Increasing the Use of the Surgical Safety Communication Tool: A Clinical Informatics Optimization Project

Purpose: The surgical safety communication tool was developed in 2015 at the recommendation World Health Organization (WHO). Based on data gathered through extensive consultation, the communication tool aimed to decrease errors and adverse events, increase in teamwork and communication, and provide another layer of safety to our patients throughout their surgical procedure. Furthermore, it was designed to maximize patient safety in the perioperative arena.

It consists of four sections: 1) before operating room: addressed by the RN (pre-op nurse) with patient/patient representative; 2) before induction of anesthesia: addressed by anesthesia provider and RN (circulating nurse); 3) before skin incision: addressed by anesthesia provider, RN, and, surgeon; and 4) before patient leaves OR: addressed by anesthesia provider, RN, and surgeon.

Our organization experienced an increase in incidents involving perioperative processes and surgical communication — specifically, pre-procedure antibiotic administration. This clinical informatics optimization project was proposed in order to increase the use of the surgical safety communication tool in the main OR. The goal was to obtain > 95% documentation compliance for each of the four phases of the tool.

Interventions: A survey was developed and adapted from the system usability scale to assist with gathering information pertaining to the current state of the project, relying on staff observations and interviews. Reasons for the lack of documentation on the tool included the following: inconsistent workflow, as some staff felt they were double documenting; time constraints; difficulty in accessing the device in the operation room; and limited availability of mobile devices when interviewing the patient in the pre-operative area. The intraoperative nursing staff was also responsible for the pre-operative phase of documentation.

Utilizing a business intelligence analytic tool, a baseline data was obtained in August 2019. Information was distilled in the form of poster board education and displayed in the staff lounge area. Education focused on the practice recommendations of the World Health Organization, and regulatory bodies expectations were outlined. Data was obtained daily, and a hard copy was hand-delivered to the manager. Outlined were the members of the nursing staff responsible, as well as a drill-down of the outlier cases. In addition to leadership holding staff accountable, one-on-one follow-up, including follow-up communication via email, was performed with staff during rounding. The A3 problem solving tool was also utilized for the optimization project.

Outcome: There was increased use of the surgical safety communication tool for each of the four phases. Documentation compliance increased from 81.9% to 96.7% among the phases with an average of 95.5%. Incidents involving untimely pre-op antibiotic administration was minimized to zero.

Implication for practice: The WHO (World Health Organization) recommends the use of the surgical safety communication tool as it assists in preventing errors and adverse events, and in promoting patient safety. By monitoring the use of the surgical safety communication tool closely and educating and communicating with staff in order to clear expectations and with leadership holding staff accountable, there should be minimal perioperative incidents, which will ultimately benefit the patient and the organization.