The foundations of operating-room patient safety are built on teamwork, readiness and a relentless commitment to following the proven best practices. Here’s a behind-the-scenes look at some of the key building blocks at Novant Health.
Under pressure
Operating rooms need to be “positive pressured,” which means air must be pressured to flow out of the room so there’s no potential for air coming into the room and possibly exposing a patient to infection, said Chip Phifer, director of plant engineering services for Novant Health. So operating room air flows into corridors which are also positively pressured, but at a lower level. Those corridors flow into neutrally pressured hallways set at normal levels. Air pressure levels are monitored 24/7.
To further protect patients, ORs are set to completely “turn over” the amount of fresh air every three minutes to further enhance infection prevention, Phifer said. Compare that to the average office building, where it can take 2 to 4 hours for a turnover of fresh air.
Ready for anything
If a power outage occurs because of weather or accident, hospitals are all supported by instant backup generators that restore lights and power within 10 seconds. In the operating room, key lighting and medical machinery are equipped with sophisticated battery backup that prevent any interruption.
Sterile processing
Nearby in sterile processing, teams working in a highly controlled environment run endless trays and carts of instruments through specialized high-tech cleaning systems, following a variety of safety protocols. From there, the instruments are placed in chambers that steam-sterilize instruments at 270 degrees.
The right people in place
“When they say it takes a village, it really does,” said Karen Jenkins, director of surgical services for the greater Charlotte market. While many people could be brought in depending on the complexity of the procedure, here’s the typical core team on many surgeries:
· The surgeon.
· Physician assistant, who assists the surgeon and often closes the incisions, using stitches or staples.
· Anesthesiologist, a doctor who administers anesthesia.
· The nurse anesthetist is usually stationed by the patient’s head. They monitor the patient throughout the procedure.
· A circulating registered nurse is on hand to further ensure the safety of the patient. They provide care before, during and after the operation.
· Surgical technician, who prepares the room and equipment beforehand and then assists the surgeon during the procedure.
· Additional coordinators, assistants and technicians are also involved. They are all part of the chain of safety who work to ensure that everyone and all the necessary equipment is in place.
Once the operation gets underway
At Novant Health, everyone on the surgical team takes full responsibility for patient safety, which starts with total communication and permission for anyone to speak up or raise a question at any time, Jenkins said.
“If someone says those words, ‘I have a concern,’ what the entire team must do − and that includes everyone from the circulating nurse ... to the anesthesiologist, to the surgeon − we have to pause and we have to listen to what the concern is and we cannot move forward with the patient until that concern is addressed.”
Pro Lesson: In health care, this is known as reducing the “power gradient” between doctors and the rest of the care team. Research has shown that a hesitancy to speak up can be an “important contributing factor” in communication errors in health care. When everyone on the team feels comfortable raising a question or concern, it reduces the opportunity for errors.
Closing up
Throughout the surgery, team members track the whereabouts of all instruments, sponges, and anything else placed inside the body during the procedure to ensure that nothing is left behind. After everything is accounted for, the team uses specialized equipment to scan the patient for surgical equipment and materials.
The ceiling, too
At the end of the day, operating rooms undergo a “terminal cleaning,” which means they are thoroughly cleaned from floor to ceiling, including the ceiling. Between procedures, cleaning crews scour the room to prepare it for the next operation.