1. healthcare organizations
2. healthcare professionals
3. FDA
should strengthen the focus of existing processes on patient safety issues
1.
... [Show More] sense of trust among team members
2. development & support of proactive approach
3. dissemination & verification of receity of info to all levels of staff & management
4. sincere commitment to affirming safety as 1st priority
Culture of Safety
skill-based behavior errors generally occur
when our attention is diverted and we fail to monitor the actions we are performing
ex: a nurse inadvertently hits the wrong control button - the correct button is near the incorrect button
knowlege-based performance errors occur
when a nurse misinterprets a situation or incorrectly applies a rule
ex: misinterpretation of test results, or a nurse fails to respond to a device alarm
1. distraction (background noise, conversations, radios)
2. fatigue & sleep loss
3. drugs (including alcohol & caffeine)
4. juggling multiple activities
5. stress
6. boredom
7. frustration
8. anxiety
9. anger
10. physical stamina d/t occupational muskuloskeletal injury (back/shoulder)
situational factors which play a significant role in medical errors
What precaution should be taken when microfibrillar collagen is used as a hemostatic agent intraoperatively?
Avoid using it with an autologous blood salvage unit
Drains that allow for passive drainage of fluid from the body:
Penrose and T-tube
Benefits of a standardized count procedure:
1. Assists accuracy
2. Assists efficiency
3. Human error studies have shown that many errors result from deviation
Type of dressing used to prevent drying of the wound and increase the proliferation of epithelial cells:
Occlusive
When handling hemostatic agents such as collagen or gelatin sponges:
Must not be injected or allowed to enter large vessels, as extensive intravascular clotting may occur.
pledget
non-absorbable suture used when there is a possibility of sutures tearing through tissue.
common uses of a pledget
vascular closure, septal repair, myocardial closure, heart valve suturing, hepatic repair
ligature aka "tie"
strand of material tied around a vessel to occlude the lumen a nd prevent bleeding
transfixion suture
type of ligature = crisscross stitch placed to control bleeding from a tissue surface or small vessel when it is tied
bone wax
mixture of beeswax, isopropyl palmitate and a softening agent, which provides a mechanical tamponade effect to stop oozing from cut bone surfaces.
common uses of bone wax
orthopedic and neurosurgical procedures and on the sternum during heart procedures
mechanical hemostasis methods
bone wax
ligature
pledget
clamps
sutures staples
sponges
direct pressure
chemical hemostasis methods: pharmacological
epinephrine
vitamin K
protamine
lysine analogues (aminocaproic & tranexamic acid)
chemical hemostasis methods: topical ACTIVE agents
thrombins
chemical hemostasis methods: topical PASSIVE agents
1. collagen-based gelatins
2. spheres
3. flowable agents
4. sealants
Thermal/Energy hemostasis methods
1. High-frequency electric current from an ESU
2. Bipolar vessel-sealing devices
3. Laser energy sources
4. Ultrasonic energy
5. Radio frequency energy generated by Argon gas
Responsible for the accuracy of the sponge count
all perioperative personnel involved in a surgical case
required to perform the sponge count
2 people, with one being the circulating RN
simultaneously, audibly, separated
The scrub person and circulating RN should count sponges _____ and _____as each sponge is _____ from the others in the pack.
Counts should be conducted:
1. before the beginning of the operation
2. before any closure begins
3. when skin closure is begun
4. before circulating RN or scrub relief takes over
5. end of operation
standard, PPE
Use _____ precautions and _____ to prevent exposure to blood and body fluids when handling sponges.
radiopaque
Never use _____ sponges for postoperative wound dressings.
sponges with radiopaque markers must be used:
during any invasive procedure
Radiopaque sponges are used to:
drain pus, purulent, or necrotic material from a wound.
Penrose drain is used for:
abdominal surgery, peritoneal cavity, or skin wounds.
Nasogastric drain used for decompression of the stomach:
Levin tube
Nasogastric drain used to treat obstructive lesions of the small intestine:
Miller-Abbott [Show Less]