Contra Costa County AORN 2007 Delegates

Carmel T. Engel, Treasure
Kathy McCrarey, Board Member
Barbara Jones, Nominating Committee
Bruce Miller, Past President
Martha Gex, Vice President
Diane Graham 2007 President Delegate Chair

Delegate Reports

Making a Difference through Research
Diane Graham, RN Delegate chair

I attended numerous presentations at the 54 th Congress in Orlando this year so it was difficult to choose just one about which to write. However, since I am currently on a Research/Evidence Based Practice Council at John Muir Medical Center, Concord, I decided to discuss the presentation entitled “Making a Difference Through Research”. I have the impression that most nurses view research as something that is just done by advanced practice nurses or nurse researchers when actually it is front line clinical staff and their patients that can most benefit from it. Florence Nightingale was the firs nurse researcher and many of her then “revolutionary” practice recommendations were formulated by the observations of her patients. Although the value of music therapy is now supported by current research, over 100 years ago Florence required her nurses to learn to play the flute because she believed music was comforting to patients.
If we all learn to ask ourselves “Do I know why I do what I do?” we will discover whether what we do in our nursing practice is actually supported by science or is just an unproven ritual. The presenter, Dr. Sandra Siedlecki, asked “What if we (as the nursing profession) never got involved in research?” No changes in practice would ever be based on evidence, there would be no unique data base in nursing and without a unique knowledge base, N ursing would not be a profession. Patient outcomes would remain as they were in the early 1950’s with high mortality rates and increased pain and suffering. According to the presenter, the role of medicine is to cure disease but N ursing’s goal is not to cure but to make the cure more bearable. Is there a better way to do what we do ? Is there some practice that we do that seems nonsensical to us? Is there a valid reason for doing what we do or is it just because it is something that we have always done? Dr. Siedlecki stated that to get the knowledge an d learn the skills of research we should find a mentor, take a class, go to a conference or talk with nurse researchers. We need to make the time to form research groups and turn projects into studies. She told the audience to ask the tough questions “Why are we doing this and why are we doing it this way?” I really felt her presentation brought the value of doing research to an understandable level and inspired me to think about what I could do in my own prac tice to make a true difference in perioperative patient care .

Oh My Gosh, I’m In A Lawsuit!
Presented by Terri Daniels, RN, CRNFA, MCHS
Cheryl Koob, RN, Director Risk Management and Performance Improvement, MCHS

Yes, it can happen to you! The class included general information on perioperative lawsuits, and one case in particular. The sources of potential claims are:
·�� Wrong site/wrong procedure/wrong patient
·�� Informed consent issues
·�� Improper performance of procedure
·�� Surgical misadventures/complications such as lacerated or nicked bowel or blood vessel
·�� Surgical burns, fires
·�� Retained foreign bodies
·�� Positioning complications
In a 20 year review of Malpractice Claims 41% of surgical errors were caused by a lack of technical competence, and 58% of those errors were shown to be due to surgeons’ lack of experience or sk ill even within their specialty. Surgical claims data showed:
·�� 25% of errors found led to death
·�� 58% of errors resulted in a patient injury
·�� 75% occurred in intraoperative care
·�� 82% of errors were found to have systems factors
·�� One or more of four systems fact ors contributed to 68% of errors,BR> The Four System Factors are: ·�� More than one surgeon involved or multiple surgeries during one visit to the OR
·�� Surgical team pressed for time
·�� Failure to review medical records, unusual characteristics, or imaging studies immediately before operating
·�� No formal procedure for verifying correct site (time out) immediately before starting procedure
·�� Atmosphere in which surgical team members feel they are not permitted to point our errors or question physicians

The case used as example was a thoracotomy in lateral position with IV infiltration resulting in significant upper extremity injury. Patient positioning made the IV site inaccessible to the CRNA. Patient had resulting I&Ds and skin grafting. Patient sued for loss of function of arm. A private detective proved plaintiffs claim false, however, when he was seen mowing his lawn using both arms quite well. Excellent documentation saved the case. No negligence found on the part of the CRNA or hospital. Another case was discussed where a patient’s Stapes surgery was cancelled intraoperatively due to laser malfunction. Patient awarded $300,000.00. DOCUMENT ACCURATELY AND CLEARLY!!
Submitted by Bruce Miller, RN, BS, Charge Nurse IV

