Optimizing High-Reliability Organization Principles and Enterprise Risk Management to Prevent Surgical Fires

Health care risk managers rely on collaborative relationships with perioperative nurse leaders, surgeons, and frontline personnel to proactively identify and report adverse events and near misses that create unsafe situations in the surgical setting. Preoccupation with failure means becoming aware of small, seemingly inconsequential errors or deviances that are symptoms of larger issues. Examples that I have seen during surgical procedures include instances of the ESU handpiece not being holstered when not in use and skin prep solution not being allowed to dry before draping. These practice deviances are indicators of noncompliance and production pressures taking priority over patient protection (ie, patient safety), and deviances like these require leadership intervention to correct. Speaking up and reporting such deviances are the first steps in correcting them to reduce the risk of surgical fires. Doing so requires a culture of safety and a culture of continuous learning something that perioperative nurses and risk managers both work to create but often from different places in the organization.
Being sensitive to operations entails paying attention to what is happening on the front line. Illustrations of this from a risk management perspective include the following:
■ Ensure that surgical teams are performing a fire risk assessment before the start of surgical procedures and implementing a plan of care that includes specific fire precautions, such as a formal time out for ear, nose, and throat procedures.
■ Provide fire safety training and education for perioperative nurses, anesthesia professionals, surgeons, and surgical personnel. This includes fire drills and, if possible, simulation for practice and learning.
■ Monitor compliance with fire safety policies and assign accountability for behavioral choices and professional practice to perioperative nursing and medical staff leaders.
From a patient safety perspective, the risk of a surgical fire is too great not to prevent. The
occurrence of such an event negatively affects the patient, primarily in terms of human harm, but it also traumatizes the perioperative team members who are involved. The ripple effects for the health care organization include possible loss of accreditation status, loss of reputation, and a financial downturn.
The adage “everyone is a risk manager” reflects the collaboration among surgical team members and risk managers that is necessary to establish best practices in surgical fire safety that are supported without compromise. This collaboration is exemplified in a reliability culture of continuous learning, which embraces safety as a core value and embeds it in the enterprise risk management process so that health care organizations can thrive in a changing environment that rewards safe and trusted care.

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