Menorah Medical Center July 12, 2013

David Bock, MD, urologist

by Linda Friedel | Reprinted courtesy of KC Nursing News

Kelly Fehlhafer, RN, drew attention in her black and white striped shirt and black pants. It was not your usual scrubs that day.

“Health care is stressful enough to provide that excellence they deserve,” said Kelly Fehlhafer, RN, BSN, MBA, CNOR, director of surgery at Menorah Medical Center.

“You add a little fun to the environment. It only makes things better.”

Fehlhafer dressed as an umpire on June 12 to draw attention to National Time Out Day. Umpires are the ones who blow the whistle to signal a time out for the teams, she said. Though Fehlhafer forgot her whistle, the message was clear.

“As leader in perioperative, it’s important to recognize the staff and the hard work they do every day but especially in time out, every case, every procedure,” she said.

Hospitals across the nation have been adopting the National Time Out Day awareness campaign since 2004 when the Association of periOperative Registered Nurses (AORN) first launched the campaign. The organization launched National Time Out Day as a support for surgical nurses — to empower them to speak up for safe practices in the operating room and educate others. The awareness campaign is supported by the Joint Commission, the World Health Organization, and the Council on Surgical and Perioperative Safety. The goal is to increase awareness of safe practices for patients undergoing surgery or any procedure. Fehlhafer, a member of AORN for 20 years, said she relies on the organization to keep her updated on the literature and policy changes in the profession.

“That’s important to me — the access to the professional website and the literature that is available,” she said.

This is the first year Menorah acknowledged National Time Out Day, Fehlhafer said. She had been involved in the awareness campaign in other hospitals where she formerly worked and wanted to start the tradition at Menorah.

“It’s an important part of our perioperative practice,” Fehlhafer said. “I wanted to bring attention to the day and all the other professions in procedure areas as well as patients and their families.”

Fehlhafer spent part of her day in the hospital’s cafeteria along with other perioperative nurses and staff members educating patient families about time out practices in the operating room. They passed out f lyers and offered cake to reinforce the message. Fehlhafer said her team of perioperative nurses remains largely behind the scenes. Often patients and their families are unaware of the safety practices that go on, such as checking and double-checking patient names and their surgery sites.

“We were able to discuss with the patient families and other staff how important time out is in procedures,” she said.

Surgery is stressful work, and perioperative nurses like Fehlhafer are drawn to the profession because they like to advocate for their patients, she said. Fehlhafer said she went into nursing because she wanted to make a difference. She went into the OR because she felt called.

“I knew when I was a student and went through the OR,” she said. “I knew the OR is where wanted to be. I wanted to be that patient’s advocate.”

Fehlhafer drew attention from staff, visitors and administrators the minute she walked in on June 12. That was the point, however, she said. Patient families had a chance to talk to perioperative staff members whose loved ones were going through surgery or other procedures that day. It was a time to educate them and offer assurance, she said. The goal was to let them know about safety procedures the hospital has in place, Fehlhafer said.

“It’s part of our routine and part of what we do to keep them safe,” she said. “They were very appreciative. It was information that people didn’t know. It was also an opportunity for people to not only learn but to be appreciative of what we do.”

Feedback for National Time Out Day overall was very positive, Fehlhafer said. The program focused on the OR this year, she said, but caught the attention of several other departments. The cath lab and interventional radiology want to be a part of the national awareness day next year, she said.

“Role out to other procedure areas that do time out as well,” she said. “It’s important to promote that it’s not just in the OR. It’s any time you are doing a procedure on a patient whether it’s at the beside or the OR.”

Time out has been incorporated into practice for many years at Menorah, said Tony Schaefer, RN, BSN, CNOR, perioperative nurse manager. It is constantly reviewed, she said.

“Every year we add something into our practice,” Schaefer said.

According to AORN, nationally there are 40 wrong-site surgeries each week.

“There are still wrong site surgeries occurring every day,” Schaefer said. “This is something we can do to make it safe for our patients.”

Time out is that final pause before surgery, Schaefer said. Make sure everyone is on the same page and that everything is correct. It is a time to ask if the surgical team has all the right equipment, she said. Is the radiology film available?

“All those last-minute checks,” Schaefer said. “The best set-up for patients.”

In the ten years Schaefer has practiced as a perioperative nurse she has seen the criteria for time out increase, she said. Time is always a consideration, she said. There were a lot of roadblocks, she said. Schaefer said the surgical team implemented The Joint Commission’s SCIP criteria, Surgical Care Improvement Project, to ensure right site, right surgery and right equipment.

“It insures we have everything we need for this patient,” Schaefer said. “Everything we do should be patient- focused.”

Surgery requires briefing and de-briefing, Schaefer said. Safety measures such as having patients state their names and known allergies and having the surgery staff introduce themselves are routine, she said. Measures are done in name of safety but also assist patients in other ways.

“It gives the patient a sense of comfort,” Schaefer said. “They are brought back to this strange environment. It’s also a way we want to make our patients feel comfortable.”

Schaefer said it is her daily goal to keep patients safe and the staff empowered with knowledge. Today the general public is more aware of what goes on and what could go on, she said.

“It’s definitely not just a job,” Schaefer said. “I am very passionate about the OR.”

National Time Out Day draws attention to a procedure and practice that saves pain and suffering, said Kelly Reno, CNO at Menorah.

“We need those reminders,” she said.

Checklists and debriefing are a matter of taking five to seven minutes to pause, Reno said. Safety measures are mandatory and imperative and need to be done in a logical team-focused way, she said. The physician is seen as manager of the team. That does not always translate to equality and everyone in the room speaking up.

“It takes a physician and team to speak up,” she said. “That is the ultimate patient safety issue. Any opportunity we have to recognize and promote evidence-based safety tools we need to do that.

“Everybody is there for the same purpose and that is patient safety. It’s about breaking down those silos.”