Preoperative Screening in Surgery

Health & FitnessMedicine

  • Author Cyrus Mungai
  • Published May 4, 2023
  • Word count 3,563

Patient Injury Caused by Positioning for Surgery

Introduction

Patient safety is among the most profound aspects of healthcare delivery that healthcare providers must embrace to enhance the common universal goal of improving healthcare quality. Leadership is also at the core of providing quality healthcare by ensuring patients are safe in the hospital setting. The leaders have a substantial role to play in ensuring that the patients are safe from challenges that may arise. Sevdalis, Hull, and Birnbach (2012), argues that when structure of the organisation, environment ambiguity, production requirements, and the natural stress of managing critically sick patients are coupled, human error becomes practically impossible to avoid. Leaders must constantly work to set an example, manage resources, and enhance procedures. Successful leaders support safety measures and develop systems that handle issues raised by patients and front-line healthcare workers.

Furthermore, Albright-Trainer et al. (2020) contend that leaders may take rapid, decisive action to protect patients and employees by fostering an atmosphere where individuals feel secure discussing issues and speaking up with concerns. This is critically necessary for the delivery of high-quality medical care. The bottom line is that managers that promote a positive work environment encourage higher job satisfaction among employees, decreased burnout, fewer medical mistakes, and a generally increased safety culture (Trainer et al., 2020). Furthermore, effective leadership is essential for patient safety because it creates a safety culture, prioritizes resource allocation, guides decision-making, encourages accountability, and fosters continuous improvement. Patient safety eventually develops inside the hospital environment as a result of this.

This quite inquisitive study brings forth the role of leadership in addressing the quite detrimental risks of injury that patients face by positioning the surgery. According to Nascimento et al. (2020), surgery positioning is crucial to performing safe and effective operative procedures, despite the risks it poses to patients because of how they are positioned on the operating table. Its objective is to give surgeons the best possible anatomical exposure. Hence, this assignment will focus on a comprehensive understanding of the fundamental importance of proper patient positioning in surgical procedures. Additionally, the study will also focus on identifying the potential risks and complications associated with incorrect patient positioning during a surgical procedure. Effective strategies developed from theoretical analysis of existing scholarly literature are discussed on the most fundamental ways of ensuring patient safety during surgical positioning. Furthermore, this comprehensive analysis of the issue of patient safety is achieved through a critical evaluation of existing literature to bring forth significant knowledge that is quite essential for real-life situations in healthcare settings.

Patient Injury Caused by Positioning for Surgery

The operating theatre is a critical area in a hospital where surgical procedures are performed on patients. Nevertheless, the challenges patients face within the operating theatre environment are also significant. Among the most significant challenges that bring forth the safety of the patient during the surgery process into question is the patient's propensity to get injured due to ineffective positioning of the patient. Surgery placement is a crucial part of carrying out safe and effective operative operations, even though there are risks to patients due to their position on the operating table (Nascimento & Rodrigues, 2020). Additionally, it aims to give surgeons the best possible anatomical exposure. The risk of injuries for patients during the Intraoperative positioning process of surgery is still among the most significant patient safety concerns within a healthcare environment. The positioning of the patient on the operating table is determined by the type of surgery that will be done and by the patient's physical health. Intraoperative positioning aims to place the patient in the best possible posture for surgery while reducing pain and consequences. Healthcare professionals often handle intraoperative positioning before and occasionally throughout a medical operation. Positioning is a shared responsibility between anaesthesiologists and surgeons, who must be aware of the patient's correct position, the time of the process, and the potential need to reposition the patient. Among the essential ways that can be incorporated as a shared responsibility is using healthcare team-based measures that include training, standardization, and simulation (Sevdalis, Hull, and Birnbach, 2012). Furthermore, it is crucial to comprehend that improper patient placement can harm the patient's condition in the long term and the short-term. Additionally, it is essential to have a deeper understanding of the various patient positioning styles and the attributed challenges, which is essential for developing comprehensive strategies that will address the safety concerns arising from patient positioning.

