Evidence-Based Practice Proposal - Section D: Solution Description

Evidence-Based Practice Proposal
Section D: Solution Description
Portia Stephens
Grand Canyon University: NUR 699
May 22, 2019
Section D: Solution Description
At Cleveland Clinic, the incidence of wrong site surgeries is less likely to occur as the organization implements strategies to prevent this occurrence and engages in ongoing education of the operating room staff and the use of a safety checklist in the operating room. Tom Miheljevic, the current CEO and President of the Cleveland Clinic Health System, in an online document refers to zero as our non-negotiable target for serious safety events in the hospital and outpatient environments (2018). This move for change has improved the culture of the organization globally where Zero is considered as something that should not occur and referred to as “Start Strong and Finish Strong”. This is combined with the Universal Protocol developed by the Joint Commission in 2004 with the idea of safety checklists, as proposed by Boston surgeon Atul Gawande in 2009 (as cited in Miheljevic, 2018). The launching of this process "start strong and finish strong" is bringing all our facilities closer to target zero every day (Miheljevic, 2018). According to Miheljevic (2018), every voice on the team is heard, caregivers, patients and family are equal partners, anyone can speak up, and anyone can stop the line with a concern.
Current research made by Geraghty et al. (2017), reported incidence of wrong-site surgery occurring in approximately 1 in every 100,000 surgical cases varying among different specialties. According to Geraghty et al. (2017), the data reported in the United Kingdom recorded about 124 cases of wrong-site surgery from April 2014 to March 2015, where this number of incidence is the highest number of documented cases in their country in a single year. In the United States, approximately 2,700 patients are harmed by wrong-site surgery each year (Collins et al., 2014). The use of a checklist greatly reduces the incidence of wrong-site surgery and is cost effective in the long-term both to the patient, the staff involved and the institution where the possibility of legal implications would exist.
The occurrence of wrong-site surgery should be eradicated or avoided as these events cause great harm not only to the safety of the patients but also to the institutional integrity of health professionals around the world. To minimize the occurrence of these avoidable events, the proposed solution or intervention needed is the implementation of a surgical safety checklist that was developed by the World Health Organization (WHO). The checklist can be in a poster format posted in the operating room, which is very cost effective, or with an electronic scheduling system using monitors to easily encourage the compliance of the surgical team in implementing the checklist.
In a complementary study made by Weiser et al. (2010), the evaluation of the checklist's effectiveness in reducing the rate of complications and deaths during emergency surgical procedures was observed. This study focused only on urgent surgery operation, within 24 hrs of assessment, rather than scheduled surgery. The initial observation revealed a significant reduction of mortality cases from 31 in 842 cases (3.7%) to 13 in 908 (1.4%) and morbidity cases from 151 in 842 cases (18.4%) to 102 in 908 cases (11.7%). The positive effects to patient safety of the WHO checklist promote a reduction in wrong-site surgery.
In another study by Van Klei et al. (2011), the authors made a retrospective cohort study; which included 25,513 adult patients in the University Medical Center Utrecht, from January 1, 2007 to September 30, 2010 about the use of the WHO checklist. The patient's data were collected from the hospital's information system. The study revealed the implementation the checklist reduced the crude mortality rate of patients in the hospital due to wrong-site surgery ...