Talking to Your Nursing and Surgical Tech Colleagues

Could This Happen Here?

The Time Out• Time Out Led by circulator.• Circulator stated procedure as booked “Percutaneous

adductor tenotomy of the right and left groin”. • Team not actively listening or engaged but stated that they

agreed with Time Out. • Attending surgeon made incision and proceeded to open

and not do the procedure percutaneously as booked and as consented.

• Circulator observed large incision and questioned attending surgeon pointing out that the consent did not match the procedure.

More Facts• Attending surgeon stated that he had previously

talked to the family about the possibility of opening, but did not discuss with the team or write it on the consent.

• Circulator requested the consent to be corrected with the family and the consent was later amended.

• Team subsequently got into bleeding that required a general surgeon to assist with vascular repair.

What Could Have Helped?• If the surgeon led the time out and actively

participated.

• If a briefing was conducted where the operative plans and change in procedure would have been discussed.

We are very good at what we do….We can be even BETTER

How Can the Checklist Help Us Be Better?

• It makes sure that we do the things that our surgical patients need every time.

• It improves communication, teamwork and the culture of safety in our hospital.

• It can make surgical teams better prepared by reviewing necessary equipment and the operative plan.

Physician Acceptance and Leadership support is the

Critical Factor in Successful and Meaningful Use of the

Checklist

How Do We Feel in the OR as Nurses

• Before going into the OR I need to prepare my approach depending on surgeon or team.

• I know when there will be a battle and I need to prepare my response.

• Try to be positive during the surgical case, no matter what happens.• Nursing carries the load to ensure that the safety checks are

completed.• I don’t want to be the enforcer but sometimes need to be for patient

safety. • I am not the right person to convince a surgeon who refuses to do

this.• Some frustration when team is not open and I feel shut down.

How Do We Feel in the OR as Scrub Techs

• I am part of the team and am responsible for patient safety as much as everyone else.

• I don’t want to waste time fighting about this- I wish we could just do it!

• Ready to change my approach, depending on who I am working with in the OR.

• The majority of the team will listen and participate, but I may need to help remind the surgeons to follow policies.

• Willing to back up circulator and to take on equal responsibility to ensure that this is completed for my patient.

• I think that it is the right thing to do.• If I were the patient I would want it done for me.

We Can Make a Difference

• It is important to work as a team to improve the safety and outcomes of our patients.

• We are not powerless to make change.

• We are part of a surgical team and often in the position of leading that team – that is a privilege and an opportunity to make a difference.

Your Role In This

• You have the power to initiate and lead the checklist, if needed.

• Speak up when information is not shared or if you have questions.

• Become a leader in the OR when other team members do not.

• Engage the attending surgeon to brief about the patient and the surgical procedure with the team.

• Initiate introductions.

• Set a professional tone.

• Encourage team members to speak up.

• Encourage the team to debrief before the patient leaves the OR.

What is This Really About?

• This isn’t just about you as an individual and what you need.

• Everyone is in the room for the patient and all of the people around you need your help, encouragement and leadership.

• Surgery is a team effort and the most effective and safe surgical teams recognize that.

This is About Teamwork

• Communication

• Coordination

• Team performance valued over individual performance

• Leadership