As operating rooms and surgical staffs become busier, leveraging technology to improve caregiver and patient safety will be paramount. Stryker Surgical Technologies is on a "Journey to Zero," meaning achieving zero harm in the operating room.
One way they strive to do this is helping achieve zero retained surgical sponges.
During a July webinar hosted by Becker's Hospital Review and sponsored by Stryker Surgical Technologies, several experts on retained surgical items discussed the problem of RSIs and how technology can address the issue. Panelists included:
- Julie Cahn, DNP, RN, CNOR, CNS-CP; senior perioperative practice specialist, Association of periOperative Registered Nurses (AORN)
- Clancy Harrington, change management consultant, C2 Consulting
- Valerie Marsh, clinical assistant professor, University of Michigan School of Nursing in Ann Arbor
- Dena Salamon, nursing director, operating room, Cleveland Clinic
- Rachel Nelson, SurgiCount brand specialist, Stryker
Five key takeaways:
- Although RSI incidents are rare, the impact can be devastating. The most common RSIs are surgical sponges, which can lead to infection, abscess, adhesion, fistulas, obstructions, perforations, reoperations or death for patients. Risk factors for RSIs include incorrect counts, long procedures, more than one procedure and human factors such as distraction or fatigue. Emotional costs on patients, families and healthcare staff are high. In addition, the institution's reputation is likely affected, and there may be costs for fines, litigation and settlements.
- Adjunct technology should be utilized to bring RSI incidents to zero. According to Dr. Cahn, AORN now recommends that surgical departments "implement adjunct technology to verify the location or the outcome of manual counting procedures for soft goods." AORN has shifted its recommendation from "may evaluate" to "should implement" this technology. Although manual counting remains important, it is susceptible to human error. In fact, during instances when an item has been retained, the count has been reported as correct between 62 percent and 88 percent of the time. "Adjunct technology is needed to help improve the accuracy of manual counting procedures," Dr. Cahn said.
- SurgiCount from Stryker supports RSI reduction efforts. "This product addresses key sponge management issues," Ms. Nelson said. "SurgiCount enables surgical teams to count and scan unique sponges, quickly locate lost sponges with RFID technology, quantify blood loss and digitally connect to the EMR and user dashboard." SurgiCount can detect a sponge left inside a patient.
- Reducing RSIs requires addressing stakeholder challenges and perceived barriers to change. Implementing a new process and technology to reduce RSIs requires making changes, which is often hard. "Remember that every project can be viewed from many angles, so try to stand in the shoes of your stakeholders and figure out how to speak a language that each one finds most compelling," Ms. Harrington said. For example, surgeons tend to respond best to data. The patient safety message may appeal to nurses, while administrators will be interested in financial implications. Ms. Salamon noted the importance of addressing barriers, such as the perception of additional time for procedures, delayed cases and costs of the technology. "When you focus on patient safety and the benefits of the technology, it's really a no brainer," she said.
- Instill a proactive mindset to prevent incidents and share successes. Ms. Harrington suggested that teams envision what they would do after an incident occurred — and then proactively take actions before an incident occurs. "Processing a mock routine surgical item event can offer perspective," she said. Ms. Marsh shared that each department at her hospital displays a board showing the date of the last retained item. "Some are going on almost three years of no retained items," she said. "That's empowering for people to see."
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