Adapting the World Health Organization's Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol.

Objectives: The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. Background: The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC. Methods: A pre-post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites' health surveillance systems. Data analysis: Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. Setting: The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. Anticipated impact: We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.

Does the Type of Surgical Headwear Worn in the OR Matter? A Review of Evidence and Opinions.

Proper surgical attire is essential in decreasing surgical site infections; however, the effectiveness of the different types of headwear is a controversial topic. We conducted a narrative review based on studies identified through a focused literature search to summarize and critically assess evidence and opinions on the most appropriate type of headwear for OR personnel. We included 48 articles: 17 original research studies and 31 non-peer-reviewed articles of various types. Research published before 2014 mostly supports the complete coverage of all hair, which aligns with the 2015 AORN guidelines. However, more recent literature rebuts these guidelines and emphasizes the importance of clean headwear. Although earlier studies (published before 2017) lacked scientific rigor, later studies (published after 2017) have other various limitations, including missing data on compliance, surgery-related techniques, and surgical attire other than headwear. The findings from this review highlight the importance of solid evidence-based guidelines and expert collaboration.

We Asked the Experts: The WHO Surgical Safety Checklist and the COVID-19 Pandemic: Recommendations for Content and Implementation Adaptations.

BACKGROUND: As surgical systems are forced to adapt and respond to new challenges, so should the patient safety tools within those systems. We sought to determine how the WHO SSC might best be adapted during the COVID-19 pandemic. METHODS: 18 Panelists from five continents and multiple clinical specialties participated in a three-round modified Delphi technique to identify potential recommendations, assess agreement with proposed recommendations and address items not meeting consensus. RESULTS: From an initial 29 recommendations identified in the first round, 12 were identified for inclusion in the second round. After discussion of recommendations without consensus for inclusion or exclusion, four additional recommendations were added for an eventual 16 recommendations. Nine of these recommendations were related to checklist content, while seven recommendations were related to implementation. CONCLUSIONS: This multinational panel has identified 16 recommendations for sites looking to use the surgical safety checklist during the COVID-19 pandemic. These recommendations provide an example of how the SSC can adapt to meet urgent and emerging needs of surgical systems by targeting important processes and encouraging critical discussions.

Back to Basics: Social Determinants of Health.

Social determinants of health (SDOH) are the conditions that people are born into and live under that affect their health. Nurses are responsible for addressing these determinants when possible. Perioperative nurses encounter the effects of SDOH when patients express concern about surgery scheduling times, transportation, child care, and other support-related issues during the perioperative period. Some SDOH are related to social identity (eg, race, ethnicity, sexual orientation) as a result of the oppression and discrimination that some groups experience. Perioperative nurses can establish trust with their patients by identifying their needs and partnering with community-based organizations to address some of those needs (eg, transportation, legal assistance), which may help relieve stress for their patients and promote better postsurgical outcomes. Although health care workers can assist individual patients to address the effects of SDOH on their health and life, policy change is needed to ensure long-term benefits.

Back to Basics: Minimally Invasive Surgery.

In the past 20 to 30 years, minimally invasive surgery (MIS) has become commonplace in almost all surgical specialties. The needs of the perioperative team and patients are different during MIS than during traditional open surgery. The equipment and instrumentation required to perform MIS are extensive and continue to evolve as new techniques are developed. As advances in MIS occur and more procedures are completed using this method, some surgeons are conducting research studies related to the efficacy of certain longstanding MIS protocols. Perioperative nurses are challenged to stay current on the available technology and results of research studies so that they can provide safe patient care. This Back to Basics article will provide basic strategies for perioperative nurses to ensure successful MIS outcomes for patients.

Treatment of pancreatic cancer with intravenous vitamin C: a case report.

Pancreatic ductal adenocarcinoma (PDA) has a dismal prognosis and is often discovered at an advanced stage with few therapeutic options. Current conventional regimens for PDA are associated with significant morbidity, decreased quality of life, and a considerable financial burden. As a result, some patients turn to integrative medicine therapies as an alternate option after a diagnosis of PDA. Intravenous pharmacologic ascorbic acid (PAA) is one such treatment. The use of PAA has been passionately debated for many years, but more recent rigorous scientific research has shown that there are significant blood concentration differences when ascorbic acid is given parenterally when compared to oral dosing. This pharmacologic difference appears to be critical for its role in oncology. Here, we report the use of PAA in a patient with poorly differentiated stage IV PDA as an exclusive chemotherapeutic regimen. The patient survived nearly 4 years after diagnosis, with PAA as his sole treatment, and he achieved objective regression of his disease. He died from sepsis and organ failure from a bowel perforation event. This case illustrates the possibility of PAA to effectively control tumor progression and serve as an adjunct to standard of care PDA chemotherapy regimens. Our patient's experience with PAA should be taken into consideration, along with previous research in cell, animal, and clinical experiments to design future treatment trials.

