“Time Out”: Implementation of Systems To Improve Safety for Patients and Healthcare Workers in the Operating Room

ISSUE: The infection control and surgical staff at Via Christi Regional Medical Center (VCRMC) identified two areas to improve HCW and patient safety in the operating room (OR). There was inconsistent use of the Neutral Zone (NZ) for passing sharps during surgical procedures and lack of verification that preoperative antibiotic prophylaxis was administered to the patient prior to incision. PROJECT: The surgical staff implemented measures to identify the correct operative site as required by the JCAHO. Prior to the incision, the surgeon calls a “Time Out” and every member of the surgical team stops to verify the correct operative site. The surgical staff has successfully incorporated other safety measures into this event, including establishment of the NZ location and verification that the prophylactic antibiotic dose has been administered. The circulating nurse documents the Time Out activity on the OR record. RESULTS: The surgical team has successfully incorporated this process into the operating room work flow. Development of a process has increased awareness of these measures and has helped achieve standardization across multiple campuses and surgical areas. LESSONS LEARNED: A systematic approach toward safety measures can improve compliance. Incorporating additional measures into the Time Out to identify correct operative site has allowed our facility to improve application of the NZ and timing of antibiotic prophylaxis. Both HCWs and patients have benefited from this process change.