Implement protocol for `sterile OR’
"Surgical teams have seen successful reductions in distractions and improved workflow after implementing a `sterile cockpit’ protocol during critical phases of operations," says Michelle Feil, MSN, RN, senior patient safety analyst at the Pennsylvania Patient Safety Authority in Plymouth Meeting, PA.
This concept has been borrowed from the aviation field. All communication in the cockpit is restricted to information that is necessary for handling the plane during critical phases, such as takeoff and landing, Feil says. "For surgical teams, these critical phases need to be identified by the team," she says.
Critical phases for the OR team have been defined as briefing, time-out, and debriefing, according to the Pennsylvania report. However, the critical phases might vary according to the procedure and the staff member’s responsibilities, Feil says. "For instance, induction may be a critical phase for an anesthesia provider, nerve dissection or creation of an anastomosis may be a critical phase for the surgeon, and surgical counts or specimen labeling may be critical phases for nurses," she says.
Small talk is inevitable, and it even can help improve teamwork and job satisfaction, Feil acknowledges. "But it is up to each individual member of the team to make sure that they are not creating a situation in which they themselves will be distracted, and that they are not distracting others," she says.
Nick Sevdalis, PhD, senior lecturer in the Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, says that for interventions such as a "sterile OR" to be successful, you must have buy-in from the OR staff "and an active effort to change a culture of distractions,’ for lack of better term."