We noted an innovative approach currently being utilized by a participant hospital in the Florida Patient Safety Corporation Near Miss Reporting System. The facility is utilizing a device called the Preoperative Checklist first utilized and developed by operating room physician and nursing staff at Strong Memorial Hospital in Rochester, New York. The “checklist” is a plexi-glass board with a panel of sliders and protective vinyl coating on the back. The slider panel corresponds to a customized process list. Each slider must be physically moved from red to green to complete the checklist and must be verified by two team members. The board is mounted on the wall of each operating room in a spot that is easily visible to the surgical team (see Preoperative Checklist photo on the following page) (8)
The board is customizable to address individual user requirements. This device, as configured by our participant facility, prominently displays categories of the preoperative patient verification process. Thirteen steps must be confirmed by two members of the surgical team before the official Time-Out (immediately before surgery, after the patient is positioned, prepped and draped) is to occur. Members confirming the steps must be the circulating RN and another licensed member of the surgical team.
Preoperative patient verification process categories that are displayed on the board are
as follows:
- Patient identification – TWO identifiers
- Allergies
- Consent signed
- History & Physical
- Site verification
- Implants/Special Equipment*
- Radiological exams*
- Antibiotics given*
- DVT prophylaxis*
- Beta Blockers*
- ABO Compatibility*
- Surgical Pause/ Final Time Out
- Other
The circulating RN and licensed surgical team member will confirm concurrently the 13 categories (if applicable) by sliding the 13 windows on the Preoperative checklist from red (not confirmed) to green (confirmed). Surgery will not commence until all categories are green. If any of the 13 categories are not applicable they will be moved to green. If any discrepancies between team members exist, surgery will not commence until resolved. The circulator RN is responsible to assure the Preoperative Checklist. Board is cleared (categories should be moved from green back to red after the patient has left the OR). All written information must be erased after the completion of the case.
The University of Rochester Strong Memorial Hospital staff report that the board has enabled identification of near-misses. Examples of items caught through preoperative
use include: wrong pre-op meds, wrong consent, outdated H&P, missing EKG, allergies not noted, no beta blocker when indicated and no prophylaxis.
Information about the Preoperative board usage can be obtained through indeltalearning.com or call 866-738-7893.
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