AORN Journal
Volume 86, Issue 6 , Pages 933-935, December 2007

I'll Google That

  • Lois Hamlin, DNurs, RN, FRCNA, FCN (Foundation Fellow ACORN and Senior lecturer)

Facility of Nursing, Midwifery & Health, University of Technology, Sydney, Sydney, NSW, Australia

Article Outline

 

Hello (or as we say, “G'day”), and a warm welcome from Australia, the land down under. Although our roles and the delivery of perioperative nursing care vary internationally, as indeed, they do nationally and sometimes locally, we are nonetheless bound to each other by our practice of nursing in perioperative settings.

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Adverse Events 

Our “high tech/high touch” setting is a powerful force for good, but we know all too well it also has the potential to cause great harm to our patients. Australia was the first country in the world to undertake a nationally representative study of adverse events in hospital patients.1 The study revealed a 16.6% incidence of adverse events, of which 51% were considered preventable. Half of these adverse events were associated with a surgical procedure.

Kable, Gibberd, and Spigelman2 reported even higher levels of adverse events among surgical patients (ie, 21.9%). Of these patients, 13% suffered a permanent disability and 4% died. The researchers noted 48% of the adverse events were preventable. Not dissimilar results to these have been reported in the United States3 and elsewhere in the last few years. These chilling data have been the drivers of much-needed cultural change and have resulted in the development of many patient safety and risk management strategies; however, we still have a long way to go.

In Australia, the federal government published its first annual report of sentinel events this year, although some states have been publishing their own data for several years. Although there is no absolute consensus, it is agreed that sentinel events are key indicators of systems failures—events in which death or serious harm to a patient has occurred.4 Of the 130 events identified in the Australian report, and of particular concern for perioperative nurses, the greatest number of sentinel events (ie, 53) were “procedures involving the wrong patient or body part.” The second most commonly occurring events were “retained instruments or other material after surgery requiring re-operation or further surgical procedure” (ie, 27 cases). It is acknowledged that this is not the sum total of sentinel events and that the true incidence of, for example, retained instruments or other material after surgery is unknown and unknowable. Nonetheless, 80 cases associated with a sentinel event, or more than 60% of the total reported in one year, were associated with diagnostic and interventional procedures, many of them occurring in the OR.

Designing and delivering care to eliminate or minimize these events is very much within the scope of every perioperative nurse. We are all greatly assisted in this endeavor by the work of perioperative nursing associations, in particular via professional standards and recommended practices. My doctoral research about the role and effectiveness of perioperative nursing associations, and in particular the Australian College of Operating Room Nurses (ACORN), highlighted the value and utility of these standards and recommended practices.5

Of particular interest to my research was ACORN Standard A3, “Counting of accountable items used during surgery” (ie, the counting standard),6 which I explored in detail. In the process, I uncovered some disturbing facts and beliefs. An issue that emerged in the course of my research was the difficulty in determining the true incidence of inadvertently retained surgical items—the very mishap that the act of counting should avert. Still this serious adverse event occurs4 and may or may not be reported.

It is imperative that we move away from a “blame and shame” response when such errors occur, to one of open disclosure and reporting when mistakes are made. This reflects our need to acknowledge that many errors occur because of systemic or structural design flaws and that we must focus our efforts on creating a culture of safety in which we are able to discuss mishaps freely.3, 4 Further, we have powerful tools to assist us—sophisticated computing hardware and software that facilitates the collection and aggregation of data about the incidence and nature of errors and near misses. Subsequent analysis of these data allows us to learn from our mistakes. This brings me, in a very roundabout way, to the title of my editorial!

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A Google Search 

In preparing a paper about this aspect of my research (ie, counting) for the recently held World Conference on Surgical Patient Care, I decided to gather some up-to-date figures on retained surgical items by conducting a conventional database search. Then I decided to see what a Google search would produce. Upon entering the term retained surgical sponge, I was rewarded with an astonishing 177,000 hits and an eclectic range of information and “facts.” It was simply overwhelming! What do you or I do with this plethora of data and information? How do we make sense of it? What do patients—past, current, and future—think when they access the same information? How do we respond if they quiz us about the incidence of this serious event in our own facility? I decided do some research about this source.

Google is the dominant search engine on the Internet.7 Google is a play on the word googol, a term popularized by Ed Kaisner and Jim Newman in their book Mathematics and the Imagination.8 It refers to the numeral 1, followed by 100 zeros. Use of the term reflects Google's mission to organize the immense, seemingly infinite amount of information available on the Internet.7 I'm not sure they've achieved the part about organizing data—or perhaps I have unrealistic expectations. There is no doubt that information and communication are the very essence and heart of Google; however, unlike the majority of traditional, scholarly sources, information obtained via a search engine such as Google is not necessarily accurate, authoritative, or even true.