Among the most common patient positioning methods is the Supine patient placement, in which the patient rests on his or her back, with the legs straight and the arms at the sides or propped up on arm boards. It is most frequently employed for abdominal surgery and other surgeries involving the extremities (STERIS Healthcare, 2018). Skin disintegration, vertebral strain, nerve damage, cardiovascular compromise, and respiration compromise are some significant risks of this position if held for extended periods. Another crucial placement method is the prone position, which is face down with the breasts, genitalia, arms, and legs in as normal an anatomical alignment as possible. The entire OR staff log-rolls patients to it after administering the anaesthetic. In addition to other health problems, this style contributes to troubles with skin aging, damage to women's breasts or men's genitalia, and other problems (STERIS Healthcare, 2018). The Kraske positioning applied in rectal surgery is well attributed to bearing the same patient health risks as the Prone positioning style.

The lithotomy positioning style commonly applied during gynaecological or genitourinary surgery is also attributed to having the same patient health risks as the kin breakdown and nerve damage, as well as if the legs are elevated or dropped too quickly, the patient may potentially feel hypotension. Lastly, lateral positioning is well attributed to bearing the potential risks of decreased breathing, skin disintegration, and nerve damage (STERIS Healthcare, 2018). Hence, because the risks attributed to patient positioning are several, it becomes essential to identify the most comprehensive leadership strategies to address the instances that may lead to ineffective patient positioning during a surgical operation.

Leadership styles in Operating Theatres

Effective leadership is critical in addressing the daily challenges faced in the operating theatre. Leadership in the operating room necessitates the capacity to change approaches depending on the situation. Furthermore, it lays the groundwork and the necessary framework for the protocol in the operating theatre, which is essential in delegating roles to minimize patients' risk of further injury during the surgical process. Among the most profound leadership styles is the Transformational leadership style (Arnold & Fleshman, 2020). It is a common consensus within the healthcare field that the surgical team doing the operation is motivated and inspired to perform to their greatest capacity by transformational leaders inside the Transformational operating leaders' foster room. A crucial culture steered the operation, encouraging workers to voice their concerns and urge ongoing quality improvement.

Arnold and Fleshman (2020) also contend that the team develops under transformational leadership. Coercive, imaginative, evolutionarily adaptive, direct democracy, pacesetting, and mentoring are all significant team leadership styles. The style employed to lead the team can also differ. The head of the surgical team, typically the surgeon in the operating room, must be continually adapting and aware of the variables affecting certain norms and etiquette. The dominating notes room only sometimes has e a loud ng one. Hence, the transformational leader ought to focus on essential strategies that will improve the team's cohesiveness and maximize the team's potential during the surgical process. This is essential in prioritizing patient safety in the face of a surgical operation.

Furthermore, the traits that transformational leaders must possess are not a contentious discussion. It is a common consensus that effective transformational leaders ought to possess essential leadership characteristics such as the capacity to motivate people to seek out better means of achieving a goal and to continuously keep the larger good in mind (Arnold & Fleshman, 2020). Additionally, transformational leaders within a surgery operation team should bear the potential to organize individuals into teams that can do tasks. They are crucial in ensuring team members are matched in ways that will help them succeed together during the surgical operation (Arnold & Fleshman, 2020). Arnold and Fleshman (2020) also propose that for surgeons to be effective leaders during the operation process of a patient and reduce the propensity of risks associated with surgery positioning, the leaders must have the ability to enhance a group's capacity to become happier and more motivated through strong relationships that make the leader feel like a team member and make the team feel in control of every outcome, whether good or bad. Furthermore, transformational leaders ought to possess excellent conflict-resolution abilities. Finding strategies to highlight that particular issue is their next step after learning what needs to improve. The correct leadership style can help to foster teamwork, safety, and high-quality care. Good leadership is essential in addressing the daily problems faced in the operating room.

