AORN journal
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Retained surgical items were the most frequently reported sentinel event in 2010, according to The Joint Commission. Perioperative nurse leaders at Children's Hospital Boston, a pediatric teaching hospital, conducted a quality improvement initiative to reduce or eliminate incorrect counts and count discrepancies, which increase the risk of an item being unintentionally retained after surgery. ⋯ The initiative reduced the number of incorrect counts and count discrepancies by 50% between 2009 to 2010. These initiatives continue to be expanded, and the results have been sustained on an ongoing basis.
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In the fall of 2008, perioperative leaders at Brigham and Women's Hospital, Boston, Massachusetts, conducted a two-week trial of the World Health Organization Surgical Safety Checklist in the main OR. The checklist was incorporated by using a Plan-Do-Study-Act cycle. In 2009, we began a 14-week rollout of the surgical safety checklist to all our ORs. Critical factors that led to the success of this implementation included gaining executive leadership endorsement; recruiting volunteers from each discipline to lead the project; using quality methodologies to ensure a thoughtful, organizing implementation; providing frequent feedback and data; and confirming standardized use of the checklist by creating a policy.
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Achieving hemostasis is a crucial focus of clinicians working in surgical and trauma settings. Topical hemostatic agents-including mechanical hemostats, active hemostats, flowable hemostats, and fibrin sealants-are frequently used in efforts to control bleeding, and new options such as hemostatic dressings, initially used in combat situations, are increasingly being used in civilian settings. To achieve successful hemostasis, a number of vital factors must be considered by surgeons and perioperative nurses, such as the size of the wound; bleeding severity; and the efficacy, possible adverse effects, and method of application of potential hemostatic agents. Understanding how and when to use each of the available hemostatic agents can greatly affect clinical outcomes and help to limit the overall cost of treatment.
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Randomized Controlled Trial
The effectiveness and cost of passive warming in adult ambulatory surgery patients.
Hypothermia is a common problem for surgical patients and can result in many complications. Because few studies compare methods of passive warming, we used an unblinded, prospective, experimental, randomized design to compare the effectiveness of two passive methods of normothermia management in the postanesthesia care unit (PACU). ⋯ The treatment group had temperatures that were significantly higher than those of the control group 30 minutes after arrival in the PACU, and the treatment group experienced a greater change in temperature from baseline measurements to those taken at 30 minutes. The treatment group also used fewer warmed blankets, resulting in cost savings for the PACU.