Veritas-Reporting for the Operating Room

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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. 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

15. 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

16. 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

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

18. 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

19. 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

20. 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

21. 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

22. 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

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

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

25. 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

26. 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.

27. 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

28. 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

29. 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 .

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

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

32. 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

33. 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

34. 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.