30 Strategies to Target Top 10 Patient Safety Issues

Authors of an AORN Journal article recommended strategies to address the top 10 safety issues reported in a 2012 survey of members of the Association of periOperative Registered Nurses.


The authors reviewed current evidence for each safety issue and suggested ways perioperative nurses can further improve safety. Recommendations focused on enforcing evidence-based guidelines, collaborating across disciplines and communicating effectively. Here are 30 of their recommendations. Their full recommendations are available in the AORN Journal.



1. Preventing wrong site/procedure/patient surgery

•    Collaborate with scheduling personnel from surgeons' offices to implement a checklist for scheduling surgery.
•    Before the patient is transferred to the operating room, preoperative nurses should verify all necessary documents are available and surgeons should verify and mark the site using these documents.
•    Strictly enforce adherence to the time out.


2. Preventing retained surgical items

•    Minimize distractions and multitasking while managing counted items.
•    Alert the team that the count will be starting.
•    Participate in evaluating and selecting adjunct technology, and consider the ability of technological devices to detect failures in managing sponges. 

3. Preventing medication errors 

•    Separate medications for adults, pediatric patients and neonates.
•    Provide medication reference sheets with IV titration dosing guides for all medications in all concentrations available.
•    Standardize medication trays within the facility, including stocking the separate trays with appropriate doses for the patient receiving care. 

4. Preventing failures in instrument reprocessing 

•    Establish centralized oversight of a facility-wide reprocessing program.
•    Ensure personnel competency.
•    Require documentation of reprocessing steps.

5. Preventing pressure injuries 

•    Conduct a preoperative skin assessment.
•    Position and transfer patients in a manner that prevents shearing.
•    Collaborate with wound ostomy nurses to review internally collected data about pressure injuries and take corrective action based on this evidence. 

6. Preventing specimen management errors 

•    Label specimens accurately.
•    Eliminate multitasking during specimen management.
•    Ensure verification before sending the specimen out of the OR.

7. Preventing surgical fires 

•    Perform a fire risk assessment before making the initial incision.
•    Communicate about the use of an open source of oxygen or flammable prep agent before making the incision.
•    Allow ample time for flammable prep agents to dry.

8. Preventing perioperative hypothermia

•    Conduct multidisciplinary education about the pathophysiology of perioperative hypothermia and the effectiveness of interventions.
•    Use preoperative as well as intraoperative active warming.
•    Use prewarmed IV fluids.

9. Preventing burns from energy devices 

•    Educate perioperative personnel on how to use the device safely.
•    Have staff demonstrate competency.
•    Use the device in a manner consistent with the manufacturer's instructions. 

10. Responding to difficult intubation or airway emergencies 

•    Collaborate with anesthesia professionals, otolaryngologists and nurses in other areas in which anesthesia is administered to develop a comprehensive and institution-wide difficult airway management program.
•    Conduct a preanesthesia risk assessment.
•    Designate a rapid response team.


More Articles on Patient Safety:

Study: Quality Improvement Intervention Slashes Infection Rates
Study: Nurse-Directed Protocol Reduces Catheter Use 50%, CAUTIs 70%
Patient Safety Tool: Stop-the-Line Assertive Statement Training

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