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Veritas-Reporting for the Operating Room

Veritas-Reporting for the Operating Room. Purpose. To assist the staff in choosing the correct Event categories and Nature of event categories in order to have consistency through out all the Operating Rooms To provide accurate data from the event reports to manage and improve our patient care.

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Veritas-Reporting for the Operating Room

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  1. Veritas-Reporting for the Operating Room

  2. Purpose • To assist the staff in choosing the correct Event categories and Nature of event categories in order to have consistency through out all the Operating Rooms • To provide accurate data from the event reports to manage and improve our patient care

  3. The Beginning • To enter an Event Report: • Clinical Workstation, click on Veritas Icon • Administrative Workstations ,click on VUMC home page, go to Eskind Digital Library, Choose “ V “, scroll down to Veritas RM and click. Log in “no feed back”.Use your VUNetId. • When you get to Event Category ,choose the one that fits your situation

  4. Event Categories • Patient: any event involving inpatients,outpatients, or clinical issues • Visitor/Physician/Other: any event involving visitors,family members, students, contract employees,or non-faculty physicians. • Property/Equipment/ Narcotic Counts: no association with a patient

  5. Nature of Event • It is in this Category that the person submitting the Report has a number of choices to make. • Choices must be consistent. The following is an explanation of the categories with O.R.specific impact Categories that are non-OR related [High forceps deliveries] or that are self explanatory[Falls] or that apply to the OR the same as to the rest of the units[Cardiac/Respiratory arrest] will not be discussed here.

  6. Admission Unanticipated • Admission Unanticipated: • Any unscheduled or unplanned admission following any ambulatory or out patient procedure • Transfer – Unanticipated Intra Hospital • Sudden, unexpected change in patient condition requiring a change in unit I.e. to SICU etc

  7. AMA/Elopement/LWBS • Against Medical Advice{AMA} - patient leaves the hospital against the advice of the physician • Elopement - patient chooses to leave the hospital without the knowledge of the physician or any other staff. • Left Without Being Seen{LWBS}- patient completes a registration process then leaves the hospital and is not treated

  8. Accidental Skin Injury • Any injury to the patient which could be the result of a medical procedure or other facility related injury, such as: • Red pressure areas due to positioning • Betadine burns,rashes • Towel clip injury • Lacerations, scratches apparent upon removal of drapes that did not exist preoperatively

  9. Anesthesia Related Event • Unexpected patient outcome or complication following anesthesia • Tooth damage • Skin damage from taped ET Tube • DOES NOT include infiltrated IVs or any other IV issue • Anesthesia Recall the patient remembers the surgery

  10. Blood Administration / IV Access Related • An event related to the administration of IV solutions or blood products • Transfusion reactions • Infiltration, contaminations • Phlebitis • Delays in administration • Wastage • Wrong Blood • Clotted port • Access cap issues

  11. Blood and Body Fluid Exposure • Non Employees only • All OR staff, Attendings, Residents, Students on rotations from schools with which we have a contractural relationship will need to use Tennessee First Report of Work Injury Form. • Needle sticks are handled as above

  12. Conduct/ Behavior/Altercation • Patient, Staff, Physician, Visitor displays a negative change in behavior during the course of direct or indirect care or service

  13. Consent Form Related • Variances to be reported: • No consent • Incomplete consent • Consent and procedure do not match • Patient revokes consent, chooses not to have surgery

  14. Delay in Response Time • Significant disruption in care or a delay in response by individual/department other than Perioperative Services (Does not include lab test results) • All Perioperative Services delays will be captured using the Delay tab in VPIMS

  15. Diagnosis-Related • Incorrect, incomplete or delayed diagnosis which may or may not affect change in treatment. • Missed fracture • Negative frozen section –positive for cancer on permanent slide • Cholelithiasis instead of appendicitis

  16. DOA/Death Unanticipated • All interoperative deaths . • Do not use for Organ Harvests

  17. Dissatisfaction • Non – Patient Related • Visitor,Physician or other non patient expresses dissatisfaction with an adverse outcome, increased risk potential, or the potential for a catastrophic outcome. • Patient Related • Same as above

  18. Three Equipment Choices Equipment Related: use for non-medical equipment malfunction Furniture, vacuum cleaners, lamps Malfunction of Medical Device Disposable, Single use: Drains, Internal Staplers Malfunction of Medical Device Reusable: Instruments, power equipment, Bovie, Laser

  19. Health Care Related Infection • Nosocomial or not present on admission • Not related to underlying disease or diagnosis • Postop wound infection following a Class1 “clean” case. This is a new category to report

  20. Intubation Related • Involves any issues relating to the ETT • Repositioning • Accidental extubation • Change in condition after planned extubation • Airway issues during a tube change • Emergent reintubation

  21. Medication-Adverse Reaction • Patient has unexplained, new, or serious reaction to a drug. • An adverse reaction is unrelated to the drugs pharmacological effects that occurs at normal doses indicated by manufacturer. • Class 1 [ mild] rash, hives, nausea, vomiting • Class 2 [ moderate] Requires therapeutic intervention/prolonged hospitalization • Class 3 [severe] threatens life, permanent disability, coma • Class 4 [death] results in death

  22. Medication Issues • There are two main categories • Medication –Adverse Reaction • Medication –everything else • Administration • Dispensing • Prescribing • Monitoring • Order entry • These are self explanatory

  23. Patient Identification • An event that includes- • No ID band • Incorrect ID band • Two patient identifiers do not match

  24. Procedure/Treatment /Test • An event related to procedures, treatments, tests, and processes • Specimens,lost, mislabeled • Test results delay • Contaminations,breaks in technique • Interdepartmental issues –Lab,Central Sterile, Steril-Tek, Blood Bank, Patient units • Instrument issues • Bed issues • Case boarding issues • Room Issues- Lights, bugs

  25. Special Note • Procedure, Treatment, Test is a big category for the OR • Choose this category when no individual category exists • Example: no id band or no consent. Both are procedure related but they each have a category of their own. • In this event, use the specific category, not the general one.

  26. Removal/Repair Organ/Body Part • Unplanned removal or repair of an organ or body part • Nicked organs, blood vessels requiring additional surgery • Nicked organs or blood vessels resulting in patient injury

  27. Sponge /Needle/ Instrument Count • An event involving omissions and variances in counts. • Event reports are filed on all of these, even the frequent “bring backs” • There is a place for choosing the type of incorrect count

  28. Type of incorrect count • The choices are: • Instrument • Needle • Sponge • Incorrect count-closed wounds • Incorrect count- packed wounds • Using the “ packed wound” choice is where all the trauma wounds that we bring back for debridement needs to be documented .

  29. New Occurrences • The following categories are new events requiring reports • Return to surgery within 48 hours • Transfer –Unanticipated - Intra-hospital • Transfer – Unanticipated –Outside facility

  30. Wrong Site/ Wrong Procedure • Misidentification of surgical site • Incorrect procedure performed • A “near miss” should also be entered

  31. Near Misses • Facilitates evaluation and identification of causes[s] to prevent an event from actually happening: • Improperly stored equipment/medication • Wrong patient identification • Wrong site/side identification • Laps /raytecs found on x-ray before wound closed or patient out of room

  32. Near Misses/ Medications • To enter a medication near miss click the medicine bottle on the log in screen instead of clicking on the “Login’ button

  33. Finally • This information plus all the categories not discussed is located in the handy reference material mounted on the left side of your computer screen.

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