Back to Basics: Pneumatic Tourniquet Use.

Pneumatic tourniquets are commonly used in surgeries involving the limbs to achieve a nearly bloodless surgery and an optimal operating field or when administering regional anesthesia during surgery on a limb. Complications can arise from the use of tourniquets, including nerve injuries, pain, compartment syndrome, pressure injuries, chemical burns, and tissue necrosis. More serious injuries-including deep vein thrombosis, thermal damage to tissues, severe ischemic injuries, and rhabdomyolysis-also can occur. Therefore, it is important for perioperative team members to understand how to use pneumatic tourniquets effectively and safely to provide the best possible care to patients. This article addresses the safety risks to patients when using pneumatic tourniquets and optimal safe use of these devices.

Back to Basics: Radiation Safety.

Perioperative team members and patients are frequently exposed to radiation during operative and other invasive procedures. The use of equipment that emits radiation (eg, a fluoroscopy unit) is beneficial for diagnosing and treating patients but carries the risk of harm if team members do not follow radiation safety guidelines. Perioperative team members should implement safety precautions for themselves and their patients when radiation is used. This Back to Basics article addresses the basics of radiation safety and the precautions that perioperative team members should implement in the perioperative setting.

Back to Basics: Sterile Technique.

Sterile technique is an essential patient safety principle that reduces the risk of microbial transmission to patients during surgery. The ability to establish and maintain a sterile environment is an important skill for all perioperative team members. Understanding the principles of sterile technique is crucial for anyone entering the perioperative environment. This Back to Basics article reviews sterile technique and the importance of all perioperative team members adhering to aseptic principles.

Back to Basics: Patient Care Transitions.

One of the most critical aspects of high-quality patient care is communication. If a breakdown in communication occurs, vital patient information may be overlooked and not communicated at the patient hand over. Breakdowns in communication contribute to a majority of errors in health care. Implementing a standardized hand-over protocol serves to improve the safety and reliability of this process and help decrease the risk of patient harm. This Back to Basics article highlights the steps to a successful hand over and provides strategies for developing an effective standardized communication process to reduce health care errors.

Back to Basics: Counting Soft Surgical Goods.

Retained surgical items (RSIs) pose serious consequences for patients and are a significant threat to patient safety. Perioperative team members are morally and ethically responsible for the prevention of RSIs and should understand how to reduce the risk of occurrence. The prevention of RSIs does not rest in the hands of one individual. It is a multidisciplinary endeavor that aims to reduce the risk of RSIs, and team members should hold each other accountable. This Back to Basics article focuses on the process of counting soft surgical goods, which are the most common RSIs.

BACKTO BASICS: ENVIRONMENTAL CLEANING.

The need for a clean perioperative environment is a basic principle for all perioperative team members. Recent evidence suggests that the environment plays a role in the occurrence of health care-associated infections (HAIs), including surgical site infections. Frequently cleaning high-touch surfaces helps prevent the spread of infections, and routinely cleaning and disinfecting the patient's environment can reduce the level and frequency of contamination and the risk of HAIs. Perioperative personnel should use a bundled approach to perform a standardized cleaning routine and implement a successful monitoring program.

Back to basics: procedural sedation.

Patients undergoing surgery frequently receive procedural sedation from RNs in the perioperative setting. With appropriate training, perioperative RNs can administer procedural sedation safely and effectively, helping to eliminate the pain and anxiety often experienced by patients. Facility sedation protocols should provide guidance on training requirements, the RN's role, the credentialing process, the medications the RN may use, and when anesthesia personnel should be consulted. Creating these protocols is guided by state scope of practice laws, Centers for Medicare & Medicaid Services Interpretive Guidelines, and accreditation requirements. Training, physician guidance, and appropriate protocols give the necessary support for perioperative nurses to provide safe and effective procedural sedation.

Back to basics: implementing the surgical checklist.

Surgery is complex and technically demanding for all team members. Surgical checklists have been implemented with different degrees of success in the perioperative setting. There is a wealth of evidence that they are effective at preventing patient safety events and helping team members master the complexities of modern health care. Implementation is key to successful use of the surgical checklist in all invasive procedural settings. Key strategies for successful checklist implementation include establishing a multidisciplinary team to implement the checklist, involving surgeon leaders, pilot testing the checklist, incorporating feedback from team members to improve the process, recognizing and addressing barriers to implementation, and offering coaching and continuous feedback to team members who use the checklist. Using these strategies will give the perioperative nurse, department leaders, and surgeons the tools to implement a successful checklist.