Mrs Tagaloa has expressed concern at being asked the same questions about her identity and impending surgery by a number of different staff members. a. Why are these multiple checks undertaken? b. Describe each stage of the World Health Organization (WHO) Surgical Safety Checklist (SSC) and identify when they are required to be performed. c. How do you address Mrs Tagaloa's concern?

Question

Mrs Lanuola Tagaloa is a 54-year-old Samoan woman who has lived in Australia for the past 15 years. She was admitted on the day of surgery for an elective vaginal hysterectomy with anterior/posterior colporrhaphy. She has a history of asthma and has type 2 diabetes mellitus (diagnosed at 42 years of age). Mrs Tagaloa has a history of grand multipara. She has a BMI of 30+ and falls into the obese category, but appears otherwise fit and well. She lives at home with her extended family and is responsible for the care of her mother and school-aged children. The admissions nurse informs you that Mrs Tagaloa is very softly spoken and did not maintain eye contact. She was accompanied by a female family member and overheard to be conversing in her native language.

What will be an ideal response?

Answer 1

Answer:
a. The WHO SSC was developed to prevent unnecessary surgical deaths and avoidable complications. Use of the SSC improves communication and teamwork, activities that are known to lead to safer patient outcomes.
b. Sign In—prior to the induction of surgery. During Sign In, and in the presence of the patient, the circulating nurse verbally confirms:
correct patient, procedure and site (including site marking where appropriate)
valid consent
patient's allergy status
completion of anaesthesia safety check, airway assessment and presence of pulse oximetry
risk for blood loss
availability of prosthesis/other special equipment PRN.

Time Out—involves all members of the surgical team and occurs prior to skin incision. Time Out requires participating staff to verbally confirm:
all team members have introduced themselves by name and role
correct patient, procedure and site
anticipated critical events (surgical, anaesthetic and nursing)
prophylactic antibiotics administered within last 60 minutes
VTE prophylaxis ordered PRN
essential imaging displayed PRN.
Sign Out—the period during or immediately after wound closure. Team members to review and confirm:
surgical procedure completed
correct count and identification of all other accountable items
identification and verification of specimens
equipment malfunctions or issues
review of postoperative care with identified strategies prior to patient leaving the operating room.
c. It is essential to explain all activities and nursing actions to Mrs Tagaloa prior to undertaking them. This includes explaining that asking the same questions is an activity that enhances patient safety and occurs with all patients. All team members should introduce themselves to the patient, explain their role and provide reassurance. Explanation of anticipated events helps minimise patient anxiety and assists patients to become involved in the decision-making process. Mrs Tagaloa's family member could be included in the preoperative period and SCC process, if appropriate and with Mrs Tagaloa's consent.