Background: Errors in healthcare can be catastrophic and devastating, not only for the patient and family, but also for healthcare providers and the medical institutions involved. The magnitude of medical error in the United States is widespread according to the Institute of Medicine (IOM). While the specific incidence of wrong-site surgery is largely unknown, in 1996 the Joint Commission on the Accreditation of Healthcare Organizations (TJC) introduced a policy that addresses what is referred to as sentinel events. Since the implementation of the policy, operating room (OR) reporting identified errors in ambulatory settings, inpatient operating rooms, and other inpatient settings. Wrong-site surgery incidents were reported in all surgical specialties. Despite increased patient safety awareness in the healthcare industry, procedural errors remain a major problem. Foreground: An initial assessment was conducted with the sample RNs revealing a lack of awareness and knowledge of the utilization of a dedicated timeout checklist for patients undergoing invasive procedures outside the OR. This lack of awareness was further substantiated through documentation evaluation of several non-OR procedures, affirming lack of adherence to the time-out protocol. Failure to implement TJC recommendations in non-OR settings creates the risk of serious errors occurring. Adhering to universal protocol timeouts prior to beginning surgery must be applied to non-OR procedures to improve patient safety. The need existed to increase the culture of safety regarding non-OR procedures. Evidence-based Practice Framework: The intent of this Capstone was to implement the clinical practice guideline in the use of timeout checklists for surgical procedures performed outside of the OR setting. The theoretical foundation for this project was Roy’s Adaption Model. Rosswurm and Larrabee’s Model for Evidence-based Practice Change was the selected practice framework applied throughout this capstone. Methods: A comprehensive educational training was conducted at a large, nonprofit hospital located in Southeast Teas. The staff training was conducted with six Registered Nurses (RN) regarding utilization of non-OR checklists. Charts were reviewed to compare the utilization of checklist documentation before and after the training implementation. After staff training, a significant increase in timeout documentation was noted suggesting that educating staff nurses is effective in improving utilization of timeout checklists for surgical procedures performed outside the OR setting. Conclusion: Findings from this capstone suggest that provider education, chart audit and feedback, and subsequent monitoring for sustainability are effective means of implementing and measuring practice change. Educating nurses to adhere to universal protocol timeouts prior to beginning procedures both inside and outside the OR will have significant impact in preventing wrong-person, wrong-procedure, and wrong-site errors. Sustaining this practice will result in improved patient safety. In addition, nurses, hospital administrators, and the overall healthcare system will also realize a significant benefit.
