Patient Safety - OR Today

A Mediaplanet Guide to Patient and Professional Safety

Patient Safety

Jennifer Stone The “Wizards of Waverly Place” actress turned ER nurse shares how she balances her two passions

Focusing on patient safety drives better outcomes and greater profitability The benefits of mentoring new OR staff across all disciplines

JUNE 2021 | FUTUREOFPERSONALHEALTH.COM

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COVID-19’s Lasting Effect on Patient Safety & Better Healthcare Practices

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ealthcare professionals are innately caregivers, tending to patients in good times and bad. Yet despite their practiced resiliency, the microbiological attack that caught the world unprepared took a tremendous toll on even the most seasoned medical personnel and hospital administrators.

Any discussion of healthcare delivery from this moment forward compels us to pause and reflect on a year of stress, sacrifice, and extraordinary accomplishments. In hospitals across the country, heroic clinicians worked tirelessly amidst dire circumstances.

Every new challenge was an opportunity to think differently. We turned snorkel masks into PPE

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and flew ventilators across the country. For many, and for healthcare overall, the experience was transformative in unexpected ways.

We now have a collective responsibility to maintain the creative mindset that carried us through and apply what we now know we can do to promote safer patient care and help hospitals serve their communities.

At our organization, where anesthesia clinicians pivoted to join critical care teams, we looked for the silver linings in the pandemic’s dark storm. The most difficult days offered the most meaningful opportunities to innovate in real time and collaborate, to find solutions that saved patients’ lives and kept clinicians safe. When nothing was normal, when the old ways of doing things were no longer viable, every

John F. Di Capua M.D., CEO, North American Partners in Anesthesia (NAPA)

new possibility was a glimmer of hope.

Put patients first This new esprit de corps in hospital settings is something valuable that emerged from the chaos of COVID-19, something worth saving and nurturing as healthcare professionals work continuously to advance patient safety.

Inspired leaders from every department can create positive change by motivating others toward success. Our organization believes leadership works best when we

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bring people together, when we champion what we can achieve, and when we put patients first.

As the pandemic surged, our united mission to prioritize patient safety empowered people across all positions to speak up and urged us to welcome the creativity found in diverse voices. A lack of communication is the No. 1 failure that causes patients to be at risk. Enhancing care team communication is critical to improving patient outcomes. In operating rooms and executive offices, we can continue to listen and to respect and value voices from every member of our teams.

Embrace change What else can we do? Best practices today demand that we embrace technologies

that make us work smarter and keep our patients safer.

As early adopters of the surgical safety checklist, our organization found that the critical communication mandated by this simple but important tool effectively reduced preventable medical errors. Newer innovations offer game-changing ways to ensure that individual providers and care teams are equally informed about pre-operative risks and are working together across the perioperative care continuum, from multimodal pain strategies to reducing readmissions. Negative outcomes come at a very significant cost, both emotional and economic. A can-do approach to stronger patient safety programs will promote better patient experiences and commensurate economic benefits to healthcare providers. n

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Publisher Chloe Addleson, Nellie Dubin Business Developer Joelle Hernandez, Gretchen Pancak Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Kayla Mendez Lead Editor Mina Fanous Copy Editor Taylor Rice Partnership and Distribution Manager Jordan Hernandez Director of Product Faye Godfrey Cover Photo Ian Phillips All photos are credited to Getty Images unless otherwise specified. This section was created by Mediaplanet and did not involve OR Today. PLEASE RECYCLE.

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Educating Patients and Providers About Managing Pain Without Opioids Over the last 20 years, there’s been an increased focus on patient satisfaction and pain control.

How COVID-19 Has Changed Surgery Forever

Dr. Jonah Stulberg, assistant professor of surgery at Northwestern Medicine and director of opioid reduction practices for the Illinois Surgical Quality Improvement Collaborative, says now is the time to reset expectations both for patients and providers.

Resetting expectations “The hardest thing that we need to overcome is this culture that’s built up around the elimination of pain,” he says.

Since the risks of taking opioids have also historically been downplayed, patients now expect to be pain-free around the time of surgery.

Dr. Stulberg, who is also on the opioid reduction task force for the American College of Surgeons, says 80 to 85 percent of patients are prescribed opioids following a procedure. According to Dr. Stulberg, this is the wrong approach.

Instead, it is important that patients start with drugs that have the lowest risk of addiction, such as acetaminophen or ibuprofen. Then, additional medications can be introduced as needed.

A positive outlook “Pain needs to be adequately treated but not eliminated,” says Dr. Stulberg.

Patients should talk with their doctor about pain management before their surgery.

There is hope for the future. He says some promising non-opioid pain products in clinical trials may offer prolonged pain management for 3-5 days. Plus, the healthcare community may start adjusting their pain management practices.

“If we can make that cultural shift, [it] will fundamentally do a lot of good for society,” he says.

Kristen Castillo

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Beverly K. Philip M.D., FACA, FASA, president of the American Society of Anesthesiologists, provides answers to common questions about surgery in a COVID-19 world.

Will I need a COVID-19 test before surgery?

