenomenological study describing the embodied experience of time when living with severe incurable disease This article presents findings from a phenomenological study exploring experience of time by patients living close to death. The empirical data consist of 26 open‐ended interviews from 23 patients living with severe incurable disease receiving palliative care in Norway. Three aspects of experience of time were revealed as prominent: (i) Entering a world with no future; living close to death alters perception of and relationship to time. (ii) Listening to the rhythm of my body, not looking at the clock; embodied with severe illness, it is the body not the clock that structures and controls the activities of the day. (iii). Receiving time, taking time; being offered – not asked for – help is like receiving time that confirms humanity, in contrast to having to ask for help which is like taking others time and thereby revealing own helplessness. Experience of time close to death is discussed as an embodied experience of inner, contextual, relational dimensions in harmony and disharmony with the rhythm of nature, environment and others. Rhythms in harmony provide relief, while rhythms in disharmony confer weakness and limit time.