Briefing and Debriefing Tool

AHRQ Safety Program for Surgery

Introduction

Problem Statement

Surgical site infection (SSI) prevention remains a global public health priority. Patients in acute care hospitals underwent more than 16 million surgical procedures in the United States in 2010.¹ Using National Healthcare Safety Network (NHSN) definitions and surveillance methods, the overall national SSI rate is approximately 1.9 percent. A recent meta-analysis showed that SSIs are the third most costly healthcare-associated infection (HAI) per event, accounting for more annual health care costs than any other major infection.² SSIs are common HAIs: A recently published point-prevalence survey of HAIs across 10 States showed that 4 percent of patients had 1 or more HAIs by NHSN definitions, and SSIs accounted for approximately 20 percent of all HAI cases.³ SSIs continue to impart an enormous burden on patients, their families, employers, and society.

Purpose of This Tool

This tool will help your safety program team reduce or eliminate the potential for an SSI.

Please Adapt This Tool

A team of clinicians designed this tool for a specific clinical setting. Please modify this tool to best fit your team’s needs.

How To Use This Tool

Follow the instructions in each table included in this tool. Start with “Before Induction of Anesthesia.” Then, go to “Before Skin Incision.” Then, follow the checklist outlined in “Before Patient Leaves Operating Room.” If the procedure is considered minor, complete the checklist presented in the “Minor Procedures” table, and provide the information adjacent to that table. This checklist is for your internal use only. How you modify or follow this checklist is up to you. Only your team knows the approach that will work best in your perioperative area. To help guide your team through the quality improvement intervention design process, you can use the Learning From Defects Through Collective Sensemaking Tool in the AHRQ Toolkit to Promote Safe Surgery

Before Induction of Anesthesia

SIGN IN

Patient has confirmed:

___ Identity (name and date of birth)

___ Site (along with marking)

___ Procedure

___ Consent

Does patient have a:

___ Known allergy?

____________________________________________________________________________

Difficult airway or aspiration risk?
____________________________________________________________________________
Access issues:
____________________________________________________________________________
Preoperative concerns:
____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Before Skin Incision

TIMEOUT

Introduction of team
Confirmation:
- Correct patient
- Site
- Procedure
- Opening temperature ______(in operating room)
Anticipated critical events:
- Surgeon review:
  - Critical or unexpected steps, operative duration, anticipated blood loss
  - Separation of clean and dirty instruments
- Anesthesia review:
  - Patient-specific concerns
- Circulating review:
  - Equipment availability, malfunctions, or concerns
Critical issues:
- Deep vein thrombosis prophylaxis:
  - Medication and dosing schedule _____________________ (marked on board)
- Sequential compression devices
- Foley: Who inserted ___________________________________________________
- Steroid coverage ___________________________
  - Followup cortisol level
- Antibiotics:
  - Selection
  - Dose
  - Redose (marked on board)
- Starting hemoglobin____________
  - Blood available
- Glycemic control starting blood glucose (BG)________ mg/dL
  - BG less than __________ mg/dL (plan)
- Beta blockade

Before Patient Leaves Operating Room

SIGN OUT

Nurse verbally confirms with team:
- Count correct
- Specimens labeled correctly
- Clean/dirty instrument separation
- Equipment issues/review
  Operator error versus posting error:
  ____________________________________________________________________________
  
  ____________________________________________________________________________
Team reviews concerns:
- Beta blockade
- Blood
- Glycemic control (blood glucose less than ________ mg/dL [plan])
- Pain management
- Deep vein thrombosis prophylaxis:
  - Medication and dosing schedule
  - Sequential compression device
  - Can Foley be discontinued within 24 hours?

Items to be addressed:

Please provide your comments and your contact information, and we will follow up personally with you on any issue you address:

If no comments, indicate not applicable (N/A):___________
Attending surgeon: ________________________________
Anesthesia personnel: _____________________________
Circulating nurse: _________________________________

Issues or comments:

____________________________________________________________

Contact information for response and/or followup:

____________________________________________________________

Minor Procedures

Patient has confirmed:
- Identity by name and date of birth.
- Procedure.
- Consent.
- hCG (human chorionic gonadotropin) hormone complete (if female).
Share names and roles of the surgical team.
Antibiotics given, if appropriate.
Patient positioned to prevent injury.
Potential problems of the case identified and discussed.
All equipment available for case.
Staff has working knowledge of equipment.

References

1. Centers for Disease Control and Prevention. Surgical Site Infection (SSI) Event. April 2015. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf.

2. Zimlichman E, Henderson D, Tamir O, et al. Health Care–Associated Infections. JAMA Intern Med 2013;173(22):2039. PMID: 23999949.

3. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370(13):1198-1208. PMID: 2467016.

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