You will likely be required to have a negative COVID-19 test. If you need emergency surgery and test positive or results aren’t available, health care providers will take extra precautions, using enhanced PPE and placing you in quarantine for recovery. For non-urgent surgery, patients without COVID-19 symptoms should have a negative polymerase chain reaction COVID-19 test prior.

Does COVID-19 or the vaccine interfere with anesthesia?

No evidence exists that COVID-19 or the vaccine interferes with anesthesia. However, because surgery puts extra strain on your body, you should wait until you are fully recovered or fully immunized after vaccination.

Is it safe to have surgery if I had COVID-19 or been vaccinated?

You can have surgery once you’ve fully recovered from COVID-19. The ASA recommends waiting four weeks (if you had no or mild symptoms) to 12 weeks (if you were admitted to the ICU) to have

surgery. If you’ve been vaccinated, schedule surgery two weeks after the final dose.

Should I wait until I’m vaccinated to have surgery?

If you are having non-emergency surgery such as a hip replacement, it is wise to get vaccinated first.

Will surgery take longer now?

Most institutions have added time between surgeries for increased cleaning, so surgery may occur later or take longer to schedule. n

Why Patient Safety Needs to be a Priority for Hospitals and Surgery Centers

A focus on patient safety provides better outcomes for patients and drives profitability and customer satisfaction for hospitals.

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orth American Partners in Anesthesia (NAPA), one of the leading single-specialty anesthesia and perioperative management companies in the country, prioritizes a commitment to safety and quality care. Every year, they serve about three million patients at over 500 healthcare facilities nationwide.

“We are really focusing on the patient,” says Julie Marhalik-Helms, BSN, RN, Vice President of Quality Improvement (QI) at NAPA. “We want patients to have a great experience, and we want to make sure that they have the best clinical outcome.”

NAPA uses a multi-pronged approach to achieve best outcomes and high quality care, including

partnering with clinical sites to implement Enhanced Recovery after Surgery (ERAS®) protocols, utilizing a patient-centered, evidence-based approach to improve patient care, decrease recovery time, and optimize patient outcomes.

Patient Safety Institute, one of only 93 Patient Safety Organizations (PSOs) in the United States approved by the Agency for Healthcare Research and Quality (AHRQ), to create a Culture of Safety across NAPA’s organization.

Patient outcomes Since 1986, NAPA has continually invested in technology, people, and processes to promote exceptional experiences for its patients and anesthesia clinicians. The company’s QI team now manages an anesthesia clinical database with over 10 million anesthetics reported, mining information to disseminate to its clinicians in 20 states and elevate patient care. Most recently, NAPA founded the NAPA Anesthesia

Reducing costs As NAPA continues to support the implementation of ERAS protocols at its hospitals and ASCs, it is also keenly focused on the prevention of unanticipated critical events and complications. Initiatives to enhance patient safety provided under its PSO include safe table case reviews, root cause analyses, innovative communication practices, and clinical education across the company’s national network of

nearly 6,000 anesthesia providers.

Additionally, NAPA’s Quality team regularly conducts quality meetings in which anesthesia leaders throughout the organization review complex cases, discuss standards of care, review patient safety and outcomes data, and highlight monthly patient safety topics that are presented to clinical quality leaders in an open dialogue forum. Marhalik-Helms says, “While publications cite a cost savings between $1,500$5,000 per patient for use of ERAS protocols, the costs associated with treating preventable complications and readmissions can be well into the tens of thousands of dollars. We focus on all aspects to promote the best results.”

Hospitals and ambulatory surgery centers (ASCs) also benefit from NAPA’s strong focus on QI. The federal Centers for Medicare & Medicaid Services (CMS) collects a variety of data to calculate a star rating for medical care facilities and clinicians, which is available to the public. NAPA’s Quality and Patient Safety Program provides support to its partnering facilities to optimize ratings, and has voluntarily reported quality data to the CMS Quality Payment Program (QPP, previously PQRS) since 2015, before reporting was linked to reimbursement. NAPA’s Patient Experience program has a proven track record in support of higher reported patient satisfaction, which is another factor in CMS’s star rating.

Marhalik-Helms says, “Our goal is to support our clinicians so that they can take the best care of our patients, and also to be a strong partner to our client hospitals and surgery centers.” n Kristen Castillo

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Reduce Risk of SSIs with Preoperative Skin Antisepsis AORN’s new recommendations for preoperative patient skin antisepsis work to reduce risk of surgical site infection before a patient enters the operating room.

Surgical site infection (SSI) is the costliest healthcare-acquired infection, with an estimated annual cost of $3.3 billion and nearly 1 million additional inpatient days annually. To support implementing practices that reduce the patient’s risk of developing an SSI, the Association of periOperative Registered Nurses (AORN) has revised its Guideline for Preoperative Patient Skin Antisepsis to reduce the patient’s risk of developing an SSI before they even enter the OR. Preoperative decolonization program SSIs can be caused by the patient’s own flora.

