Significant focus has been placed on patient safety in the Operating Suites to mitigate vulnerabilities with wrong-site surgery, surgical fire risks, and infection prevention practices. However, the potential for patient harm with minor procedures outside the surgical realm is often not considered a top priority for patient safety programs, even though the number of minor procedures is more prevalent. How well is your organization assessing your risks with procedural safety?
Minor procedures encompass a wide range of possibilities, including vascular access insertions, dental procedures, diagnostic testing, and other actions performed during patient care. Each presents its own unique patient harm risks. Organizations should ensure they risk assess these procedures to determine these unique risks as they develop their mitigation strategies. For our purposes, we will add the typical risk elements that will apply to all.
Key Elements of an Organizational Procedure Safety Review:
Risk Assessment:
Identify potential risks associated with each procedure and take preventative measures. Utilizing the principles of risk assessment, organizations should review procedures to identify potential patient safety risks. To support safe patient care, identified issues should be mitigated through checklists, training, and process modifications. These risk assessments should periodically be repeated to determine if any changes to practice or the care environment have created new risks.
Effective Communication:
Clear and concise communication between all healthcare team members, including verbal and written updates, to avoid misunderstandings. An effective and safe procedural team will ensure that all members are clear on their responsibilities, the elements of the procedure, and any emergency procedures. The Operative Suites utilize the time-out process to address these issues before incision to ensure all team members agree with the safety elements of the surgical procedure and can voice any concerns. Organizations should consider using the time-out process with minor procedures to ensure that all staff members communicate clearly and address any concerns for patient safety before the procedure.
Evidence-Based Practices:
Implementing procedures and safety protocols based on the latest research and proven effective methods. Implementing proven protocols from evidenced-based practice supports safe patient care and positive outcomes. Reviewing patient safety resources for the latest in harm prevention practices can keep staff abreast of potential risks during procedures. Look for literature that addresses patient harm events to determine if your practice is vulnerable.
Staff Training:
Providing regular training for all healthcare staff on safety protocols, including proper techniques and emergency procedures. Use your risk assessment to identify those issues that require staff training and/or competency. Ensure that you keep your procedure team's skills current with ongoing training. Use identified risks or near misses to update staff with changes in practice. Incorporate drills on emergency protocols to make sure your team knows how to respond to patient emergencies.
Patient Identification:
Always verify patient identity before any procedure to avoid administering treatment to the wrong person. Despite advances in patient identification processes, including bar code scanning, wrong patient procedures still occur. Organizations should review their patient identification process for all procedures to ensure that before any procedure, the patient's identity is verified according to your policy. If the patient does not indicate English as their primary language, staff must ensure they use their interpretive services process to complete this task.
Hand Hygiene:
Consistent hand washing or using hand sanitizer by all healthcare staff before and after patient contact to prevent infection spread. According to the World Health Organization, appropriate hand hygiene prevents up to 50% of avoidable infections acquired during health care delivery, including those affecting the health workforce. Does your organization audit hand hygiene practices with procedures? Are you also reviewing proper glove use?
Procedural Verification:
Utilizing a procedure safety checklist to confirm all aspects of a procedure are correct, including the patient, procedure site, and necessary equipment. Surgical checklists are hard-wired into the Operative environment patient safety process. A review of minor procedures demonstrates that the use of checklists is not as consistent even though these procedures do present with risk. Is there verification of the procedure site, and is this process consistently practiced? Organizations should risk assess their procedures to determine what elements should be included in procedural checklists. Is there a risk of a procedural fire? If so, then a fire risk assessment should be included in the checklist. Reviewing past reported incidents through Risk Management could also provide insight into checklist elements. Using checklists also implies that if there is concern with a particular element, this is addressed before the procedure.
Quality Monitoring and Reporting:
Monitor compliance with safety practices during procedures and promptly report any adverse events or concerns. Using observational data on compliance with safety protocols and practices is key in determining if staff practice is aligned with policy. Identify and address shortfalls. Review reporting data to determine if there are issues that were not considered vulnerabilities.
Summary
Organizations should address procedural safety as integral to their overall patient harm prevention efforts. Surgical procedures, with their invasiveness do present with more significant harm; however, medical procedures are more numerous and performed often in less controlled environments, which makes them potentially more susceptible to patient harm actually occurring. Addressing the key concepts presented here can help your organization reduce the risk of procedural patient harm events.
For questions or to learn more contact the C&A team at 704-573-4535 or email us at info@courtemanche-assocs.com.
Courtemanche & Associates specializes in Healthcare Accreditation and Regulatory Compliance Consulting Services. With over 30 years of being in business and 100+ years of healthcare experience amongst our consulting team, we are ready to assist with your accreditation and regulatory compliance needs.
