VHA's Surgical Site Verification Program Reaches 550 Hospitals; Program Introduces ``7 Absolutes'' To Reduce Surgical Errors.

Health/Medical Writers

IRVING, Texas--(BW HealthWire)--Jan. 14, 2002

VHA Inc., a nationwide network of leading community-owned health care organizations and their physicians, has implemented a new patient safety program aimed at preventing surgical site errors, and more than 2,600 physicians and nurses from 550 hospitals have gone through the program so far.

The preventive program was developed based on 240 in-depth interviews with surgeons, anesthesiologists and perioperative nursing staff from six medical centers and months of research in operating rooms.

"VHA chose to put resources into addressing this patient safety imperative because our members named it as a top 5 area of concern," said Lillee Gelinas, vice president and chief nursing officer at VHA. "Three key groups -- surgeons, anesthesiologists, nurses, and other perioperative specialists -- worked together to bring this project together. We are championing this issue across our entire membership. In doing so, we've seen an elevated interest in this topic, even from organizations that have good track records with addressing patient safety issues."

The program was launched in the spring of 2001 by VHA as part of its ongoing effort to help member health care organizations address the issues of clinical quality and patient safety. This program was overseen by VHA's Clinical Affairs group, and the content was developed by the VHA Perioperative Leadership Learning Network and VHA nursing leaders. VHA health care organizations perform more than 7.7 million surgical procedures annually, approximately 30 percent of the surgeries performed in U.S. hospitals.

Adverse events in surgery are the most frequent and costly type of medical error, according to a report by the Joint Commission on Accreditation of Healthcare Organizations. According to JCAHO's latest report, surgery on the wrong body part constituted 76 percent of the surgery errors. Orthopedic surgery was the most common procedure for wrong-site surgery.

Janet Lewis, RN, MA, administrator of surgical services at Integris Health in Oklahoma City, and a member of the VHA perioperative leadership learning network that developed the program, brought it back to the management team and surgical staff at Integris. "As we looked at refining our policy for surgical site verification, we discovered surgeons had differences of opinion about the best way to identify surgical sites," said Lewis.

"For instance, in some facilities surgeons marked the site with a yes and the non-operative site with a no. In some cases, surgeons preferred to have the site marked with an "X." We considered the recommendation from the American Academy of Orthopedic Surgeons, which recommends that doctors sign their names on the site. Our goal was to eliminate the confusion by having a consistent policy, since surgeons and nurses work at many difficult facilities in the community."

"We gathered a representative group of surgeons to discuss this issue and share the information from the VHA program. Subsequently, they helped us develop a consistent standard for surgical site verification. As a result of this effort, we've heightened the level of awareness about this issue across our surgical teams, and we have a consistent standard in place against which we can measure and monitor our performance. We now report results to our quality committee and at every operating room committee meeting."

Steve Jatala, RN, BSN, is director of surgical services at 178-bed Sutter Roseville Medical Center in Roseville, Calif., and another member of the VHA perioperative leadership learning network that developed the program. Prior to implementing the program, Jatala said the 50 surgeons who regularly performed surgeries at the hospital had not been marking the surgical sites with pens. They were concerned that ink from the mark would leach into the incision and could create infections. Instead of marking the site, the surgeons would post sticky notes with instructions on the patients' foreheads. The crude method worked, but the surgical team wanted to pursue a higher standard that left less room for confusion over handwriting and interpretation.

The surgeons agreed to implement the VHA method and are now using specialized surgical markers to mark surgical sites, and all 160 members of the surgical services staff have gone through the VHA program. The 7 Steps signs are posted in the operating rooms and the pre-op areas, so even patients can be aware of the hospital's procedures.

As a result of following the VHA 7 Steps methodology, Jatala said several potential errors were averted in recent months. "In one case, an orthopedic surgeon has multiple knee operations scheduled on the same day. The second case was a left knee arthroscopy. The third case was the right knee arthroscopy. The ancillary staff did not change the set up and positioning devices for the right knee and the nurse used the previous set up and prepared the left knee for surgery. The mistake was discovered when the surgical team paused to verify the site before the incision, as the VHA program recommends."

The VHA clinical project team that worked on this program developed the step-by-step process to prevent any incorrect surgery. Referred to as the "7 Absolutes, these steps make up a clinical practice model that can serve as a foundation for each health care facility as it develops its policies and procedures for surgical site verification. The "7 Absolutes" are the minimum standards hospitals should consider as they develop their own guidelines. The Absolutes were developed as part of VHA's Operating Room Safety Program, which provides tools and education for operating room professionals to help them create a safe environment for patient care.

NOTE: To see the 7 absolutes that can be used to avoid surgical site errors, go to the News Room at www.vha.com.

About VHA

VHA Inc. is national health care cooperative that represents more than 2,200 leading community-owned health care organizations and their affiliated physicians. VHA comprises nearly 26 percent of the nation's community hospitals, including many of the nation's largest and most respected institutions. VHA offers programs and services to help its members improve financial and clinical performance, and as a cooperative distributes income annually to members based on their participation. In December 2000, VHA was named one of the "100 Best Companies to Work For" for the second consecutive year by Fortune. For more information on VHA, go to www.vha.com.