PATIENT SAFETY - PowerPoint PPT Presentation


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PATIENT SAFETY Protecting Patient s Right General Patient Safety Measures Admission of the Patient to the Operating Room PRPD/DN/DM/2010 – PowerPoint PPT presentation

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  • Protecting Patients Right
  • General Patient Safety Measures
  • Admission of the Patient to the
  • Operating Room
  • PRPD/DN/DM/2010

Protecting patients rights
  • protection of patients personal moral and legal
    rights begins at the time of admission.
  • The course of action involves correctly
    identifying patients, safeguarding their right to
    privacy and their right to make choices regarding
    their care and keeping confidential all records
    and reports.
  • Personnel who obtain consents or witness them
    should be aware of the conditions that ensure
    validity of the consent.

  • A signed consent must also be an informed
    consent, which implies adequate communication
    with the patient regarding the procedure or
    procedures for which the consent is being signed.
  • No surgical procedure should be performed without
    a signed and witnessed informed consent.
  • The surgeon is ultimately responsible for
    informing the patient about the proposed
    operation or other invasive procedure, its
    inherent risks and complications, and for
    obtaining consent.
  • On the patients arrival in the operating room,
    the circulating nurse and anaesthesia provider
    are responsible for verifying that the consent is
    on the chart and is correct, properly signed and
    witnessed before the administration of

General patient safety measures
  • Minimizes human error helps eliminate hazardous
    conditions for the patient undergoing operative
    or other invasive procedures.
  • In all perioperative settings, where the patient
    is unable to protect himself or herself, nursing
    personnel must provide protection for the
  • Communication of vital medical information to
    surgical team members is essential to safe
    patient care.
  • An allergy identification band is used to
    communicate a patients allergy to a given
    medication or substance. Patients should be
    queried regarding allergies to medication or food

  • All medication must be checked three times before
  • (1) When removed from the drug cabinet
  • (2) Before being drawn up in the syringe
  • (3) Before being given to the patient
  • Patients hearing tends to become more acute
    after administration of the perioperative
    medication and in the induction stage of
  • A quiet environment is essential for all
    patients awaiting surgery. Noise in the OR should
    be controlled and conversation kept to a minimum.

  • Stretchers and operating room beds must be
    stabilized with the wheels locked when a patient
    is moving from one to another.
  • All safety devices on stretchers and operating
    room beds must be in proper working order.
  • Locking mechanisms, side rails, restraint straps,
    intravenous standards, hydraulic controls,
    armboards and other protective devices should be
    used whenever necessary.

Admission of the Patient to the Operating room
  • Is a critical time for the perioperative nurse to
    gather data and help plan for the patients care
    and safety.
  • It is the opportunity to collaborate with the
    patient by identifying and verifying his or her
    needs and then planning care to meet those needs.
  • Empathic communication, good listening skills,
    being alert to nonverbal communication, offering
    gentle reassurance, providing explanations and
    utilizing comforting behaviours are essential
    attributes of perioperative nurses.

Institutional policy and procedure for patient
  • Should include the following steps
  • The perioperative nurse verifies the patients
    identification orally with the patient (if
    feasible) and compares the name on the surgical
    schedule with the name on the patients armband
    and medical record.
  • The procedure to be performed (including the
    operative site, side, and surgical approach) is
    verified by the patient and matched with the
    surgical posting, medical record, and consent
  • The operative consent form, history and physical
    examination record, laboratory results, and other
    examination or diagnostic results should be
    complete before surgery and reviewed by the
    perioperative nurse as part of patient assessment

  • Allergies previous unfavourable reactions to
    anaesthesia or blood transfusion previous
    reaction to latex religious cultural,
    spiritual, or ethnic preferences and any
    advanced directive must be carefully noted.
  • The patient should be queried about personal
    effects, including clothing, money, jewelry,
    wigs, religious symbols, and prosthesis such as
    dentures, lenses, glass eyes and hearing aids.
    The nurse is responsible for ensuring the safe
    handling and proper disposition of patient
    property and valuables.

  • The perioperative nurse should review the orders
    and results concerning pre-operative skin
    preparation, medication administration, and
    elimination, such as enema results and the amount
    of urine voided or collected through a catheter.
  • It is important to determine whether preoperative
    dietary and fluid restrictions (NPO status) have
    been maintained, this is crucial in preventing
    the aspiration of gastric contents during
    anaesthesia induction.

Cont .
  • The nurse should meticulously document any
    medications, fluids, blood, or blood products
    administered as ordered during the immediate
    preoperative period.
  • The nursing staff should apply side rails,
    locking devices, and safety straps on stretchers
    and operating room beds to prevent falls and
    injury to the patient during transport, transfer
    and positioning.

A Preoperative Checklist
  • It is frequently used to prevent oversights,
    omissions, and sentinel events, displays critical
    items to be checked preoperatively.
  • Sentinel events defined as an unexpected
    occurrence involving death or serious physical or
    psychological injury, or risk thereof.
  • (JCAHO, 1997)

Clinical Documentation
  • A record should be kept of each operation,
  • - the preoperative diagnosis
  • - the surgery performed
  • - a description of findings
  • - the specimens removed
  • - the postoperative diagnosis
  • - the names of all persons participating in
  • intraoperative care
  • This operative record is a permanent part of the
    patients chart.

Intraoperative Patient Care Record
  • Should include
  • Evidence of a patient assessment upon arrival in
    the operating room which includes an assessment
    of patients skin condition immediately before
    and after the procedure.
  • Evidence of a plan of care individualized for the
  • Any sensory aids or prosthetic devices worn by
    the patient on admission to the operating room
    and their subsequent disposition.
  • Patient position, including supports or
    restraints used.
  • Location of dispersive electrode pad placement
    and identification of ESU and settings used.

  • Location of temperature-control device placement,
    with identification of unit used and recording of
    time and temperature.
  • Placement of monitoring electrodes.
  • Medication administered or dispensed by the
    perioperative nurse.
  • Presence of catheters, drains, packing and
  • Location of tourniquet cuff placement,
    identification of unit, pressure setting and
    inflation and deflation times.

  • Fluid output, including blood loss estimates, as
  • Type, size and appropriate identifying
    information (such as serial number) of implants.
  • Skin-preparation solutions used, areas prepped,
    and any reactions to prep.

Cont .
  • Known allergies to medications, prep solutions,
    tape, latex, etc.
  • Sponge, sharp, and instrument counts taken and
    results obtained.
  • Wound classification.
  • Time of discharge and disposition of patient from
    operating room, including mode of transfer and
    patient status.

In Conclusion
  • Perioperative nursing document needs to describe
    the assessment, planning and implementation of
    perioperative care that reflects
    individualization of care, as well as
  • the evaluation of patient outcomes.
  • The design format such as Checklistswill
    minimizes time needed for the documentation
  • The End