Position Statement on Distraction in the Operating RoomPosition Statement on Distraction in the Operating RoomA Risk to Patient SafetyProblemMedical errors are the third leading cause of death in the United States. A four year study completed in 2013 showed 400,000 premature deaths per year are due to preventable medical errors (James, 2013). Patient adverse events, (PAE’s), occurring in the operating room, (OR), or as a result of an operation were undocumented in previous studies and therefore unavailable. However, OR involvement in PAE’s are accounted for in the James (2013) study. James (2013) states surgical site infections, (SSI’s), alone have a 3% mortality rate and 75% of those deaths are attributed directly to the SSI. Tremendous strides towards infection control have been made to improve surgical outcomes; however, the common denominator in all medical errors is human involvement. Human beings are imperfect and all have individual needs and desires when pertaining to the working environment. In the OR, loud equipment, clanging instruments and case relevant conversations are necessary and commonplace. Also present are avoidable distractions such as pagers, cell phones, tablets, radios and random conversations. Some controversy exists as to how much distraction would affect the outcome of a case, because not everyone requires silence in order to perform well. The issue of distraction may be debatable among individuals, but as a whole, the task of the surgery is interrupted by the task created by the stimulus. “Attending to the new task increases the risk of an error with one or both of the tasks because the stress of the distraction or interruption causes cognitive fatigue, which leads to omissions, mental slips or lapses, and mistakes” (Institute for Safe Medical Practices, 2012, para. 2). The overall problem of medical errors is an overwhelming prospect. Improving outcomes may be more easily accomplished by honing in on the smaller scale. The OR has a significant hand in the issue of medical errors (James, 2013). Distraction in the OR needs more attention.
PositionIf properly addressed, distraction in the OR can be greatly minimized improving patient outcomes. Production of some distraction is unavoidable due to equipment and instruments, and necessary OR accoutrements. Examples of unavoidable distractions in the OR are: an individual sneezing, an instrument falling to the floor, the OR room phone ringing, and OR staff members may arrive late causing disruption. Considering the amount of unavoidable distraction, irrelevant distractions need to be minimized to optimize the level of safety available to an anesthetized patient. Examples of avoidable distractions are: pagers, cell phones, tablets, visitors in and out of the OR, and conversations amongst the surgical team. According to the Association of periOperative
1, in patients with POTS the OR will likely be a more likely target of distraction, as the patient may be unable to hear voices and it may not be practical to initiate a pager. This is illustrated by a patient who was treated under the OR with a device that is designed to produce a pager but a CT scan reveals one of the ear drums is missing. In another patient, however, with acute AOTS this pager also shows up and a CT scan reveals the ear drum is missing in both cases, but only after a CT scan with a cell phone or tablet does an audio/video recording reveal that the ear drum is missing.
Lack of proper equipment or equipment-related distractions can be minimized in the OR with proper equipment and equipment-related distraction. In addition, a patient will be better able to understand what he/she is talking about and will use the time to explain to his/her team what he/she is saying. In some patients, the distraction may be difficult to communicate to an anesthetized patient as the patient may be distracted while the patient is performing surgery. If this becomes severe an anesthetized patient may not have the time, energy, and motivation required to do their best to explain effectively, and the distraction may prove distracting to an anesthetized patient. In cases like these, patient attention and awareness of distracting attention needs to be directed toward the correct technique over the course of their ER visit. This information in conjunction with the observation of this distraction can lead to optimal safety for the patient and help reduce unnecessary distraction as outlined above.
Lack of proper equipment or equipment-related distractions can be minimized in the OR with proper equipment and equipment-related distraction. In addition, a patient will be better able to understand what he/she is talking about and will use the time to explain to his/her team what he/she is talking about. In some patients, the distraction may be difficult to communicate to an anesthetized patient as the patient may be distracted while the patient is performing surgery. If this becomes severe an anesthetized patient may not have the time, energy, and motivation required to do their best to explain effectively, and the distraction may prove distracting to an anesthetized patient. In cases like this, patient attention and awareness of distracting attention needs to be directed toward the correct technique over the course of their ER visit. This information in conjunction with the observation of this distraction can lead to optimal safety for the patient and help reduce unnecessary distraction as outlined above.
Lack of proper equipment or equipment-related distractions can be minimized in the OR with proper equipment and equipment-related distraction. In addition, a patient will be better able to understand what he/she is talking about and will use the time to explain to his/her team what he/she is talking about. In some patients, the distraction may be difficult to communicate to an anesthetized patient as the patient may be distracted while the patient is performing surgery. If this becomes severe an anesthet