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Communication in an Operating Room Environment; Improving patient safety by utilizing a TeamSTEPPS approach

From the 2018 HVPAA National Conference

Nathan Woody (UNC School of Medicine), Janet Chadwick (UNC Hospitals), Peggy McNaull (UNC School of Medicine)

Background

Utilizing a multi-disciplinary workgroup composed of Anesthesia, Clinical, and Surgical team members, UNC Perioperative Division with the UNC School of Medicine Surgical and Anesthesia divisions launched a revised Surgical Safety initiative in January 2017.

Objectives

Through joint analyses of the overall TeamSTEPPS application, adherence to established Universal Protocol processes, and existing training plans, the team developed a roll-out for additional training and process revisions. Comprehensive audits performed by the anesthesia staff over a 2-week period prior to project launch showed overall compliance with Universal Protocol elements was 24%.  The adherence to the Debrief process was only 7%.  TeamSTEPPS training to Perioperative clinical staff was performed bi-weekly with all new hire staff members.  However, the surgeons and the anesthesia team members were not receiving training on a routine basis.

Methods

In January 2017, during a simultaneous presentation effort at three different physical locations and via WebEX, TeamSTEPPS was presented to 630 Anesthesia, Clinical, and Surgical team members. Each of the participating departments have TeamSTEPPS master trainers who delivered the presentations.   In addition, a new surgical safety checklist poster was placed in each OR outlining revised Universal Protocol elements and responsible party assignments.

Results

An online audit tool has been used in over 5000 audits during the subsequent 7 months. Results have shown a marked increase from 7% to 95% in compliance with the debrief elements.  Overall compliance with all Universal protocol steps has increased to 97% at all 3 facility locations.  Results are being reported by facility location as well as surgical specialty.   Both the Perioperative Leadership team and the Perioperative Quality Council review audit results monthly to evaluate progress, stability, and areas for concern.  A letter was drafted from the CMO/VP Medical Affairs to all OR RNs stating full support for the process.  The letter also outlined expectations for surgeon performance and adherence to the established process.  This letter was further signed by the Chairs of each surgical specialty department.

Conclusion

Since August, 2017, all three components of the checklist have met or exceeded the 90% compliance target set by the organization, with the Sign-in and Time-out being greater than 90% compliance since February 2017. Additionally, the auditor can also document when perioperative personnel do not participate.  In those instances, the Medical Director of the Operating Rooms is notified to address non-compliance.

Implications for the Patient

Standardized expectations surrounding safety considerations and communications are vital initiatives within the surgical arena. Reviews of root cause analyses have demonstrated that poor communication is the primary cause of sentinel events.  The teamwork principles inherent to TeamSTEPPS facilitate open and standardized communication across all members of the perioperative team.