Question

CASE 1 You are assigned to scrub on a case, and you have just finished setting up the back table and instruments. The surgeons are gowned and gloved. The circulator is completing the skin prep using an alcohol-based antiseptic. As soon as she finishes, the surgeons ask for drapes. You see that the patient's skin is still quite wet with the prep solution, and you hesitate in starting the draping, knowing that the prep solution has not dried. You remark on this to the surgeon, and he replies, "Come on- come on, let's get going on this." A few minutes later, the edge of the drape catches fire. The fire is quickly extinguished, re- vealing a second-degree burn of the patient's skin. Who do you believe is responsible? What documentation is needed? Who should be notified? CASE 2 Your patient is a 70-year-old man scheduled for a hernia re- pair. Your role is assistant circulator. The registered nurse cir culator asks you to go to the holding area to see whether the patient has arrived. When you arrive at the holding area, the patient is there with the surgeon. The patient's speech is slurred, and he appears to have difficulty hearing the surgeon. As the surgeon looks over the chart, he notices that the patient has not signed the operative permit. He asks you to witness the patient's signing. What will you do? CASE 3 While scrubbed on a case involving surgical treatment of car- pal tunnel syndrome, you complete the instrument, sponge, and needle count. You are missing a needle. You tell the sur- geon that the count is incorrect. He replies, "Oh, don't worry. The needle can't be in the wound, it's too small. I would be able to see it. Let's close." What will you do? CASE 4 While in the locker room, you notice that one of your co- workers is emptying the pockets of her scrub suit. There are two vials of injectable medications. You cannot see what they are. She puts them in her purse and leaves. What do you do?

Answer 1

CASE 1

Unanticipated events can occur in a healthcare setting that can result in serious injury or even death of the patients. Such events are referred to as sentinel events. They mainly arise due to negligence. In such cases, a sentinel event report has to be submitted for quality assurance and risk reduction. This report is also helpful while taking any legal action against the accused who is/are responsible for the event. The report mainly consists of the following details:

• Date and time of the incident
• Where the incident took place
• People present at the time of the incident
• Description of the actual event

The report must be in accordance with the guidelines or hospital policy. Emotional and judgmental statements and exaggeration must be avoided.

In the case mentioned, the patient suffered from second-degree burn due to the carelessness of the surgeon even after being notified about the wetness of the drape. Since, the nurse had notified the surgeon about it but he hesitated to take it into consideration, the surgeon is mainly responsible for the incident. But others present in the room like anesthetist, nurses, etc. are also partly responsible as they did not try to stop the surgeon from doing so.

An incident or sentinel event report must be filed in this case. The report is written in the hospital’s designated form which will have details mentioned previously. It should be immediately submitted and should in professional and precise language.

Since the incident took place in the operating room, the report must be submitted directly to the supervisor of the operating room or any other concerned personnel. This will then be given to the risk management or the legal action team who may conduct investigation and notify the hospital’s insurance company.

CASE 2

In the case mentioned, the patient is not in complete consciousness while the surgeon is briefing about the surgery and no one is accompanying him. This seems to be in an emergency situation and immediate action needs to be taken. Hence, life saving measure must be initiated and ensure the consent form is signed immediately and the nurse must be present as the witness and must place her signature as the witness.