And what of the Internet itself? It is changing as it moves from an information repository to an information environment that is continually adapting to individual need.9 There are challenges here; streaming data is increasingly ubiquitous and available in massive volume—to wit, the outcomes of my search on retained surgical sponges! How do we, indeed should we, use the Internet, which combines historical as well as immediate information, to inform our understanding? What, if any, standards apply?

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Using Credible Sources 

With advances in digital technology, the world's best books and scholarly journals will become increasingly available on your computer monitor at the touch of a key or perhaps on an interactive tabletop.10 Google, with Google Book Search and Google Scholar,7 and Microsoft's Window's Live Premium Search11 are busy digitizing all of the books and other sources and/or indexing all the world's scholarly output, with a view to making them both easily accessible and more authoritative. A longer term challenge is to adapt the Internet to individual need, which raises many other issues such as copyright of material—already problematic12—and an individual's privacy,9 issues that are beyond the scope of this editorial.

So, armed with a little more information, I decided to repeat my search using the term retained surgical sponges on Google Scholar. This produced a more manageable result, 231 hits covering 30 pages or screens. This latter search produced data that were from credible sources, mostly medical and other journals, including the AORN Journal. It was a little better aggregated though not necessarily organized. Additionally, it contained information spanning 30 years, and so a fundamental concern remains—what to do with all of this information?

One thing is certain; in our time-starved, information-overloaded lives, we can rely on the information contained in our professional journals and web sites, presented at conferences, or used to develop our standards. This information has been subject to peer review and other forms of scrutiny, is mostly evidence-based, and is regularly reviewed and updated. Further, when our perioperative practice is underpinned by standards and recommended practices developed by our professional associations, we are in a strong position to reassure our patients of the quality of care they'll receive from us.

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References 

  1. Wilson RM , Runciman WB , Gibberd RW , Harrison BJ , Newby L , Hamilton JD . The Quality in Australian Health Care Study . Med J Aust . 1995;163(9):458–471
  2. Kable AK , Gibberd RW , Spigelman AD . Adverse events in surgical patients in Australia . Int J Qual Health Care . 2002;14(4):269–276
  3. In: Institute of Medicine  ,  Kohn LT ,  Corrigan JM ,  Donaldson MS editor. To Err is Human: Building a Safer Health System . Washington, DC: National Academy Press; 2000;
  4. Australian Institute of Health and Welfare (AIHW)  , Australian Commission for Quality and Safety in Healthcare (ACQSHC)  . Sentinel Events in Australian Public Hospitals 2004-05 . Canberra, ACT, Australia: AIHW; 2007; http://www.aihw.gov.au/publications/index.cfm/criteria/Sentinel%20events/area/H Accessed October 26, 2007.
  5. Hamlin L . Setting the Standard: The Role of the Australian College of Operating Room Nurses . Sydney, NSW, Australia: University of Technology; 2005; [doctoral dissertation]
  6. Australian College of Operating Room Nurses (ACORN)  . Counting of accountable items used during surgery . In: Standards, Guidelines and Policy Statements . Adelaide, SA, Australia: ACORN; 2002;p. A3
  7. Google corporate information: company overview. Google . http://www.google.com/intl/en/corporate/index.html Accessed October 26, 2007.
  8. Kasner E , Newman J . Mathematics and the Imagination . New York, NY: Simon and Schuster; 1940;
  9. Flexible information solutions to solve unpredicted problems. Information and Communication Technologies (ICT) Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO). http://www.ict.csiro.au/page.php?cid=9. Accessed October 26, 2007.
  10. Walters C . All hands on the table for cyber communication . Sydney Morning Herald . October 4, 2007;21
  11. Tiedt D . Internet providers show how it's done . Sydney Morning Herald . September 24, 2007;15
  12. CAL to Google: ask and you shall receive . Calender: the Newsletter of the Copyright Agency Limited . June 2006;1; http://www.copyright.com.au/CALendar/CALendar_0606.pdf Accessed October 26, 2007.

 Editor's note: Google, Google Book, and Google Scholar are registered trademarks of Google, Inc, Mountain View, CA. Windows Live Premium Search is a registered trademark of Microsoft Corp, Redmond, WA.

PII: S0001-2092(07)00722-3

doi:10.1016/j.aorn.2007.11.018

AORN Journal
Volume 86, Issue 6 , Pages 933-935, December 2007

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