Upper Airway Laser Safety
Clinical Improvement/Innovation Poster Session #109
Margaret M. Wojcik, RN, CNOR, CMLSO, Christiana Care Health Services, Newark, DE

The purpose of this presentation was to highlight the Patient Safety issues unique to Otorhinol aryngology and Head Neck Surgery such as the use of lasers in the airway with its potential to create an airway fire. I was impressed with the 3 - step process for the surgical team that was presented, with the circulating RN verbally announcing the fire risk assessment prior to the start of each procedure, and documenting such on the “ID of Patient, Procedure and Surgical Side/Sites, and Fire Risk Assessment” form used at Christiana Care.

Step 1: Surgical Team prepares room and patient: No flammable agen ts, Halon fire extinguisher, moistened sponges, ET tube cuff w/ tinted saline, and lowest concentration possible of O2, with N2O avoided, for head/neck procedures w/supplemental O2, coat facial hair near site w/water soluble surgical lubricating jelly

Step 2: Laser Operator will verbally confirm with all members of surgical team: Fire Risk Assessment Check - off list for Upper Airway Laser Procedures Are we using a laser safe endotracheal tube? Is the Oxygen concentration 30% or lower? Is there methylene blue/saline in the endotracheal cuff? If using an O2 mask or nasal prongs, has the O2 been turned off for at least one minute? Has the patient used a hair product that could be combustible: i.e. hairspray? Is the operative field protected with wet towels? Are the patient’s eyes protected? NO NITROUS OXIDE!!!

Step 3: In the event of an airway fire, take the following steps: Stop ventilation Disconnect oxygen source Removed burned tracheal tube Flood airway with water, if needed Mask ventilate/reintubate Di agnose injury, provide therapy by bronchoscopy Administer short - term steroids Administer antibiotic and ventilatory support as needed

Delegate Report Submitted by Martha Q. Gex,RN,BSN,CNOR,SN IV

SCIP(SKIP) SURGICAL CARE IMPROVEMENT PROGRAM
ENDURANCE, CHALLENGE, OPPORTUNITY
BY DAVID R. HUNT MD AND LINDA K GROAH RN MSN CNOR

Avoidable deaths are the most extreme consequence of defects in health care, but harm is another important factor and on e that tragically affects many more lives. Many harmful effects have lasting effects on the lives of patients and their loved ones.
For this reason the SCIP project has been formed by the Centers for Medicare & Medicaid Services, the Center for Disease C ontrol and the Joint Commis s ion. ion. The goals of this project is to improve the care of the surgical patient by standardizing practices to reduce surgical complications. It is a unique partnership that promises to be a transformational undertaking in Health Care.
Partners in SCIP believe that a meaningful reduction in surgical complications depends on Surgeons, Anesthesiologists, Peri - Operative Nurses, Pharmacists, Infection Control Professionals and Hospital Executives working together to intensify thei r commitment to making surgical care improvement a priority.
The Practices they want to implement across the country to improve surgical outcomes are:

  • 1. Universal Protocols; Time - Outs - conduct a pre - operative verification process, patients name, procedure, side and site and relevant documents.
  • 2. SSI - Accounts for 14%to 16% of all hospital acquired infections and are a common complication of care. Surgical Site Infections - Hand washing is the number one method to prevent the spread of infections. No more razors in the OR. Clippers should be used sparingly to decrease the amount of small cuts to the skin or not at all.
  • 3. Antibiotics - to be given one hour or less before the skin incision to receive the maximum effects of the drug.
  • 4. Sequential Compression Stockings - to be placed on every patient having a general anesthetic to help prevent deep vein thrombosis. 5. Forced - Air Warming - to all patients one hour before they enter the surgical suite, during the OR experience and post - op to keep the core temperature at 36degrees Cent igrade which in turn shortens the length of stay in the PACU, decreases the pain threshold and initiates healing faster. By the year 2010, medical costs will increase by 50% across America. Our population will have a markedly higher increase in people ove r the age of 65. We need to start now with ways to make the surgical experience safer for our patients. Beginning with these tools is a start in making a nationwide effort to keep our patients safe without further harm within the Hospital Experience. Thank - you for allowing me to be a Delegate for the 2007 AORN Congress,
    Carmel T. Engel RN, CNOR

    What is Exceptional Service?

