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Best Practices Toolkit: Surgery

The resource links below are provided for informational purposes only and are not intended as legal or medical advice. Links to outside training programs are suggestions of potential resources for training and should not be considered an endorsement of content or the company. Med-IQ bears no responsibility for the accuracy, legality, or content of any external site. The concepts discussed during the webinar, as well as the list below, represent some suggestions for improving practice and are not intended to be all-inclusive.

Team-Based Care

• Agency for Healthcare Research and Quality. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). Accessed October 7, 2021.
  • TeamSTEPPS Pocket Guide. Accessed October 29, 2021.

Preventing Sentinel/Never Events

• Agency for Healthcare Research and Quality. Toolkit to Promote Safe Surgery. 2017. Accessed October 29, 2021.
• Association of Perioperative Registered Nurses. AORN Comprehensive Surgical Checklist. Accessed October 29, 2021
• Association of Perioperative Registered Nurses.  Prevention of  Sentinel Events. Accessed December 9, 2021
• The Joint Commission. Universal Protocol Resources. Accessed October 29, 2021

Retained Surgical Items

• Weprin S, Crocerossa F, Meyer D, et al. Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review. Patient Saf Surg. 2021;15(1):24.
• Steelman VM. Retained surgical items: evidence review and recommendations for prevention. AORN J. 2019;110(1):92-96.
• Pellegrini CA. Retained foreign bodies: can we stem the tide? Accessed October 29, 2021.
• The Joint Commission. Sentinel Event Report 51: Preventing Unintended Retained Foreign Objects. Accessed October 29, 2021.
• Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med. 2003;348(3):229-235.

Wrong Site, Wrong Procedure, Wrong Patient

• Reducing the Risks of Wrong-Site Surgery: Safety Practices From The Joint Commission Center for Transforming Healthcare Project. 2014. Accessed October 21, 2021.
• Agency for Healthcare Research and Quality. Patient Safety Network. Wrong-site, wrong procedure, and wrong-patient surgery. September 7, 2019. Accessed October 21, 2021.
• Association of Perioperative Registered Nurses. AORN Position Statement on Preventing Wrong-Patient, Wrong-Site and Wrong-Procedure Events. Accessed December 9, 2021.
• The Joint Commission. Reducing the Risk of Wrong Site Surgery. Accessed October 29, 2021.
• Yonash R, Taylor M. Online supplement to “Wrong-site surgery in Pennsylvania during 2015–2019: a study of variables associated with 368 events from 178 facilities.” Patient Safety. 2020;2(4). Accessed October 29, 2021.

Environment of Care and Medical Devices

• Anesthesia Patient Safety Foundation. Surgical Fire Prevention: a Review. Accessed October 29, 2021.
• Association of Perioperative Registered Nurses. AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care. Accessed December 9, 2021
• Association of Perioperative Registered Nurses. Fire Prevention Assessment Protocol. Accessed October 29, 2021.
• ECRI Institute. 2020 Technology Hazards List. Accessed October 29, 2021
• US Food and Drug Administration. Medical Device Safety. Accessed October 29, 2021
• US Food and Drug Administration. Medical Device Recalls. Accessed October 29, 2021
• The Joint Commission. Potential Risks of Robotic Surgery. Quick Safety. 2014;3. Accessed October 29, 2021
• Agency for Healthcare Research and Quality. Patient Safety Network. Robotic Surgery: Risks vs. Rewards. Accessed October 29, 2021

Interprovider Communication

• Agency for Healthcare Research and Quality. Medications at Transition and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. AHRQ Pub No. 11(12)-0059. Reviewed August 2012. Accessed October 7, 2021.
• Crucial Learning. Crucial Conversations for Mastering Dialogue. Accessed October 7, 2021.
• AANA, AORN, ASPAN Position Statement on Workplace Civility. Accessed December 9, 2021
• American College of Surgeons. Surgical Documentation Primer. 2019. Accessed November 1, 2021.
• Institute for Healthcare Improvement. SBAR Tool: Situation-Background-Assessment-Recommendation. Accessed November 1, 2021.
• Wiegmann DA, Wood LJ, Solomon DB, Shappell SA. Implementing a human factors approach to RCA2: tools, processes, and strategies. J Healthc Risk Manag. 2021;41(1):31-46.
• Ariadne Labs. Operating Room Crisis Checklists. 2017. Accessed December 14, 2021.

Communication With Patients

• Agency for Healthcare Research and Quality. AHRQ Health Literacy Universal Precautions Toolkit. Reviewed September 2020. Accessed October 7, 2021.
• Agency for Healthcare Research and Quality. AHRQ’s Making Informed Consent an Informed Choice: Training Modules for Health Care Leaders and Professionals. Reviewed September 2020. Accessed October 7, 2021.
• Agency for Healthcare Research and Quality. Communication and Optimal Resolution (CANDOR) Toolkit. Reviewed October 2020. Accessed October 7, 2021.
• Agency for Healthcare Research and Quality. Engaging Patients and Families in Their Health Care. Reviewed August 2021. Accessed October 19, 2021.
• Agency for Healthcare Research and Quality. The SHARE Approach: A Model for Shared Decisionmaking – Fact Sheet. Reviewed September 2020. Accessed October 7, 2021.
• American Medical Association. American Association of Medical Colleges. Advancing Health Equity: A Guide to Language, Narrative and Concepts. 2021. Accessed November 1, 2021.
• The Joint Commission. Speak Up Campaigns. Accessed October 6, 2021.
  • Speak Up About Your Care. Accessed October 6, 2021.
  • Speak Up for Your Rights. Accessed October 6, 2021.
  • Speak Up at the Doctor’s Office. Accessed October 6, 2021.
• The Joint Commission. Informed Consent: More Than Getting a Signature. Quick Safety. 2016;21. Accessed November 1, 2021.

Simulation

• Center for Medical Simulation. Free Open Access Materials. Accessed December 9, 2021.
• Meling TR, Meling TR. The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis. Neurosurg Rev. 2021;44(2):843-854.
• Society for Simulation in Healthcare. Accessed December 9, 2022.