Becker's Clinical Quality & Infection Control

17 Executive Briefi ng 2 EXECUTIVE BRIEFING SPONSORED BY The journey to zero harm in the OR: Insights and best practices from Cleveland Clinic H igh-reliability health systems operate under the premise that humans are fallible and errors are unavoidable, even in the best organizations. To support the journey to zero harm, healthcare leaders create systematic solutions by using safety processes and integrative technologies in tandem. Becker's Hospital Review recently spoke with Dena Salamon, MSN, RN, director of main OR at Cleveland Clinic, about the organization's safety priorities and how operating room teams achieve safety goals. A culture of safety promotes employee feedback, communication and continuous improvement Cleveland Clinic has a department dedicated exclusively to quality and safety, which focuses on the continuous enhancement of safety for all patients, employees and visitors. This well- rounded program forms the foundation of the organization's safety culture. According to Ms. Salamon, "We are committed to a just culture so we can improve the care we deliver and prevent potential errors. It's not meant to be punitive. Employees are encouraged to speak up when they see something isn't right. That gives the quality and safety department a chance to improve processes and change workflows so we can practice in the safest manner. One of our top priorities is meeting the national patient safety goals set by The Joint Commission." Communication plays a central role in Cleveland Clinic's commitment to safety. In fact, Ms. Salamon noted, "If communication is lacking in a healthcare organization, it can really make or break you in terms of safety." Before and during every surgical case, the interdisciplinary team and patient communicate with one another. The surgeon, anesthesia, the circulating nurse, the patient and anyone involved in the patient's care participates in a meeting called a huddle. "We want patients to speak up and take part in their care," Ms. Salamon said. "We think that's very important. It helps us to hit the necessary things during the surgical procedure." Robust education in the perioperative space may reduce the risk of harm for patients and providers Cleveland Clinic has developed a thorough education program for nurses, surgical techs and surgical assistants. This includes weekly in-services to ensure everyone is trained and knows how to do the right thing. "We continually introduce new products into the OR," Ms. Salamon said. "We want everyone to feel comfortable with them and to understand their usage. The in- services provide them with the opportunity to ask questions and to do a deep dive." In addition, surgeons routinely conduct morbidity and mortality conferences. Nurses are welcome to join if there is a particular case they are interested in or if they were part of something where they would like more education. Cleveland Clinic has approximately 54 operating rooms in the main OR. This excludes cardiac, vascular and thoracic. Nurses that have been newly hired for the OR must participate in a six- month orientation. They are educated within the subspecialty that they were hired into. At the end of their orientation, new hire nurses may visit other services to familiarize themselves with product locations and people who can answer questions. Given the importance of OR safety, Cleveland Clinic is also reaching back into the talent pipeline and participating in outreach with nursing schools to make sure that perioperative nursing practices — including safety — are incorporated into their curricula. Well-defined processes may minimize the impact of common hazards in the OR To reduce or eliminate the risks associated with common operating room hazards, Cleveland Clinic has adopted a variety of protocols. Surgical teams use timeouts, for example, to minimize distractions. "Before a surgical incision is made, every participating team member in the operating room stops for a timeout," Ms. Salamon said. "Even if you are simply in the room to retrieve a supply, you must pause if a timeout begins." Another important OR process is the safety checklist. Cleveland Clinic has integrated safety checklists into the preop, postop and intra-op phases of surgical procedures. "The safety checklist is similar to what a pilot does before taking off in a plane," Ms. Salamon said. "We make sure we have all the medications and equipment we need. We confirm that we have the correct patient and are prepared to do the right procedure. These are all areas that we cover before making a skin incision." When the procedure is over, the surgeons conduct a sign-out process, recapping what they did, outlining the postop care plan and enumerating the specimens that were removed and where they need to go. All of this helps deliver the best results possible for patients.

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