Evidence-Based Practice
Discovery
The nursing practice issue of interest is the preventable surgical errors that occur due to the lack of mandatory time-out and briefings. The number of surgical errors has increased over the years leading to poor patient outcomes. Therefore, it is necessary to develop a solution that can eradicate the problem and inform the surgical nurses on the precautions they should take (Kumar & Raina, 2017). The scope of the problem shows that over 4,000 surgical errors occur annually in the United States. Over a period of 20 years, over 9,000 medical errors have been contested in court. The cost of the lawsuits was $1.3billion. Among the surgical patients, 6.6 patients died of medical errors, 32.9 were permanently injured while 59.2 were injured temporarily (Leong, Hanskamp-Sebregts, Wal & Wolff, 2017). The surgical errors mostly occurred among patients who were 40 years and above. Among the patients operated on wrongly, they amount to over 25,000 deaths annually in the United States (Network, 2017). The scope also indicates that surgeons involved in severe surgical errors were found to be involved in multiple medical errors. Statistics indicate that 60 percent of the errors occur due to operating on the wrong side such as the wrong arm, side of the head, eye or leg.
Summary
The practice problem is that failure to carry out time-out and briefings for surgical patients increases the likelihood of surgical errors. Healthcare providers are thus required to have the surgical briefings and time-outs to ensure they have the right patient, the right information on the surgery site, and the condition of the patient. Statistics indicate that over 4,000 surgical errors occur annually, and most of them leave patients in severe conditions or dead. Therefore, surgical errors can be reduced drastically within months if all healthcare providers adhere to the recommendations.
PICOT question: Does the implementation of a mandatory time-out and briefings for surgical patients reduce the incidents of wrong patient/site/procedures in surgical cases within six months?
The other sources used for data and information include systematic reviews, articles from respected authorities. Network (2017) shows that time-outs have been embraced in the surgical rooms to reduce the cases of surgical errors. It indicates that the time-outs should not be rushed or carried out amidst work-related pressure since it might be rendered less effective. On the other hand, Leong, Hanskamp-Sebregts, Wal, and Wolff (2017) carried out a study on the effects of perioperative briefing and debriefing on patient safety. The study indicated that preoperative briefing improved the climate in the operating room. The briefing was important since it reminded the healthcare providers of the specific details of their surgical work. Kumar and Raina (2017) show that surgical errors are preventable and thus all stakeholders should play their role to prevent the errors. It is thus necessary to create awareness among surgeon’s fraternity to address the issue.
Algie et al. (2015) carried out a systematic review of interventions for reducing wrong‐site surgery and invasive clinical procedures. The purpose of the study was to evaluate the effectiveness of clinical and professional interventions in reducing medical errors including wrong patient surgery, wrong site, and wrong surgical procedure. The systematic review involved searching for articles from Cochrane Library, EMBASE, Caribbean Health Sciences database, CINAHL among other recognized databases. The scholar argues that specific interventions are necessary to reduce the wrong-site surgery which is a disastrous medical error. The results of the study show that educational interventions were effective in reducing medical errors in dental operations. However, the strength of the evidence is weak since the results relied on two studies from specific populations. Therefore, more research is needed to verify the applicability of the educational interventions in medical practice to reduce surgical errors.
The evidence-based solution appropriate for the project is to carry out intensive time-outs which include checking for details of the appropriate patient, surgery site and surgical procedure. The evidence is supported by the studies carried out by Algie et al. (2015), Network (2017) and Leong, Hanskamp-Sebregts, Wal and Wolff (2017). Most of the medical errors in the surgical rooms occur due to lack of proper verification of details. For example, an error may occur because the last name of a patient is similar to another patient. When the nurses use one name to identify patients they are prone to the error of picking the wrong patient. The second evidence-based solution is that intensive research should be carried out to enlighten the surgical professionals on what they should do (Algie et al., 2015). The studies will also shed light on the weaknesses that lead to surgical errors. They will also recommend solutions that can be used to overcome the problem. Currently, the research is shallow and thus clinicians cannot make reliable decisions to solve the diverse problems that occur in the surgical rooms.
Translation
The practice guidelines that can be used to eliminate surgical errors is to design the surgical team in a way that the team members will have alternative roles. The reason for alternative the roles is to ensure the team members can counter check what their teammates had done (Algie et al., 2015). It will also be easy to identify preventable errors such as operating on the wrong patient. For example, a teammate can easily confirm if the right patient has been identified by counter checking the condition, the surgical site, and the disease. The second solution is to ensure that the surgeons who are found responsible for any medical error they should be placed on probation to prevent more severe conditions. The probation will be used to evaluate the mental condition of the person, the skills, qualification and experience in handling similar surgical operations. There is also a need to find surgeons who are involved in preventable errors and motivate healthcare providers who do their work correctly.
The change process involves various stakeholders including myself as the nurse. My role will be to identify the patients with their three or two names, medical record number, and date of birth. My responsibility is to ensure the patients taken to the surgical room are the right ones. The surgeons will be the other stakeholders whose role is to carry out intensive time-outs and briefing to verify all the details. The top management of the hospital including the nurse leaders will be involved in ensuring the practice guidelines are followed and punitive measures are implemented against those who fail to follow them (Algie et al., 2015). The nurse informaticist will be a critical stakeholder in ensuring the patients’ records are complete by accurately recording all the patient details.
My responsibility in the change process as a nurse is to become innovative, participate in creating new knowledge, development of policies and implementation of technologies. The innovativeness will involve proposing evidence-based solutions to the current problems. I will also participate in the creation and dissemination of knowledge to the various stakeholders. It is also my responsibility to collaborate with top management to develop policies which will ensure that the surgical errors are prevented permanently. I will also participate in the development of technologies that can be used to reduce medical errors by providing ideas on the real issues that occur in surgical rooms.
