During my practical training in the OR, I have noticed that there are a few things that might make a patient feel uncomfortable and unsafe already before they enter the operating room and when they are in the operating room awake waiting for the anesthesiologist to come and put them under genereal anesthesia, or during spinal, epidural or local anesthesia, when they are awake and not sedated during the surgery. I have been in the operating theaters in two different hospitals (in Kuopio University Hospital during my preoperative practice, and now in the Central Finland Central Hospital) and I have been able to compare the two. Many things are done differently in these two hospitals, and I have also noticed differences in how they take care of the safety of the patients.
One difference (concerning patient safety) I have noticed between the two hospitals is that in Kuopio the nurses always talked to the patient on the way from the preoperative unit to the operating room. Here in Jyväskylä I was quite shocked to find out that the nurses only greet the patient, and while they walk from the preoperative unit to the operating room, they are quiet and the patient quietly follows the nurse. Some may wonder why this is such a big deal for me, but my mentor in Kuopio told me that she always wants to talk to the patient because it helps to create a feeling of trust and safety, since most patients are scared and nervous before their surgery.
In Central Finland Central Hospital one very important step always seems to be skipped by the surgical team. The surgeon starts the operation without going through the checklist. There are only a few surgeons who want to go through the checklist. The use of the checklist and attitudes towards it have been studied here in Finland. The study shows that majority of the staff of the operating rooms have a positive attitude towards it and find it helpful. The checklist is a helpful tool when it comes to safety in the operating rooms and preventing errors. Though, there are still nurses and surgeons who don’t find the checklist important. The World Health Organization has created the surgical safety checklist to improve safety in the operating rooms, which is why it should always be used. (Aaltonen, Blomgren, Helmiö, Ikonen, Pauniaho, & Takala, 2012; Paterson-Brown, 2010.) In Kuopio University Hospital they always went through the checklist. The checklist seems to be something that is used depending on the hospital and the surgical team (even though it should always be used).
It has been studied that noise in the operating rooms can be a risk for patient safety. According to the study, background noises, such as music or chatting, can lead to misunderstandings among the surgical team. Some of the team members might not hear something important if there is loud music playing or if the team members are chatting, and miscommunication is one reason for possible medical errors. Thus, clear communication is important when it comes to patient safety in the operating rooms. Loud noises can also affect negatively in one’s concentration skills. Other factors that can negatively affect in concentration skills are stress and fatigue. That is why it is important that the staff members also take care of their own health. (Paterson-Brown, 2010; Journal of the American College of Surgeons, 2013.) The negative affect of loud noises is something that I have noticed in the OR. Many nurses and surgeons want that there is music playing on the background which I also find nice if the music is not loud. Then there are those who want to listen to heavy metal and turn the volume up. That is already a bit too much. First of all, it is difficult to hear what the other team members are saying, and second of all, the loud music makes it hard to focus on monitoring the patient as an anesthesia nurse.
These are just a few things that I have paid attention to during my practice. I’m happy that I have had the chance to be in two different hospitals so I have seen the differences. I as a nurse want to ensure the safety of my patients. I want to be the nurse who talks to the patients on the way to the operating room, and I want to be the nurse who will suggest going through the surgical safety checklist if it seems like it is going to be ignored.
Aaltonen, L., Blomgren, K., Helmiö, P., Ikonen, T., Pauniaho, S. & Takala, A. 2012. First year with WHO Surgical Checklist in 7148 otorhinolaryngological operations: use and user attitudes. Clinical Otolaryngology 37, 305-330
Journal of the American College of Surgeons. 2013. Noisy Operating Rooms May Jeopardize Patient Safety. Issue 273. Accessed on 10 of June, 2018. Retrieved from http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=8&sid=9dda16c2-fa04-4ff6-a0b1-2c9bfbdb01e2%40pdc-v-sessmgr01
Paterson-Brown, S. 2010. Improving patient safety in the operating room – everyone’s responsibility. Clinical Risk, 16, 6-9