MSSC
4152900-55880000SBAR for Universal Protocol with Surgical/Operative Invasive Procedure Implementation and ToolkitSituation: We have had wrong site, wrong patient surgeries in Wichita; we have had surgical fires; we have had patients not receive the correct antibiotics. We know that our time out processes are unreliable, i.e. there is great variability in how they are conducted and several facilities have been cited on recent regulatory surveys.Background: An effective time out has been shown to reduce mortality by 44%; morbidity by an almost equal amount.* The Joint Commission, CMS, BlueCross/Blue Shield, HCA, and Ascension all require a standardized time out.Assessment: A city wide initiative to drive reliability is the most effective way to meet the problem of variance among physicians, proceduralists, and operative and invasive teams.Recommendation:The following steps should be completed:Proceduralists, physicians, and staff will view the two time out videos for process and content.A brief pre-test and a short post-test will be completed to validate the understanding of content.The surgical/operative invasive procedures will be audited using a standardized tool in real-time to assure compliance and provide an opportunity for just-in-time education.Tool KitMSSC Website – (Gold button, top of home page)SBARVideo links Video Link,?Surgical/Operative Invasive Procedure Overview link: Link,?Surgical/Operative Invasive Procedure Educational Video link: Invasive Procedure Poster with identified roles - Medical Society of Sedgwick CountyUniversal Protocol with Time Out documentation formFire Risk Assessment Protocol-American Society of AnesthesiologyEducation Huddle Tool Policy per facility for Universal Protocol: Preventing Wrong Person, Wrong Procedure, Wrong Site Events and Fire PreventionIntegration of Electric Health Record (EHR)Pre and post tests for physicians, proceduralists, and staffAudit tool being tested and finalized*Links to evidence-based literature (de Vries, et.al. Bliss, et.al; Haynes, et.al.)Additional, AORN 3’x6’ Poster, Presented in Chicago, March 28-April 4Attitude Survey with results ................
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