283 - Introduction of Interdisciplinary Sign Out/Debrief Tool to Improve Patient Safety in the Operating Room
Description: A perioperative working task force was assembled which consisted of multiple disciplines (nursing, surgeons, anesthesiologists, physician assistants, and radiology) that were asked to brainstorm on the areas in our practice that we needed to improve our communication to prevent safety related events. One of the charges of this group was to look at existing tools and determine whether they served to standardize and support communication of safe care expectations. During a three-day Hardwired Safety Tools Workshop, there was interdisciplinary discussion of how to improve existing workflows and add safety tools in the operating room. This dialogue fostered perioperative collaboration on content and commitment about what is needed to communicate during a “Surgical Debriefing” as well as elicit their opinions on how to create a safer environment for the surgical patient. The team created a sign out/debrief which would occur at the end of the surgery, prior to the surgeon leaving the operating room. A poster version of the tool was trialed in specific operating rooms for surgical team feedback and content reworded based on consensus. The task force developed an education plan to socialize and educate on the new safety tool. The plan used multiple teaching methods including computer based learning as well as multiple in-services, tips sheets, and newsletters. The tool is available in the operating room as a laminated poster and serves as a reference and prompt for the discussion at the end of the surgery. Completion of the tool is documented by the RN in the electronic medical record. The use of the tool has helped to improve patient safety and early identification of potential safety issues, which are now addressed in the operating room. The use of a sign out/debrief should be incorporated into the workflow for all surgical teams to improve patient safety.