Preventing OR Specimen Errors

Tuesday, December 8, 2020 3:43:58 PM America/New_York

Operating Room Specimen Errors can be devastating as it can affect the patient diagnosis, treatment and outcome.  Imagine having the correct diagnosis given to the wrong patient, or a diagnosis that never makes it to the patient because the specimen is lost! How about those mislabeled specimens, labeled left when it should be right or right when it should be left?  Worse than that, how about the retained specimen that never makes it to the lab because it was “forgotten” to be removed?  

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Posted in Surgical Patient Safety By Sally Fulmer

Protect the Heels with Evidence Based Interventions

Monday, November 2, 2020 12:30:06 PM America/New_York

The supine position is the most common surgical position with the patient lying on their back with the head, neck and spine in a neutral position.   This position is not without pressure injury risk as there is increased pressure and shear forces to the scapula, occiput, elbows, sacrum, coccyx, and heels. Today we are going to look at ways to mitigate the risk for pressure injuries (PI) to the heel, related to the supine position. When a patient lies supine, all the pressure of their lower legs and feet rest on the heel.  Heel PI represents approximately one third of pressure injuries acquired, and can result in increased morbidity and mortality. In some cases, heel pressure injuries can lead to amputation of the affected limb.

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Pressure Injuries: A Never Event, Part 3

Wednesday, September 30, 2020 9:39:38 AM America/New_York

The National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance reports that hospital-acquired pressure injury prevalence in acute care settings to be approximately 10%; their effects on both patients and hospitals is significant. In the previous blogs, we have discussed what can be done to mitigate risk in the preoperative and intraoperative phases of care.  Today, we will discuss the importance of continued risk assessment and interventions in the postoperative phases of care.

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Pressure Injuries: A Never Event, Part 2

Monday, September 21, 2020 1:23:42 PM America/New_York

Last time we talked about the Hospital Acquired Pressure Injury (HAPI) and the unnecessary cost, pain and suffering that can accompany them.  Perioperative pressure injuries are real, as Spector, Limcangco, Owens and Steiner (2016) point  out, perioperative pressure injuries can increase the cost of surgery-related hospital stays by an estimated 44% and may add approximately $1.3 billion annually to health care costs in the United States.  

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Pressure Injuries: A Never Event, Part 1

Tuesday, August 25, 2020 1:29:00 PM America/New_York

Hospital Acquired Pressure Injuries (HAPI, formally pressure ulcers) can result in a lifetime of pain, suffering and even possibly death for the patient. HAPI rates are reported to the National Database of Nursing Quality Indicators (NDNQI) which is the, “Only national, nursing quality measurement program that provides hospitals with unit-level performance comparison reports (NDNQI, 2010b, p. 2). Healthcare leadership can use the information provided by the NDNQI to establish organizational goals for improvement at the unit level and mark progress in improving patient care and the work environment.

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