The project involves various stakeholders including surgeons who have four years of experience and certified by the board. The role of the surgeon is to provide accurate information on what happens in the operating room and how the errors occur. The anesthesiologist is required to show how the level of consciousness of the patient is affected by surgical errors. Scrub techs are involved since they will be responsible for showing how the medical equipment used during the surgery leads to surgical errors (Kumar & Raina, 2017). The circulating tech is providing information on whether time-outs and briefings are carried out all the time before an operation. Nurses are also involved as the first assistants to the surgeon during the operation. They will be crucial in showing how nurses propagate surgical errors and how the cases can be reduced.
A cost-effective analysis is necessary for the trial since it will compare two options and determine the best. The two options include weighing if mandatory time-out and briefings are important to reduce surgical errors or not (Kumar & Raina, 2017). The cost analysis will indicate if other interventions are better compared to mandatory time-out and briefings. The stakeholders to be involved in the cost analysis includes the surgeons, nurses, top management, circulating tech and scrub tech.
Implementation
The process of gaining permission to plan and carry out the trial has various steps. The first step is to answer all the questions in line with the integrated research system. The second step is to fill the clinical research network portfolio to ensure the authenticity of the people carrying out the trial (Leong, Hanskamp-Sebregts, Wal & Wolff, 2017). The next step is to wait for confirmation if the trial is viable or not. Once it is approved a person will go-ahead to provide full details of the project and how they intend to carry it out. The details are counter-checked with the reviews and trials already carried out to avoid duplication. Once the trial is approved permission to approve the trial will be issued. The specific committees involved include Local Clinical Research Network and Clinical Research Network. The nurse leaders will be involved to provide custom information on what should be carried out and why it is necessary.
The staff will be educated through the process of creating and disseminating knowledge. The first step will be to inform them of the reason why the change process is necessary. They will be presented with the facts and the statistics that describe the scope of the problem in the surgical rooms during a workshop (Leong, Hanskamp-Sebregts, Wal & Wolff, 2017). The nurses will be shown the proposed idea situation of eliminating medical errors. The nurses will be asked to participate as stakeholders during the process of carrying out the trial to provide information.
The timeline will consist of the various activities that should be carried and their respective timelines. The first step is to gather the facts about the scope of the problem within a period of two weeks. The next step is to present the proposal to carry out the trial and receive the approval within a week. The third step is to involve the various stakeholders and gathering information from various participants within three weeks. The final step is to analyze the data and present the findings within a period of one week.
The measurable outcomes according to the PICOT question include verifying if the implementation of a mandatory time-out and briefings is workable. The final outcome is to reduce the incidents of wrong patient/site/procedures in surgical cases within six months.
The forms to be used for recording purposes include cameras to record videos and take pictures, paperwork to document responses from stakeholders or observations.
The resources available to the staff include the reports of incidences involving wrong patient/site/procedures in surgical cases, data on the number of patients and surgeons involves. Other resources internal include findings of research studies carried out to recommend solutions to the problem. Additionally, I am available as a resource since I have been in the healthcare facility for a long time. There are also experienced professionals who have experienced the incidences first hand.
There will be meetings for the various stakeholders during the trial. The meetings will be carried out on the onset of the trial and after the permission is approved and finally before the presentation of findings. The meetings will involve the various nurses, surgeons, top management representative, anesthesiologist, informaticist, scrub tech, and circulating tech. The purpose of the meetings is to deliberate on the emerging issues and streamline the trial to generate the necessary outcomes.
Evaluation
The outcomes of the trial will be presented in a PowerPoint showing how the trial was carried out, the stakeholders involved and the methods used. It will present the incidences of surgical errors and the circumstances surrounding the issue. The report will majorly present the findings showing the effectiveness of the interventions proposed in the PICOT question. It will show whether the interventions are effective to reduce the cases of surgical errors. The purpose of reporting the outcomes will be to convince the various stakeholders that the interventions are necessary (Network, 2017). It will show them how to apply the interventions. The presentation will also leave a room for questions and comments on the outcomes. The questions will be answered based on the information acquired during the trial process.
The next step is to introduce policies in the healthcare facility that supports the outcomes of the trial. The policies will ensure continuity of care across generations. Additionally, it will be important to launch other studies on surgical errors to ensure that future decisions are based on the best and current evidence available. It will also be necessary to share information with other professionals to ensure they also cross-check the outcomes. The peer-review will help eliminate any form of bias. It is also important to assess the progress of the surgical department on the application of the outcomes (Network, 2017). The surgical department will report if the incidences have reduced and whether other measures should be taken to curb the crisis. The final step forward will be checking how other health facilities are reducing surgical errors. The information will be used to improve the outcomes to ensure the interventions applied are effective.
References
Algie, C. M., Mahar, R. K., Wasiak, J., Batty, L., Gruen, R. L., & Mahar, P. D. (2015). Interventions for reducing wrong‐site surgery and invasive clinical procedures. Cochrane Database of Systematic Reviews, (3). https://doi.org/10.1002/14651858.CD009404.pub3
Kumar, J., & Raina, R. (2017). ‘Never Events in Surgery’: Mere Error or an Avoidable Disaster. Indian Journal of Surgery, 79(3), 238-244.
Leong, K. B. M. S. L., Hanskamp-Sebregts, M., van der Wal, R. A., & Wolff, A. P. (2017). Effects of perioperative briefing and debriefing on patient safety: a prospective intervention study. BMJ Open, 7(12), e018367.
Network, A. P. S. (2017). Wrong-site, wrong-procedure, and wrong-patient surgery. Retrieved from https://psnet.ahrq.gov/primers/primer/18/wrong-site-wrong-procedure-and-wrong-patient-surgery.
