April 2004 Bulletin

Patient safety tip contest winners announced

By Mary Ann Porucznik

The first AAOS Patient Safety Tip Contest sparked the creativity of members, hospital and office staff, and patients. During the opening ceremonies of the AAOS Annual Meeting in San Francisco, 2003-2004 President James H. Herndon, MD, announced the grand prizewinner, a clever acronym submitted by John M. Purvis, MD, from Jackson, Miss.

Dr. Herndon, left, presents an award certificate to patient safety tip contest winner John M. Purvis, MD, from Jackson, Miss.

Also honored were the Top Ten Tips, which ranged from a simple way to determine if a patient would benefit from a fall prevention program to patient advice on how to have a safer hospital experience. The tips include:

Grand Prize
P.R.E.P.A.R.E. before surgery. This simple acronym serves as a checklist in the operating room. It can be used as a reminder for the final double-check prior before administration of anesthesia. A verbal recitation and acknowledgment is suggested:

• Procedure plan—Discuss everything with the operating room team.
• Radiology—Make sure images are in the room, as well as any technical equipment requested.
• Equipment—Implants and supplies are available and in working order.
• Patient—Verify that this is the correct patient, signed site, verify identification bracelet.
• Anesthesia—Be aware of the plan, positioning, and any special needs.
• Rx given—Prescription antibiotic or other medications have been administered.
• Exceptions—Are there any special considerations?

Top 10 tips
Following are the top 10 tips of all those submitted to the contest:

1. Never place a toxic dose of solutions for injection in the operating room. This way, even if the entire amount is injected, no adverse effects will occur. Glenn Rechtine, MD – Gainesville, Fla.
2. Surgeons should call patients a day or two after their hospital discharge to see how they are doing. Kevin Smith, MD – Seattle.
3. In addition to marking operative site, draw the incision on the patient as you explain the surgical procedure to him/her. Frederick Meyer, MD – Mobile, Ala.
4. Be S.A.F.E. in the operating room. Sign your site. Antibiotics preoperatively. F is for inFormed consent. Embolism — take precautions. L. Pierce McCarty, MD —Chestnut Hill, Mass.
5. Patients: Keep a pump bottle of hand sanitizer on your bed tray. It serves as a visual reminder for staff to wash their hands or put on gloves. Bonnie Wallace – Greensboro, N.C.
6. Use Velcro fasteners instead of metal clips with dressing applications for pediatric patients. John Veitch, MD – Albuquerque, N.M.
7. Call patients the afternoon or evening before elective surgery. A.J. Yates, MD – Rochester, N.Y.
8. Avoid writing “NO” on the non-operative extremity. “NO” can look like “OK” when upside down. David Kahler, MD, Charlottesville, Va.
9. Patients: When you are hospitalized, always know what medicines your doctor has ordered and always ask the dispensing nurse to tell you which medicine you are being given. John Wickenden, MD – Rockport, Maine
10. Ask the patient to stand on their best leg without support. If an individual cannot stand for 12 seconds, he/she is at risk of falling and should enter a fall prevention program. Joseph M. Lane, MD – New York City

All of the patient safety tips submitted to the contest have been posted to the AAOS Patient Safety Web site, which can be accessed at http://patientsafety.aaos.org.