Army’s Surgical Safety Procedures

Army medical treatment facilities are maintaining surgical safety by using the American College of Surgeon’s (ACS) www.facs.org National Surgical Quality Improvement Program (NSQIP) to monitor and compare patient safety data.

NSQIP is a nationally validated quality improvement program created by the ACS to measure and evaluate the care of surgical patients by applying scientific data and comparisons of care among participating hospitals.

The Army NSQIP program is part of a military, tri-service surgical quality collaboration with the Defense Health Agency (DHA) www.health.mil/dha called the “Military Healthcare Systems, Strategic Partnership with the ACS” (MHSSPACS).

The MHSSPACS partnership intends to improve educational opportunities, systems-based practices, and research capabilities in surgery. The strategic partnership will facilitate collaboration and the exchange of information between ACS and the military health system to advance high-quality cost effective care for surgical patients.

Participating hospitals are required to track the outcomes of inpatient and outpatient surgical procedures and then analyze the results. Much of the NSQIP report focuses on deaths, infections, proper procedures, falls, and returns for surgery, with the end goal to provide a picture of safety and quality at each facility.

Data points are adjusted for the size of the facility and the services offered. The data is analyzed to create a composite score related to patient management in mortality, cardiac incidents, pneumonia, renal failure, urinary tract and surgical site infections

Army’s Evans Army Community Hospital http://evans.amedd.army.mil has started using Radio-Frequency ID (RFID) sponges to ensure that the count of medical items is correct in their operating rooms. A sponge left in a patient can lead to pain, infection obstructions, problems in healing, longer hospital stays, additional surgeries and in rare cases even death.

The goal is to prevent an Unintended Retained Foreign Object (URFO) from being left in a patient after surgery. Operating room staffs have long tracked instruments and sponges used in an operation with a baseline count before the surgery. Then a second count is done before the surgeon begins sewing and incision with the final count done before closing the skin.

The RFID sponges look like normal surgical sponges but an RFID chip is embedded in the sponge. The chip enables the surgical staff to locate the sponges using a handheld wand. Even with the technology, OR nurses still keep count on the sponges used during an operation and always double check the count.

To further improve patient safety, the hospital recently implemented white boards in the ORs to assist with the counting process and to track what instruments are being used. The OR staff also uses “call backs” that requires the provider to call out when putting an instrument of sponge into a patient and then calls back when that item is removed. For emergency C sections, which normally occur outside of an operating room, a portable ultrasound is used to scan patients prior to stitching them up.

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