Silence Can Hurt Patients

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I appreciated the Patient Safety First article “The code of silence” by Donna Watson, RN, MSN, CNOR, ARNP-BC (November 2009, Vol 90, No 5). It outlined the tragedy of a health care provider diverting drugs for personal use and passing on hepatitis C to patients through used needles. The article intimated that those who suspect an abusive colleague are obligated to report it. I don't disagree. We have an implicit code of silence in our perioperative culture. We work in close quarters not only physically but also emotionally because of the pain we knowingly inflict on patients in our environment. This engenders unusual demands on the perioperative team, which may cause team members to remain silent about a potential problem with a coworker. If this was the case in the situation Watson cited, it was clearly the wrong decision and brought harm to patients.

The only point that Watson failed to include was that the patients were not receiving the pain medication intended for them. This is a source of patient suffering and prolonged convalescence and creates the potential that the patient will develop a chronic pain syndrome. I think we forget that when a team member is diverting narcotics, someone else (usually the patient) is not receiving them. This goes against our moral and ethical code for patient care.

Please include more articles dealing with the topic of silence in the OR. Its presence in the perioperative environment is damaging to everyone, whether it concerns drug abuse or disruptive behavior.