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Safety Stop: A Valuable Addition to the Pediatric Universal Protocol.
Thomas J Caruso1, Farrukh Munshey2, Brea Aldorfer3
1Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, and Physician Lead, Perioperative Improvement Team, Stanford University School of Medicine, Stanford, California.
Joint Commission Journal on Quality and Patient Safety
|September 1, 2018
Summary
Implementing a safety stop before patient preparation and draping, followed by the standard time-out before incision, significantly improved compliance with surgical safety protocols in a pediatric hospital. This enhanced Universal Protocol reduced risks associated with wrong-site surgeries.
Area of Science:
- Perioperative Medicine
- Patient Safety
- Quality Improvement
Background:
- The Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ mandates a time-out immediately before incision.
- A review identified non-compliance, with time-outs occurring before patient preparation and draping, posing patient and regulatory risks.
Purpose of the Study:
- To develop and implement an enhanced pediatric Universal Protocol to ensure adherence to World Health Organization (WHO) guidelines for surgical safety time-outs.
- To mitigate risks of wrong-site, wrong-procedure, or wrong-person surgery in a pediatric academic hospital.
Main Methods:
- A multidisciplinary team developed an enhanced protocol including a "safety stop" before preparation and draping, and a time-out before incision.
- The enhanced protocol was implemented after leadership meetings and electronic communication.
- Compliance was audited across seven operating room locations.
Main Results:
- Audits in four weeks showed 96.7% compliance (58/60) with the new policy.
- The enhanced pediatric Universal Protocol, including the safety stop, was recognized as a leading practice during a Joint Commission survey.
Conclusions:
- Moving the time-out solely to before incision presented risks, especially in pediatric patients obscured by draping.
- The integrated safety stop and time-out process effectively addressed compliance issues and enhanced patient safety in the operating room.
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