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F E B R U A R Y 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
A
hospital-acquired condition is a nice way of saying
that we messed up and gave our patient a complication
she didn't have when she checked in for surgery, like
the hip she broke when she fell out of bed or the
sponge we left inside her abdomen. Of course,
Medicare no longer pays facilities for the increased costs of care that
result when we harm a patient by one of these conditions. The intent
of withholding payment is to force us to prevent such problems in the
first place. The 4 hospital-acquired conditions that concern us most in
surgery are foreign object retained after surgery, pressure ulcers, sur-
gical site infections and falls. As I'll outline for you, in most cases we
can prevent these unwanted, undesirable reminders of surgery.
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Retained objects. If preventing retained objects is such a
high priority among perioperative nurses, why is it still being
reported as a common sentinel event occurring daily across our
nation? In the perioperative setting, there are numerous distractions
throughout a surgical procedure. Distractions are listed as one of the
leading reasons for a retained object in a surgical patient. Other
potential causes for retained objects are multitasking, not following
the established procedure for ensuring no object is left behind, pres-
sure to count quickly so the surgeon can close, the surgeon refusing
to stop closing so you can take the count, mixing items to be counted
with trash and counting too quickly.
How can we eliminate barriers in our day-to-day practice and ensure
an accurate count on every patient? First, we must provide a safe
environment for every team member in an OR in order for all team
members to feel safe to speak up when policy and procedures are not
being followed or when a suspected potential for patient harm is
noted. Being able to speak up will not eliminate the problem alone.
C O M P L I C A T I O N S
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