Adding decolonization programs for patient skin antisepsis is supported by a large body of evidence and allows the perioperative nurse to implement measures that can reduce patient risk factors associated with being a carrier of Staphylococcus. The evidence on decolonization programs includes: universal programs (treating all patients regardless of colonization status), targeted programs (treating only those patients identified as colonized), and blended programs.

Preoperative bathing The evidence about the effectiveness of preoperative bathing to reduce the patient’s own flora is presented in the guideline; the guideline recommends that preoperative bathing be implemented using a standardized protocol and clear patient instructions.

Bundled programs This guideline includes a discussion of evidence regarding evaluated implementation of patient skin antisepsis elements.

The evidence in this guideline suggests bundled approaches can be effective in reducing SSI rates.

Erin Kyle, DNP, RN, CNOR, NEA-BC, Editor in Chief, Guidelines for Perioperative Practice, Association of periOperative Registered Nurses (AORN)

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Empowering OR Professionals: Taking the Time In the modern OR, where we are focused on a fast turnover and getting our job done, it is critical that seasoned OR professionals take time to nurture new staff across all disciplines.

As busy surgical professionals, it is critical that we take time to mentor and empower new OR staff. Surgeons, PAs, nurses, and surgical technologists can benefit from each other’s shared experiences and knowledge base.

Mentoring and educating In addition to the standard OR orientation and education, there is no better opportunity to train new staff than by encouraging their early and active participation in the daily operation of the OR. For the seasoned OR professional, it is critical that we take the time to listen to the new recruit and help them to learn their role to become effective team members. The age of “eating our young” is long over. Mentoring, educating, and precepting should be the buzzwords of the modern era. The tradeoff is that new OR staff must be

seen as stakeholders in their orientation to the OR. They should complete all required learning modules and certifications required for their profession, and meet objectives set forth by the institution.

For the seasoned OR professional, it is critical that we take the time to listen to the new recruit and help them to learn their role to become effective team members.

Opportunities for growth I’ve found that there are great opportunities for growth in incorporating crisis checklists and implementing the electronic distraction protocol from the Council on

Surgical and Perioperative Safety. Many new faces to the OR are delighted to participate in the Theater Cap Challenge, and happily label their caps with their name and role. This identification is especially important for new team members and students.

New team members are vital in continuing to incorporate these safety measures into our daily practice.

Empowering and mentoring new OR staff through greater involvement and shared decision-making leads to higher career satisfaction for all involved. It enhances the flow of the operating room and can improve patient safety. Encourage new staff to ask questions and make decisions. Facilitate multidisciplinary work, from pre-op to post op, from the facilities team to the chief of surgery. It all starts with open lines of communication from all involved. Look for a new staff member to mentor today, especially from another profession. n Gerald T. Simons, PAC, Surgical PA, Board of Directors, American Association of Surgical PAs

When “Wizards of Waverly Place” star Jennifer Stone decided to earn a nursing degree, the curtain didn’t come down on her acting career.

At age 13, she began portraying Harper Finkle on the hit Disney Channel show, a character she played for half a decade. Shortly thereafter, she received some alarming health news.

“I was diagnosed with Type 1 diabetes, which inspired me to take a break from acting to get my nursing degree. I started work as an ER nurse in April 2020, and I’ve been balancing acting and nursing ever since.”

Taking the leap For Stone, pursuing a career in the medical field wasn’t an overnight decision. “I didn’t have the most positive healthcare experience during the four years it took me to get a definitive diagnosis and treatment plan. I felt like a lot of the healthcare professionals I interacted with didn’t believe what I was saying, because I didn’t fit the typical Type

pandemic teaches you about human beings and yourself.”

Making the Transition: From Disney Channel to the ER 1 model. I wanted to go into healthcare so I could make sure no one I encountered felt like they weren’t being seen and cared for when they needed it most.”

Stone even discovered a connection between her two professions. “With acting, you are required to exercise empathy with every character you play. With nursing,

you are required to practice empathy with every patient you treat. Neither work without it.”

Dealing with COVID-19 Admittedly, the past year has been full of unexpected experiences. “In nursing school, you learn a certain set of skills, and then you really learn everything once

you start your first job. Add the pandemic to it and that’s something no nurse could prepare for.”

“I learned about human resilience and stubbornness, and how much human connection is an inevitable part of nursing that you don’t teach. Nursing school teaches you a skill set. Nursing in the field during a

Interacting with former viewers Despite spending her days in scrubs, Stone still attracts plenty of fans. “I’ve been in full PPE with a mask, goggles, and cap, and they still recognize me by my voice.

It’s always very sweet, but definitely odd when someone says they enjoyed your work, and then you have to ask them about their last bowel movement.”

Chosen for the Oil of Olay “Face Anything” campaign that encourages young women to celebrate their natural beauty while exploring interests in STEM fields, Stone has advice for the next generation of students considering a career in nursing.

“Learn to expect the unexpected. I had a certain idea of what nursing would be, and then COVID-19 happened.

With nursing, you never know what it will bring, so it’s important to be ready for anything, and to remember why you got into it in the first place.” n Cindy Riley

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