Summary of Parts 1, 11 & 111
Section 1 outlined the PICO problem. It stated that human errors and poor communication among members of the preoperative, the operative team and the surgeon were the main reasons for these irregularities. Surgical time-out, accurate site marking and effective channels of communication among medical attendants are among the major guidelines to correct or lower incidences of wrong site surgery. While these guidelines are apparently effective theoretical; it is important to understand that the wrong site surgery cases are mainly caused by small errors during surgery and preoperative procedures. Thus, it is critical that an organization focuses on identifying the possible overheads that lead to such errors and place effective measures to bring to an end the occurrence of these small errors that lead to great complications. The idea is to develop policies from within the organization that facilitates a seamless transition from scheduling to preoperative procedures and subsequently to the operating room (Michaels et al., 2007).
Section 11 contained a literature review of the PICO question Data from articles researched reveal that wrong site incision occurs more frequently than is presented in research documents (Hainsworth, 2005). Importantly, findings identified that factors responsible for wrong-site incision include non- standardization in marking of surgical sites. The importance of establishing marking sites standards would enable surgical staff - awareness in complying with a protocol in executing this task. As such, each surgical team member will be held accountable for checking to ensure that their role is maintained in the correct site standardized regulation. Researchers also cited delinquent pre surgical measures are a leading cause of site mistakes
Section 111 discussed how the evidence retrieve from section 211 could be transferred into practice. The movement of information from evidence into practice has its own unique protocol. Four distinct steps are recommended to follow when transferring evidence from the data level to implementation. First a plan to move the information logically must be prepared. The second step encompasses engaging the skills of appropriate professional within the organization such as surgeons, surgical and anesthetic nurses. They are expected to facilitate the intervention with their expertise. Thirdly is execution of the plan and the fourth and final stage is evaluating the process (Spring, Ferguson, & Pender, 2014).
PICOT question restatement and significance to nursing practice.
Is human error the cause of wrong-site surgery or the problem lies with poor communication within the surgical team?
Significance to Nursing Practice
The significance of the study to nursing practice lies in the fact that human errors and poor communication among members of the preoperative, operative team and surgeon are the main reasons for surgical complications. Precisely, accuracy in surgery time-out, appropriate site markings and effective communication channels among surgical staff have been identified as useful measures in facilitating incidences of wrong site operations.
Summary of findings from the articles you selected for your literature review.
Data from these articles reveal that wrong site incision occurs more frequently than is presented in research documents (Hainsworth, 2005). Importantly, findings identified that factors responsible for wrong-site incision include non- standardization in marking of surgical sites. The importance establishing marking sites standards is that all surgical staff will be aware of a protocol in executing this task. As such, each surgical team member will be held accountable for checking to ensure that their role is maintained in the correct site standardized regulation. Researchers also cited delinquent pre surgical measures are a leading cause of site mistakes
Forty-four percent (44%) of pre-surgical patient safety rules are compromises in surgical hospitals and centers. Patient safety is paramount in any clinical procedure. Concerns regarding high nurse turn over which influence practice errors since experienced nurses are absent from the clinical setting. Consequently, the checklist system become have become ineffective for valeting patient safety. Recommendations are that the check list systems ought to be standardized and pretested at intervals for irregularities. More than one professional verification of patient’s particulars/data before surgery ought was recommended to be conducted in three phases (Hainsworth, 2005). It was ultimately suggested that the surgeon, the staff, and the team going for the surgery procedure to ensure that the marking is correct. The pen used to mark the site should be indelible to ensure that the mark remains intact before the operation. The mark should also be an arrow that extends near to, at the exact point where the incision site is located (Makary, 2007).
Inadequate communication among pre-operative and operative teams was cited also as a major concern. Significantly, teams may fail to relay vital information about surgical procedure patient that are key in ensuring a safe and right surgical procedure. Standardized pre-checking methods e as well as site marking procedures eliminates surgical errors.
Description of at least one nursing practice that is supported by the evidence in the articles.
A Nursing practice that is supported by evidence in the article relates to checking of the incision site prior to the operation. It was recommended that this be conducted in three phases. The first check recommended is to be done by the operating room head nurse the surgeon who will be present during the surgical procedure and this should be performed in the ward a day before the surgery. Together they must verify that it is the correct patient, time for surgery, type of surgery and site. This should be conducted one day before the surgery (Makary, 2007).
In second The second verification process nurses on the surgical unit are responsible on the day of surgery to verify the patient’s identity before leaving leaves the ward for the operating theatre. Also a check list noting images and documentations needed for the operating room must be noted and available for surgeon/ operating room team (Makary, 2007).
The third verification process recommended by researchers is ensuring patients’ documents coincide with their identity and surgery site marked correctly for no mistakes in making incisions to the wrong site. This should be the responsibility of the each team member with the operating room head nurse overseeing the process. With regards to markings this should be made with an pen and visible until the time of surgery. Precisely, it must show an arrow extends towards the point of the incision itself (Makary et al., 2007).
