Published on June 11, 2010

Taking a Time Out for Patient Safety

Genesis surgical teams do it for every patient, every time

When the Operating Room team on the Genesis Medical Center, Illini Campus celebrates "National Timeout Day" next Wednesday, it will re-commit to an important patient safety precaution that occurs before every surgery begins.

Wrong-site surgery and other preventable mistakes still occur too frequently in U.S. operating rooms.

Every patient, every time
That's why the Association of Perioperative Nurses began sponsoring National Time Out Day in 2004 to raise awareness about the importance of requiring the entire surgical team - physicians, nurses and surgical technologists - to pause before all invasive procedures, and to communicate as a group and confirm key information about the patient and procedure.

"Time Out" is part of The Joint Commission's Universal Protocol, which consists of three distinct parts - pre-procedure verification, marking the procedure site, and performing a "time out" immediately before starting the invasive procedure or making the incision, says Colette Kissling, RN, CNOR, Manager of the Illini Campus Operating Room.

"As we recognize National Time Out Day on June 16, it's important to remember that every day is time out day for perioperative
professionals working in all practice settings," Kissling says.

Patient safety is a No. 1 priority throughout Genesis Health System, and the "time out" before surgery is just one of many safety checks leading up to the procedure to prevent wrong site, wrong procedure or wrong person surgeries.

"The time out in the Operating Room right before the procedure is really the final ‘ta-da' in a long list of safety precautions that begin when a surgical procedure is first scheduled," Kissling says.

Take the example of patient Jane Doe, who is going to have a right total knee replacement. Jane's case is first introduced in Scheduling, when the doctor's office confirms the patient and her doctor and that she will undergo a right knee arthroplasty on Wednesday morning.

Confirming again and again
This information is confirmed again and again with Jane Doe, who will be asked to state her full name, her date of birth and her planned procedure to ensure her doctor's orders match "the right procedure, right body part and right patient." Her responses must match her ID band and be confirmed and verified with any radiologic exams, consents and other items that accompany her on her surgical journey.

The process is repeated when Jane undergoes pre-admission testing; again when she arrives at the outpatient surgery center; again when she's being prepped for surgery; and even again when she's in the Operating Room.

"We tell patients upfront that they will be asked these questions repeatedly because we want to make sure we're doing everything in their best interest," Kissling says. "Sometimes patients about to undergo surgery are stressed; they're worried; they can forget things. Asking the questions again and again can spark a memory. They might say ‘Oh, that did happen to me during my last surgery' or ‘Oh, I am allergic to that.' "

Even before Jane Doe enters the O.R. suite, the surgeon writes his or her initials on her right knee and confirms with her that this is correct.

"Marking the surgical site is a big piece of the process," Kissling says. "Staff can do all kinds of safety checks leading up to surgery, but the practitioner who is going to do the surgery needs to initial the site. That's done throughout Genesis."

When the patient enters the O.R. suite, the Registered Nurse who has done the pre-procedure verification with the patient, asks patient Jane Doe to tell the rest of the operating room team who she is and what procedure she is having done.

"Once the patient is under anesthesia, the entire team stops again and confirms ‘This is Jane Doe. We are doing a total knee arthroplasty. It's on the right knee,'" Kissling says. "This is considered to be the actual ‘time out' in the Operating Room before the surgeon makes his incision."

The Joint Commission requires all accredited health care facilities to practice a "time out" immediately prior to starting a surgical procedure as part of its Universal Protocol. The protocol also includes pre-procedure verification and marking the
procedure site.