2009-07-09 / News

Rhode Island hospitals and surgical centers adopt uniform safety protocol

By Eileen M. Daly

Rhode Island area hospitals and outpatient surgical centers have agreed to adopt a uniform surgical protocol, the Hospital Association of Rhode Island announced on June 30. The protocol is aimed at increasing safeguards to prevent the kind of wrong-site, wrong-side surgeries that have been an embarrassment to local hospitals in recent years.

According to the HARI press release, Director of Health Dr. David R. Gifford is quoted as saying, “The Department of Health applauds all the hospitals for drafting and implementing these uniform surgical procedures. Reducing wrong-site and wrong-side surgeries is a challenge for healthcare facilities across the country. Hospitals will need to work together to continuously evaluate compliance with this protocol and make revisions as they encounter unique or unexpected situations not addressed by the protocol.”

Jean Marie Rocha, vice president of clinical affairs at HARI, described the protocol as, “another milestone for Rhode Island patients; we are the first state in the nation to have unanimous adoption of a surgical protocol.”

Dr. Kathleen C. Hittner, chair of the HARI board of trustees and president and CEO of the Miriam Hospital said that she is in support of the protocol. “Hospitals have taken another important step to improve the quality and safety of the care we provide. We are proud to, once again, be the first state in the nation to make a uniform change that will have significant benefit for our patients.”

According to Rocha, the Rhode Island uniform surgical protocol follows standards developed by the World Health Organization and Joint Commission. Key elements of the Rhode Island protocol include: Two licensed providers perform the operative site marking, one being the surgeon. The surgeon marks the operative site with his/her initials. Active participation by the operating room team is guided by the use of the checklist, and a “time-out” initiated by the surgeon.

“While all hospitals previously had individual policies directing these areas, every hospital in Rhode Island will now follow these same principles,” Rocha said.

Mark Crafton of the Joint Commission emphasized the increased specificity and detail contained in the protocol. “The national protocol contains a surgical team time out. In the Rhode Island protocol, the surgeon is the designated leader of the time out. “There is no ambiguity about who is in charge of the time out,” Crafton said. This time out is used to insure that everyone agrees on the correct patient, procedure and site, Crafton said. The protocol was implemented on July 1 following a kick-off meeting convened by HARI and attended by representatives from all hospitals in the state.

In order to ensure uniform compliance, Rocha pointed to education and ongoing training. “Education and training is an ongoing process. Each hospital has procedures in place to ensure employees are appropriately trained on new policies and procedures. HARI has offered a statewide educational session and hospitals will be holding continual on-site training and education for their employees,” she said. Follow up will be conducted in the same collaborative and cooperative manner that has already been established, Rocha said. “The workgroup that developed the protocol will be continuing their efforts. Next steps will include measuring compliance and performance. In addition, hospitals will continue their tradition of sharing best practices in an effort to reveal additional opportunities for improvement.”

According to HARI the protocol has been endorsed by: the Joint Commission, Rhode Island Department of Health, Hospital Association of Rhode Island, Rhode Island Patient Safety Collaborative, Rhode Island Medical Society, Rhode Island Chapter of the American College of Surgeons and Rhode Island State Nurses Association.

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