AORN Journal
Volume 92, Issue 1 , Pages 1-3, July 2010

The Freedom to Be Accountable: One Patient, One Procedure, One Time Out Always

Article Outline

 

A decade has passed since the release of the Institute of Medicine report To Err is Human,1 which has been referred to in many forums as the seminal work that served as the “burning platform” for the safety movement in health care. Kotter defines a burning platform as a tool to help complacent organizations achieve the change that is required, “even people who are most solidly content with the status quo will begin to act differently if a fire starts on the floor beneath their feet.”2(p120) Wrong site surgery, medication errors, and other preventable medical errors still occur, however. This reality compels us to take a few minutes to consider the issue of accountability in relation to the care that we deliver as we practice the art and science of nursing.

Back to Article Outline

Accountability in Perioperative Nursing Practice 

Accountability in nursing practice is not a new concept. It has its roots in the early work of Florence Nightingale.

Nightingale stressed the importance of accountability, consistency, and truthfulness in practice. She maintained that the nurse's ability to form therapeutic relationships was predicated on caring, healing and clarity of purpose. Nurses were to consider themselves role models, maintaining dignity and presence in their interactions with patients, families and one another and being personally responsible for their moral conduct.3(p423)

As perioperative nurses, we are morally and ethically bound to be accountable for the care that we deliver one patient at a time, one procedure at a time, every time. In synthesizing the work of several nurse theorists, LaSala wrote, “Accountability has been described as a basic moral value, and a moral foundation for nursing practice. In choosing one's profession, individuals assume responsibility for adhering to the standards and for upholding the values of their profession.”3(p428)

How do we apply this concept to perioperative nursing practice? I believe that we are ethically bound to be accountable for the care we deliver, especially when we perform those tasks that are the most basic elements of our practice. Are we sure that we consistently check the package integrity and sterility indicator on every kit that we remove from a shelf when we are picking cases, setting up a room, or teaching a new perioperative nurse? When asked by a colleague if we checked all of the internal indicators in the kits, do we give a truthful response if we were rushing and may have missed one of them? Do we fully review the preprocedure assessment done by the nurse in the preparation and holding area, or do we just skim the assessment and focus on the elements that we think are important to the situation at hand? Can we unequivocally say “yes” with assurance that we did not use a workaround so that we would have time to take a break between surgeries? Do we support a time out with every patient, every time?

LaSala interprets the work of the noted nurse ethicist Sara Fry about the question “Is the ethic of caring at risk?” as follows:

Fry contends that the current and future demands on the profession will require that nurses possess strong skills in negotiation, expert communication, assertiveness, persuasion, interdisciplinary collaboration, and the technique of ‘ethical compromise’ to protect, defend, and advocate for doing what is right in the best interest of meeting the patient's needs and affecting quality healthcare outcomes while maintaining quality of life.3(p429)

As we consider this, I cannot help but reflect on AORN's commitment to patient and workforce safety, which has been a core element of our mission since the Association's inception. AORN is accountable to its members by continuing to produce tools that will help nurses in their quest to provide safe care.

Back to Article Outline

Finding a New Burning Platform 

In 2004, AORN launched National Time Out Day as an annual event. The founding goal for this initiative was to improve patient safety practices and limit the number of wrong site surgeries in a meaningful way. During the past six years, the focus of this campaign has not diminished in the hearts of perioperative nurses; however, I have heard from many nurses that its impact in practice settings has lessened over time; what was once a source of energy that drove increased compliance in the OR has increasingly become a poster campaign in operating rooms, hospital lobbies, and cafeterias.

In March, AORN introduced the Comprehensive Surgical Checklist,4 a template for safer surgery. This document, which is fully customizable, integrates the 19 elements of the World Health Organization Surgical Safety Checklist5 and elements of the Joint Commission National Patient Safety Goals6 for implementing the Universal Protocol. To my mind, this checklist has provided us with yet another “burning platform” to inspire and ignite our passion for patient safety. This work compels us, as nurses, to reflect on our freedom to be accountable.

National Time Out Day on June 16, 2010, marked the launch of AORN's new multiyear plan designed to acknowledge perioperative nurses' influence in the workplace and to support the challenges we face in successfully facilitating implementation of the Universal Protocol. I invite each of you to demonstrate your accountability and show your commitment to patient safety by taking a pledge to commit to supporting a time out with every patient, every time. Can you imagine the impact of walking into the locker room in your OR and seeing the AORN poster: “I commit to support a time out with every patient, every time”7 on every locker? Imagine the effect on a patient arriving in the preadmission testing clinic at your hospital if a poster is displayed that denotes that 100% of the nurses in this facility have taken this pledge for patient safety. Imagine the long-term effect on patient safety if we can engage the entire surgical team in this process during the course of the next year.

Our pledge does not mandate the use of any one checklist or process, although a tool such as the AORN Comprehensive Surgical Checklist is one of many resources available to assist with this work. The essence of this campaign is that, as individuals, we are responsible and accountable for our own practice, and we are not afraid to articulate our commitment to practice safely in the best interest of our patients.

I am committed to practicing safely. I have taken the pledge. Have you?

Back to Article Outline

References 

  1. Institute of Medicine. In:  Kohn LT,  Corrigan JM,  Donaldson MS editor. To Err Is Human: Building A Safer Health System. Washington, DC: National Academy Press; 1999;
  2. Kotter JP. A Sense of Urgency. Boston, MA: Harvard Business School Press; 2008;
  3. LaSala CA. Moral accountability and integrity in nursing practice. Nurs Clin North Am. 2009;44(4):423–434
  4. AORN Comprehensive Surgical Checklist. AORN, Inc. http://www.aorn.org/PracticeResources/ToolKits/CorrectSiteSurgeryToolKit/ComprehensivechecklistAccessed May 12, 2010
  5. Surgical Safety Checklist (World Health Organization). http://www.who.int/patientsafety/safesurgery/en/Accessed May 12, 2010
  6. National Patient Safety Goals (The Joint Commission). http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/Accessed May 12, 2010
  7. “I Commit” Poster. AORN, Inc. http://www.aorn.org/NationalTimeOutDay/Accessed May 12, 2010

Charlotte L. Guglielmi, RN, BSN, MA, CNOR is the AORN President and a perioperative nurse specialist at Beth Israel Deaconess Medical Center, Boston, MA. President Guglielmi has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.

PII: S0001-2092(10)00461-8

doi:10.1016/j.aorn.2010.05.011

AORN Journal
Volume 92, Issue 1 , Pages 1-3, July 2010

Article Tools