    Fred Lee was the guest speaker for the g eneral session at AORN 54 th Congress on Wednesday. He is the author of “If Disney Ran Your Hospital, 9 ½ Things You Would Do Differently ” . Mr. Lee discussed the importance of providing exceptional servi ce to our patients and members. He emphasized that survey s where patients indicated they were “ satisfied with their care” were survey s that health care giver should be concerned about . He feels that patients who are just “satisfied” have no story to tell. Everything was just okay. People who received poor service have a story to tell. They tell it often and to everybody that will list en. Patients who receive exceptional service also have a story to tell and that is what we should aim for .

    Mr. Lee related a story of a young boy with a sore th roat. His regular doctor was out of town so his mother made him an appointment with a new doctor. When the new doctor came into the room he walked past the mother, got down on one knee and talk ed to the boy first. He acknowledged his sore throat and how much it must hurt. He requested the boy ’s permission to swab his throat to “catch an invi sible germ”. He told the boy the he needed medicine and that he knew it hurt to swallow, but did the boy think he would be able to take the medicine. Then he spoke to the mother. The mother knew her son would have received medicine and a throat culture from her regular doctor, but the way this doctor related to her son in such a personal manner gave this mother a story to tell and made her feel her son receive d exceptional service.

    Mr. Lee’s presentation was motivating and energizing. It was inspiring for all levels of nursing.

    Kathy McCrarey RN BSN CNOR

    Scott Pelley and Combat Nursing in Iraq

    On Tuesday during Congress I attended a Jerry G Peers Lectureship whose speaker was 60 Minutes correspondent Scott Pelley . Scott Pelley has received 5 Emmys and the Edward R Murrow award . He does 21 pieces a year for 60 minutes.

    He showed a captivated audience a segment he did on Combat Medicine in Iraq called “ A Fighting Chance”. The video we watched showed the Air Force Theater Hospital at Balad Air Base in Iraq, in which both military and civilian patients are given the very best of care possible. He interviewed a US Air Force nurse anesthetist, Lt Col Paulette Schank who talked about the difficult situations they encounter and how the whole team works together to fight for the lives of every patient. She talked about how they sometimes win against all odds and how “sometimes he [death] wins…You try so hard”.

    After the video was over he surprised the audience by having Lt Col Schank as a guest. Lt Col Schank had recently returned from her tour in Iraq. Schank talked with Pelley about what it was like to work in a combat hospital and how difficult it was leaving knowing nurses are so needed and the job is never done . She stated that her time in Iraq was one of the most rewarding experiences in her life . She emphasized the fact that they care for not only U.S. soldiers but civilians and sometimes those who caused the injuries. The same quality of care is always given to every patient regardless of who they are . She ended by putting out a plea for nurses to serve in the military services. She also talked about her recent experiences in Peru with Health Volunteers Overseas ( http:/// www.hvousa.org ), a non profit organization.

    After Lt Col Schank parted Scott Pelley shared a series of stories about people who had touched his life. Pelley concluded that “when you have the honor to travel the world and meet people [like these]’ you begi n to wonder about the choices you and others make.” He went on to state that we the audience should find a need and meet that need. He ended the talk by reminding the audience that when they watch a news story, they should not forget that “someone risked t heir life to bring you that news for free.”

    During the hour and half talk the audience cheered , clapped and gave standing ovations several times. It was a truly inspirational talk and I felt fortunate to have been part of it.

    Barbara Jones RN, CNOR

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