Justification of response with specific references to at least 2 of the articles.
Two articles, which clearly document this preoperative safety measure are those written by Makary (2007) ‘Operating room briefings and wrong-site’ and Hainsworth (2005) ‘The NPSA recommendations to promote correct-site surgery’ retrieved from Journal of the American College of Surgeons and Nursing Times Journal. Makary‘s (2007) analysis was from a surgical nursing perspective, while Hainsworth (2005) recommendations were based on surgical errors observations committed by surgeons. This justifies the concept of surgical errors corrections’ responsibility lies with the whole surgical team, surgeon and surgical nursing staff. They are the team that must monitor patient safety from admission to discharge. Essentially, effective communication among team members has been cited as facilitating the three phase verification process.
Explanation of how the evidence-based practice that you identified contributes to better outcomes.
This evidence based practice contained in the three phase verification process is expected to eliminate numerous surgical errors. Wrong site incision has been a growing concerns in surgical interventions. The lamentation is that if nursing has moved from mere philosophy into science, why there are still so many medical / surgical errors. Stahel, Sabel, Victoroff and Varnell (2010) investigated ‘Wrong-site and wrong-patient procedures in the universal protocol era: analysis of a prospective database of physician self-reported occurrences.’ It was reported 27, 340 physicians self-reported errors in their practice better 2001 to 2008 (Stahel, Sabel, Victoroff & Varnell, 2010).
A total of 25 wrong patient and 107 wrong site errors were reported. One patient diet due to wrong site incision. Researchers concluded that ‘Strict adherence to the Universal Protocol must be expanded to nonsurgical specialties to promote a zero-tolerance philosophy for these preventable incidents’ (Stahel et.al, 2010, p 978). Consequently, this recommended three phase evidence-based practice that identified could make a significant contribution to better outcomes.
Identification of potential negative outcomes that could result from failing to use the evidence-based practice.
The negative outcomes that could result from failing to use this evidence-based practice have already been identified and creating numerous concerns. They include surgical errors related to wrong patient and wrong site incidences, which are escalating in the nursing profession. While nurses do not make incisions they work with surgeons who do. Ultimately, the entire team is accountable for patient safety within their distinct discipline and function/roles. Accumulatively, almost 50% of all malpractice trials were against surgeons in 75 of the largest counties in the US 2001, while 33% were against nonsurgeons (Bureau of Justice Statistics, 2002). Also, 4,132 medical malpractice payments were delivered to patients/relatives for surgery related malpractice in the US 2002 (Bureau of Justice Statistics, 2002). These statistics tell the magnitude of negative outcomes for non-compliance with protocol.
My strategy will entail meeting with my immediate supervisor to discuss the evidence and obtains her perspective regarding the implementation. Most organizations have a protocol through which concerns of this nature are addressed. If this evidence is not applied in my health care setting then it would be urged that steps are taken urgently to have it instituted,
Explanation of how you would communicate the importance of the practice to your colleagues.
My approach towards communicating this evidence base practice relevance to my colleagues would be obtaining statistics from the bureau of justice showing them how many surgeons and non surgeon staff have been sued for malpractice. It would be identified that the non-surgeon staff reflects surgical nurses who are responsible for adhering to protocol.
Description of movement from disseminating the information to implementing the evidence-based practice within your organization.
The movement of information from evidence into practice has its own unique protocol. Four distinct steps are recommended to follow when transferring evidence from the data level to implementation. First a plan to move the information logically must be prepared. The second step encompasses engaging the skills of appropriate professional within the organization such as surgeons, surgical and anesthetic nurses. They are expected to facilitate the intervention with their expertise. Thirdly is execution of the plan and the fourth and final stage is evaluating the process (Spring, Ferguson, & Pender, 2014).
Addressing concerns and opposition to the change in practice
The panel executing the implementation process will be available for one year after to address concerns and design strategies towards combating opposition to the project. Monthly evaluations will offer some guidance towards making adjustments related to concerns.
Bureau of Justice Statistics (2002). Medical malpractice trials. Retrieved November 4th, 2014
Hainsworth, T. (2005).The NPSA recommendations to promote correct-site surgery. Nursing
Times Journal, 101(12), 28–29.
Makary, M. (2007). Operating room briefings and wrong-site surgery. Journal of the American
Stahel, P. Sabel, A. Victoroff, M., Varnell, J. (2010). Wrong-site and wrong-patient procedures
in the universal protocol era: analysis of a prospective database of physician self-reported
occurrences. Arch Surg. 145(10):978-84.
Spring, B. Ferguson, J., & Pender, D. (2014). Implementation of Evidence-Based Practices.
Retrieved on November, 4th, 2014