Checklists, Consistency, & Charting - PowerPoint Presentation

Slide1

Checklists, Consistency, & Charting

Paige KlemSlide2

Derived by the success in aviation and pilots

‘Pause Points’Should be team focused to communicate

Precise; Efficient, and to the point

Poor communication is the single most frequent cause of adverse events“They do not try to spell out everything– a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps—the ones that even the highly skilled professionals using them could miss” (Gawande, 2010, p. 120).

Development of a checklistSlide3

Goals of a checklist:

Foster teamwork, huddleIntroduction of namesVerbal, team checklist

Create consistency among teams

The Checklist Manifesto:How to Get Things RightBy: Atul GawandeSlide4

Trialed worldwide at 8 hospitals:

↓ 36% in all major complications↓ 47% in deathsInfections decreased by almost half

Returns to OR decreased by 1/4

thCatchesAntibiotic delivery or allergiesPre-existing medical problemsInstitution of WHO Surgical ChecklistSlide5
Slide6

Know your rolePractice within your scope

Be routine with stepsAllows steps not to get missedIncorporate checklists into your routine

Allows you to handle unexpected situations

Consistency With PracticeSlide7
Slide8

Medications/solutions used

TimeoutProcedure doneContact with family/caretaker

Implants identifying info

Radiology/imaging useSpecimens and dispositionSurgical countDrains, catheters, dressings, packing, etcWound classificationChargesDisposition of patientComplicationsCharting Inclusions

Initial assessment

Including identity of patient

Surgical site marked

Times- arrival, start, completion, exit

Disposition of devices/aids

Glasses, prosthetics

Position

Safety devices, restraints

Equipment identifiers

ESU

Tourniquet

Names and times of personnel

Level of anesthesia

Surgical site prepSlide9

Significant or major breaks in sterile technique

Affects the wound classificationEquipment used

ESU

SettingsIdentifiers- ex. Biomed #Skin conditionTourniquetIdentifiers- ex. Biomed #Limb occlusion pressure, if applicableCuff pressure and inflation timesSkin protection measures and assessmentRadiation protective measuresMeasures taken to prevent RSI and countsDVT prophylaxisTransfer mechanism or devices used

Additional charting itemsSlide10

Should reflect the ongoing evaluation of the perioperative care and outcomes

Chart the same way every timeActs as communication between providersFactual and objective information

To display the patients experience

Document with the flow of nursing careDo not double chart in multiple areasAvoid unnecessary narrativesBe familiar with downtime formsCharting tipsSlide11

Surgical Wound Classification AlgorithmSlide12

SURGICAL WOUND CLASSIFICATION

45

Classification

Description

Examples of procedure type

Class I: Clean (1% to 5% risk of infection)

Uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, and uninfected urinary tracts aren't entered

Primarily closed and, if necessary, drained with closed drainage

Operative incisional wounds that follow

nonpenetrating

(blunt) trauma if they meet the criteria

Inguinal hernia repair, ventral hernia repair, thyroidectomy, exploratory laparotomy, mastectomy, neck dissection, total knee or hip replacement, craniotomy, laminectomy

Class II: Clean-contaminated (4% to 10% risk of infection)

6

Operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination

Operations involving the biliary tract, appendix, vagina, and oropharynx provided no evidence of infection or major break in technique is encountered

Bronchoscopy, laryngoscopy, cholecystectomy (open or laparoscopic approach), appendectomy, small-bowel resection, gastrectomy, transurethral resection of the prostate, cystoscopy, pancreaticoduodenectomy (Whipple), total abdominal hysterectomy, vaginal hysterectomy

Class III: Contaminated (greater than 10% risk of infection even with prophylactic antibiotics)

6

Open, fresh, accidental wounds

Operations with major breaks in sterile technique (such as open cardiac massage) or gross spillage from the GI tract

Incisions in which acute, nonpurulent inflammation is encountered

Unplanned open cardiac massage (chest incision made without skin preparation or drape), appendectomy for appendicitis, bile spillage during cholecystectomy, diverticulitis, dry gangrene (tissue death without infection) in which nonpurulent inflammation is present

Class IV: Dirty (infected) (greater than 27% risk of infection)

6

Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera

Suggests that the organisms causing postoperative infection were present in the operative field before the operation

Incision and drainage of abscess, myringotomy for otitis media, perforated bowel, peritonitis, gangrenous wound with purulent drainageSlide13
Slide14

Patient identifiers

PreOp diagnosisProcedureLocation of incision(s)

Dressing, packing

Drains, catheters, tubes Stomas, etcComplicationsAllergies and reactionsMedications, fluids, irrigation usedPositioningOther pertinent issues:FamilySpecial requestsDevicesPatient deficits

Reporting to PACUSlide15

AORN. (2015).

Guidelines for perioperative practice (2015 ed.). Denver, CO: AORN. Gawande

, A. (2010). The checklist manifesto: How to get things right. New York, NY: Picador.

Phillips. (2007). Berry & Kohn’s operating room technique (11th ed.). St. Louis, MO: Elsevier Mosby. Rothrock, J. (2011). Care of the patient in surgery (14th ed.). St. Louis, MO: Elsevier Mosby. Wound

classification, OR. (2015). Lippincott procedures. Retrieved from:

http://procedures.lww.com/lnp/view.do?pId=691246&s=p

References: