AORN Journal
Volume 88, Issue 1 , Pages 11-13, July 2008

Mutual Accountability for the Common Goal of Patient Safety

Article Outline

 

In the United States, Independence Day is the highlight of July. For children, it is the promise of picnics, parties, cookouts, and fireworks. For adults, it is also a day on which we celebrate the freedom we all enjoy as a result of the monumental sacrifices of courageous men and women.

Cries for independence united our nation, and each of our citizens is accountable for preserving that independence. Today, as our brothers and sisters in the military fight terrorism abroad and pledge themselves to protecting our freedom and our values, however, it is prudent to acknowledge that war is never won, nor peace maintained, purely by individual accountability, but also by team accountability.

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Accountability 

My father was a captain in the Army during World War II. His tour of duty kept him in Europe for 38 months, mostly under grave conditions and constant threats to his life that required discipline and fortitude to simply survive. Those values continued to define his life long after the end of the war and his safe return home. That discipline ultimately shaped my own values. I remember being told at a young age that I must “be accountable” for my life and my actions. Unfortunately, those words were usually the precursor to a discussion about my wayward behavior.

In health care settings, it is not unexpected after an error has occurred to hear the question, “Who is accountable?” The words carry the connotation that someone has failed—but should they? Why does “accountability” imply having to answer for a negative action? Why is there less recognition of accountability for success?

For health care workers, the negative connotation of accountability certainly receives the greatest publicity, particularly in light of the Institute of Medicine's release of the dramatic report To Err is Human in 1999.1 Since then, perioperative nurses have rededicated themselves to educating the public about our role as the patient's advocate in guarding against errors. Surgery is also a team effort, however, and without mutual accountability, our chances of success in the perioperative field decline dramatically. We understand that mutual accountability develops only if there is a common goal and team members respect the significance of each person's role in achieving that goal. Our goal is obvious: safe surgery.

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Team Accountability 

Traditionally, surgical care was taught in silos, with an emphasis on individual accountability and perfection, as noted by Donald Moorman, MD, FACS, at the Joint Commission Resources' Perioperative Care Symposium Focusing on Safety for Optimal Patient Care2 this past April. Dr Moorman, who is the vice chair of clinical affairs at Beth Israel Deaconess Medical Center in Boston, Massachusetts, views the traditional model as one that creates accountability avoidance. He promotes interdependent care and team accountability to mitigate error.

In the spirit of team accountability, AORN, the American College of Surgeons (ACS), and the American Society of Anesthesiologists (ASA) sponsored a summit on patient safety in February 2004 that led to the formation of the Council on Surgical & Perioperative Safety (CSPS), an association based on the mutual accountability of the perioperative team for the success of patient safety initiatives. The council's membership includes all seven health care provider associations for direct caregivers who collaborate on every invasive procedure: AORN, the ACS, the ASA, the American Association of Nurse Anesthetists, the Association of Surgical Technologists, the American Society of PeriAnesthesia Nurses, and the American Association of Surgical Physician Assistants. The council's mission is to promote a culture of patient safety and a caring perioperative workplace environment. The core principles CSPS endorses3 are:

•a universal nomenclature for the development of electronic medical records and documentation of perioperative care (including the Perioperative Nursing Data Set4);

•standards for basic anesthetic monitoring;

•the standardized “Glossary of times used for scheduling and monitoring of diagnostic and therapeutic procedures”5 developed by the Association of Anesthesia Clinical Directors;

•transfer of care principles (including AORN's Perioperative Patient “Hand Off” Tool Kit6);

•the Universal Protocol and a time out before any invasive procedure (including AORN's “Position statement on correct site surgery”7 and the AORN Correct Site Surgery Tool Kit8);

•prevention of needle sticks and sharps injuries (including the “AORN guidance statement: Sharps injury prevention in the perioperative setting”9);

•prevention of retained foreign bodies after surgery;

•prevention of fires in the OR (including the AORN Fire Safety Tool Kit10);

•prevention of venous thromboembolism;

•prevention of health care-associated infections: pneumonia, bacteremia, and surgical site infection;

•no tolerance for violence in the workplace under any circumstances (including AORN's “Position statement on workplace safety”11); and

•development and implementation of evidence-based standards of practice.

