“The most common issue I see in endoscopy/GI labs, because they are high-volume and routine, procedures get to be very rote,” says Dr. McDonnell. “While this can be a good thing, sometimes, through no fault other than human nature, shortcuts get taken.”
Dr. McDonnell says centers should actively monitor their processes and environment to ensure that standards are always followed appropriately and follow these three best practices.
1. Hardwire pre-surgery identifications. “Right patient, right procedure and other patient identifications should be performed before every procedure and should be completed with the physician in the room. The physician should be part of the process,” says Dr. McDonnell. “They need to be hardwired, so they are performed for each and every procedure. They can seem redundant, but centers need to make sure they don’t get overlooked, which can happen if it becomes too rote.”
Dr. McDonnell says hardwiring is a type of paradigm shift. “It’s leadership educating the staff that these processes shouldn’t be seen as ‘a pain in the neck’ but are there to ensure the very best care for the patient,” he says.
2. Follow proper anesthesia administration and supervision guidelines. While most centers follow all anesthesia guidelines, Dr. McDonnell says he occasionally finds a CRNA who is assigned to too many rooms or is not properly supervised by an anesthesiologist. If a GI surgeon is administering conscious sedation anesthesia, centers should ensure the physician has conscious sedation privileges on file at the center, meaning the medical staff and governing board have found the surgeon capable of administering anesthesia while performing his or her procedures, he says. If a surgeon is administering anesthesia, the center must also always ensure another staff member, usually a monitoring RN, is in the room during procedures to ensure safety and quality for the patient.
3. Ensure the patient has a ride home. Centers should assign a staff member to make sure each patient has a family member or friend available to get them home, and centers should avoid treating patients without someone to care for them after their procedure, says Dr. McDonnell. Centers can sometimes overlook confirming a patient has someone with him or her, and patients undergoing certain types of anesthesia used during GI procedures may not drive home alone.
For all of these practices, Dr. McDonnell encourages staff leadership to instill the importance of such practices to staff members. “The key is ensuring all patient safety practices are orderly, routine and hardwired,” says Dr. McDonnell. “The danger is complacency.”
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