A time out, usually associated with surgery, can be a tool used prior to any invasive procedure performed in any setting. Documentation is important and if you are not familiar with your staff in this time of staff shortages, making sure everyone is on the same page is even more important.
Posted in Risk Management on Thursday, March 10, 2022
You have probably seen it or participated in it multiple times when you are seated on an airplane:
Verbal Agreement Example
The flight attendant goes through a series of questions with those folks seated in the emergency exit row. The passengers are asked to agree verbally; shaking their head is not sufficient.
This small request is actually a risk management/safety step to confirm that the passengers have truly agreed to act as requested in the event of an emergency to enhance the safety of the other passengers and assist the flight attendants. Healthcare and aviation are frequently linked with regard to best practices for safety. So what can we learn from requesting a verbal acknowledgement and documenting that assent?
The situation presented was directly related to the shortage of healthcare workers. Temporary staff who were employed by a separate organization were brought in to assist. The provider was relying on the staff to have everything he had asked for in preparation for the procedure to be readily available. During the time out prior to the start of the procedure, the provider went through the standard time out protocols as recommended by the Joint Commission and consistent with his institution to prevent wrong patient, wrong site, and the wrong procedure from being performed. However, much to his dismay, during the procedure, it was discovered that the specific supplies he required were not at this disposal, perhaps affecting the optimal results of his treatment.
"Time Out"
You have probably heard of a “time out” and may consider it is specifically for use in an operating room. However, whether you are a physician or a dentist, the Joint Commission recommends a time out be performed prior to any invasive or irreversible treatment. For reference purposes, an invasive procedure is defined as a procedure that involves a puncture, an incision or the insertion of foreign material that exposes the patient to more than minimal risk. The time out is a pause before the procedure to encourage patient safety through communication of the team.
Time out checklists can vary by institution and specialty. However, the basics are consistent. Before the procedure:
- When possible involve the patient in the confirmation
- Identify items necessary for the procedure
- Review safety precautions based on the patient history
- Verify the patient, procedure and site
EHRs
In some instances, an EHR will provide an opportunity to confirm a time out was completed with a drop down box. However, if the treatment you are providing requires specific preparation and your staff is unfamiliar with you or your requirements consider adding another step to your time out process to confirm that you have what you need and add a line in your documentation that during the time out all staff verbally confirmed they have reviewed and supplied your requested supplies.