I encourage you to visit the CSPS web site at http://www.cspsteam.org to more comprehensively review the 12 core principles endorsed by our perioperative team as well as the newly released Statement on Violence in the Workplace.12 The site also provides supporting Internet links of interest to the perioperative team.

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Accountability on a Global Level 

The goal of team accountability is not limited to American soil. The World Health Organization (WHO) launched the Second Global Health Challenge: Safe Surgery Saves Lives in Washington, DC, on June 25, 2008.13 The team leader, Atul Gawande, MD, MPH, is a general and endocrine surgeon at Brigham and Women's Hospital, Boston; an associate professor of surgery at Harvard Medical School, Boston; and an associate professor in the Department of Health Policy and Management at the Harvard School of Public Health, Boston. Recognizing the significance of team accountability, Dr Gawande's task force created a “WHO Surgical Safety Checklist.” Information on the checklist may be found on the WHO web site at http://www.who.int/patientsafety/challenge/safe.surgery/en/index.html.

AORN is honored to have a voice in this historical effort by formally endorsing this project. Our partnership in mutual accountability now extends to the global community. Patients will be safer as health care professionals unite to become accountable for the prevention of errors rather than simply being accountable for making the mistakes.

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Keeping the Common Goal in Sight 

Perioperative nursing's future is linked to understanding and fostering mutual accountability and team performance. We will succeed if we keep the common goal of patient safety in sight. You should be proud of the pivotal role perioperative nurses play in promoting these perioperative partnerships. I know I am proud to be a small part of your team!

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References 

  1. 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; 1999;
  2. Moorman, D. Plenary—communication with perioperative services: culture of communication. Presented at: Perioperative Care Symposium Focusing on Safety for Optimal Patient Care: Improving Methods, Behaviors, and Measures for Transforming Perioperative Care; April 29, 2008; Chicago, IL.
  3. Core principles. Council on Surgical & Perioperative Safety . http://www.cspsteam.org/education/education2.html Accessed May 23, 2008.
  4. In:  Petersen C editors. Perioperative Nursing Data Set . rev 2nd ed.. Denver, CO: AORN, Inc; 2007;
  5. Association of Anesthesia Clinical Directors  . Glossary of times used for scheduling and monitoring of diagnostic and therapeutic procedures . AORN J . 1997;66(4):601–606
  6. Perioperative Patient “Hand Off” Tool Kit. AORN, Inc . http://www.aorn.org/PracticeResources/ToolKits/PatientHandOffToolKit/ Accessed May 23, 2008.
  7. Position statement on correct site surgery. AORN, Inc . http://www.aorn.org/PracticeResources/AORNPositionStatements/PositionCorrectSiteSurgery/ Accessed May 23, 2008.
  8. Correct Site Surgery Tool Kit. AORN, Inc . http://www.aorn.org/PracticeResources/ToolKits/CorrectSiteSurgeryToolKit/ Accessed May 23, 2008.
  9. AORN guidance statement  . Sharps injury prevention in the perioperative setting . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;
  10. Fire Safety Tool Kit. AORN, Inc . http://www.aorn.org/PracticeResources/ToolKits/FireSafetyToolKit/ Accessed May 23, 2008.
  11. Position statement on workplace safety . http://www.aorn.org/PracticeResources/AORNPositionStatements/Position_WorkplaceSafety/ Accessed May 23, 2008.
  12. Statement on Violence in the Workplace . http://www.cspsteam.org/education/education8.html/ Council on Surgical & Perioperative Safety. Accessed May 23, 2008.
  13. Safe Surgery Saves Lives: The Second Global Patient Safety Challenge. World Health Organization . http://www.who.int/patientsafety/challenge/safe.surgery/en/ Accessed May 23, 2008.

 Editor's note: The Universal Protocol is a registered trademark of the Joint Commission, Oakbrook Terrace, IL.

PII: S0001-2092(08)00412-2

doi:10.1016/j.aorn.2008.06.003

AORN Journal
Volume 88, Issue 1 , Pages 11-13, July 2008

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