Time-Out/Surgical site marking....

[ShirleyM]

Hey all,

I'm curious, has anyone had a hard time instituting the Time'out and Surgical Site marking in their workplace(i.e, has anyone gotten resistance from MDs about doing timeout/surgical site marking)? I know that where I work, we had resistance from a few MDs (2 names were brought up at a staff meeting about it), but now it's a non-issue. Last week at inservice we were told we had to start including patient positioning, special needs, implants, etc..in out timeout. I checked out JCHAO's website and it was mentioned as above. I look forward to your responses...thanks

[grimmy, RN]

since i've been an or rn for just about 6 months or so, the time out was new to me, but i think its a great idea, no matter what sort of team you're on. i work in a huge teaching facility, and i float through the services, so whether i am in ob or ent or ortho, i remember to do the time out. we've got a computer and paper documentation to complete for the time out, so its hard to forget it. it makes for extra complexity during vascular graft cases (where the graft is removed from one extremity to the other) and certain ortho/spine cases. its nice to see the attendings embrace it because it forces the residents to do it, even if they are "going through the motions."[/font]

[NurseFirst]

in my esperience administration, some staff, and physicians have not taken it seriously enough. what is said in meetings and prcaimed in the policy is not being done, but no one talks about it - staff nurses are aftaid to confront this. i believe that it is not possible to legislate ethical behavior. it is always easier to complain and grumble about "one more thing to do" or "hey - with some of our docs it will never happen."

am i distressed about it? yes, however i think that patient education will be the best way to address this - when patients start asking - "i thought you were supposed to mark where you do the surgery?" ther might be more compliance.

well, some of us have been around (on the earth) to see some pretty amazing changes in medicine: the use of gloves and other ppe; sharps containers; "safety" needles (which the hospitals really resisted because of cost--i've been told it was osha that laid down the law; needleless systems...) i'm actually still amazed that cpr was something that wasn't taught to the public before the 1960s or 1970s.

if a hospital is faced with the possibility of jcaho pulling their certification, changes will happen so swiftly you'll think it was always done that way.

nursefirst

[rcsc]

One would think that the threat of having their certification pulled would do it - well it was the JCAHO Guidelines that precipitated the changes they have made. What I find most distressing is how some regulatory body has to legislate and demand improvements. One would think it a moral obligation to do what is best for patients. Once the outcomes and statistics are out - and there are first hand experiences of physicians actually woriing on the wrong site - why wouldn't an organisation NOT do the right thing.

These questions are only rhetorical - Money is the bottom line, taking time our takes time away from the chargeable OR time, and it may make a physician late, or it might make some doctor mad, who then makes like miserable for first line staff and worst of all they fail to provide the best care.

Worst of all the resistance to change is so deeply ingrained - the nurses who advicate for patients are labled as Squeeky Wheels, or Trouble-makers, or a pain in the but, or anal. I have even seen it where the staff who do the right thing anyway - are blamed for high turnover, low moral, and they are fingered as the ones who are causing all the trouble.

I am on a soap box here - I had better stop while I am still somewhat civil.

:chuckle