Pagers: A Distraction in the Operating Room Kerry Berry, RN, BSN Jana Glines-Harvey, RN, BSN Danielle Wachter, RN, BSN

Transcription

1 Pagers: A Distraction in the Operating Room Kerry Berry, RN, BSN Jana Glines-Harvey, RN, BSN Danielle Wachter, RN, BSN University of California Davis Medical Center

2 Introduction Traditionally, pagers have been the mode of communication between physicians and staff within the hospital setting (Ortega, 2009). At University of California Davis Medical Center (UCDMC) pagers are widely used as the primary source of communication between surgeons in the operating room and other hospital employees. Though efficient communication is necessary for positive patient outcomes, pagers commonly become a distraction in the surgical setting.

3 Problem Statement Pagers in the operating room are interruptive and distract the surgical team from the patient in the room. Distractions in the operating room decrease the focus and alertness of the surgical team and create room for error (McDonald, 1995). The Association of peri-operative Registered Nurses supports an environment that minimizes interruptions and distractions (AORN, 2011). Objectives To explore alternatives to one-way communication devices in the perioperative setting that are supported by AORN and surgical team as safe and effective.

4 Evidence In a study conducted at Memorial Sloan-Kettering Cancer Center, pagers Emergent were diverted from the OR to a station 13% during surgical procedures for one month. The coordinator who received the pages triaged the calls as emergent, urgent, Non-Urgent Urgent 55% and non-urgent. 32% 407 pages were answered and only 13% were forwarded to the operating room, decreasing the number of distractions. 55% of the pages received were non-urgent 32% of the pages were forwarded to inpatient coverage (James, 2012).

5 Evidence At the Mayo Clinic, a trained observer monitored 31 cardiac surgeries over a 3 week period. Flow disruptions were categorized as relating to teamwork, extraneous interruptions, equipment and technology, resource based issues, or supervisory/training related issues. Pager interruptions were classified as extraneous interruptions, accounting for 17% of 178 disruptions in the OR. The study concluded that as disruptions increase, the rate of error also increases (Wiegmann, 2007).

6 Evidence AORN Position Statement Interventions (2011) Evaluate communication methods and devices used in the practice setting. Request perioperative team members leave cell phones and pagers with someone outside of the procedural environment whenever possible (Beyea, 2007). Ensure cell phones and pagers that must be answered are identified. Mute or stand-by all non-essential communication devices during surgery. Limit external communication to urgent or emergent conversations.

7 Current Practice Currently, pagers are left on the counter in the operating suite by multiple surgeons and residents during surgical procedures. Although answering pages is not part of the job description of a circulating nurse at UCDMC, responses are often expected by the surgeons. These situations are distracting for both the surgeons and the nursing staff who must divert their attention away from the patient in the room which interrupts the flow of surgery.

8 Conclusions The results of our literature review, in combination with the AORN position statement on noise in the operating room, suggest that alternative options for communication be explored in our department in order to decrease distractions in the operating room. A potential study to evaluate staff interest and the need for updated communication technology should be completed to develop evidence based support for decreasing unnecessary interruptions in the operating room.

9 References AORN, (2011). AORN Position Statement: Noise in the Perioperative Practice Setting. Association of peri-operative Registered Nurses. Beyea, S.C. (2007). Noise: a distraction, interruption, and safety hazard [Patient Safety First]. AORN Journal, 86, James, D., and Charles, K. (2012, April). Staying focused: avoiding intraoperative distractions. Presented at AORN Congress, New Orleans, LA. McDonald, J., Orlick, T., & Letts, M. (1995). Mental readiness in surgeons and its link to performance excellence in surgery. Journal of Pediatric Orthopaedics, 15, Ortega, G.R., Taksali, S., Smart, R., and Baumgaertner, M.R. (2009). Direct cellular vs. Indirect pager communication during orthopaedic surgical procedures: A prospective study. Journal of Technology and Health Care, 17, doi: /THC Wiegmann, D.A., ElBardissi, A.W., Dearani, J.A., Daly, R.C., & Sundt III, T.M. (2007). Disruptions in surgical flow and their relationship to surgical errors: An exploratory investigation. Journal of Surgery, 142, doi: /j.surg