Patient Safety in the Operating Room
Journal: Seminars in Plastic Surgery
Citation: 2006; 20: 214-218
Authors: Ellsworth, Warren A.; Iverson, Ronald E.
Maintaining patient safety in the operating room is a major concern of surgeons, hospitals, and surgical facilities. Circumventing preventable complications is essential, and the pressure to avoid these complications during elective cosmetic surgery is especially important. Traditionally, nursing and anesthesia staff have managed patient positioning and most safety issues in the operating room. As the number of office-based procedures in the plastic surgeon's practice increases, understanding and implementation of patient safety guidelines by the plastic surgeon is of increasing importance.
Key aspects of patient safety in the operating room include thoughtful patient positioning, ocular protection, proper handling of electrocautery, and airway management. If performed correctly with attention to certain anatomic landmarks, preoperative positioning of the patient can prevent nerve injury and postoperative joint or muscle pain. In this article we discuss proper patient positioning with attention to protection against nerve palsy. Further, we discuss common patient positions on the operative table and highlight special concerns associated with each position. Other safety issues including prevention of ocular injury and proper management of electrocautery are discussed.
Responsibility of postoperative complications ultimately lies with the surgeon. Careful attention to patient safety guidelines is of paramount importance to surgeons, especially during elective cosmetic procedures. Attention to detail in patient positioning, eye protection, and bovie use can help avoid unnecessary perioperative complications and significantly improve the patient's cosmetic surgery experience.
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The patient is brought to the operating room on a wheelchair or bed with wheels (called a gurney). The patient is transferred from the gurney to the operating table, which is narrow and has safety straps to keep him or her positioned correctly.
The monitoring equipment and anesthesia used during surgery are usually kept at the head of the bed. The anesthesiologist sits here to monitor the patient's condition during surgery.
Depending on the nature of the surgery, various forms of anesthesia or sedation are administered. The surgical site is cleansed and surrounded by a sterile drape.
The work flow and work practices of the operating room (OR) and central
materiel service (CMS) department are often “behind the scenes” for both patients
and other health care professionals. Every hospital will have an operating room, and every operating room must have a department to reprocess and sterilize the surgical instruments.
The operation of this work center in the hospital is crucial for patient safety
The instruments used during a surgical procedure are different for external and internal treatment; the same tools are not used on the outside and inside of the body. Once internal surgery is started, the surgeon uses smaller, more delicate devices.
Despite the stringent standards of the OR and CMS departments, potential
dangers can still exist with regard to patient safety. Particularly, infectious risk
factors related to the operating room include: individual patient associated risks,
the condition of the OR environment, ventilation systems, cleaning and
sterilization practices, and habits and practices of operating room personnel and CMS traffic and work patterns must be designed to decrease the potential for
cross-contamination of personnel and equipment.
This prospective analysis exposed significant preventable process variations and events affecting patient safety. This study enabled us to objectively establish relationships between system conditions and human factors that compromised patient safety. The system-based vulnerabilities identified offer targets for intervention to reduce the burden on providers and increase margins of safety.
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