Evaluation of the Healthcare Leadership Model

The Healthcare Leadership Model is a strategy that aims to empower, inspire, and motivate healthcare professionals to work together to achieve common objectives. The role of leaders in fostering a positive workplace culture and encouraging professional growth among their team members is emphasized by this paradigm. Nine dimensions are also listed in The Healthcare Leader: leading with caring, communicating overall vision, advocating for outcomes, involving the team, evaluating evidence, inspiring a joint mission, linking our service, creating capability, and holding to responsibility (NHS England, 2020). The leadership model of the healthcare sector from a transformational leadership approach has proven to be quite an effective strategy for addressing the patient safety concerns that are prevalent during patient positioning in a surgery procedure.

The healthcare leadership model is attributed to improving the personal leadership styles of the respective leaders during a surgical operation. From a conceptual analysis of the healthcare leadership model by NHS North West Leadership Academy (2023), the HLM outlines the behaviours of effective leaders and will aid in a leader's development by demonstrating the impact that their actions have on the environment in which they, their team members, and their colleagues operate. Furthermore, the HLM is centred on developing people's capacity to meet future problems, various experiences to foster individual and organizational learning, and serving as an example of human growth. Hence, integrating the HLM model into the transformational leadership of surgeons is quite an essential measure toward reducing the challenges that prevail in healthcare settings, particularly in patient positioning during surgical operations.

Among the essential dimensions of HLM in reducing the propensity of patient safety during a surgical placement process is the application of teamwork and communicating the overall vision. The team members must be encouraged to cooperate and communicate with the shared vision of upholding the patient's health during the surgical operation.

Patient Positioning and Healthcare Quality

The linkage between patient positioning and the quality of healthcare is quite apparent. Patient positioning bears the risk of negatively impacting the patient's overall safety during surgical operations. Patient positioning can affect patient comfort, safety, and outcomes, making it a crucial component of high-quality treatment. Additionally, is quite essential to have a deeper understanding of the fact that Injuries can be avoided, problems can be less likely to occur, and patient's comfort and happiness can all be increased with proper patient placement. According to Mitchell (n.d.), providing high-quality medical treatment is inseparable from patient safety and is the cornerstone of high patient quality.

Thus, if the healthcare staff fails to reduce the risks of injury attributed to poor patient positioning during a surgical operation, that can be considered as the provision of poor-quality healthcare; additionally, scholarly literature has proven beyond reasonable doubt that proper patient positioning, including frequent repositioning, can help prevent the development of pressure injuries such as risks associated with Supine patient placement among several others (STERIS Healthcare, 2018). Furthermore, proper patient positioning is essential for safety during procedures. Incorrect positioning can lead to injury or complications, such as nerve damage, blood vessel damage, or aspiration, which is a crucial measure for assessing healthcare quality.

Challenge: Are We Doing Enough to Prevent Patient Injury Caused by Positioning for Surgery?

Offering quality healthcare is of utmost importance. Even though there are rules and procedures to guarantee proper patient positioning, mistakes can still happen. According to recent research evidence concerning the propensity of patient positioning leading to increased chances of the patient becoming injured, it is apparent that for surgery patients, position-related soft tissue damage results in increased physical discomfort and higher medical expenses (Buli et al., 2022). Hence, it is crucial to evaluate and improve procedures to reduce patient injuries continuously. Buli et al. (2022) propose that to prevent position-related soft tissue injury, surgical teams must create or implement local protocols, and preoperative considerations should be addressed. Hence, there is a need to apply a multimodal strategy to prevent patient damage brought on by positioning for surgery effectively.

Essential Change

There is a dire need to implement essential changes to address the challenge of patient injury caused by positioning for surgery. Safeguarding the patient from physiological issues and harm due to immobility is the ultimate purpose of optimal patient positioning. Among the essential changes that can be implemented is regular training and education on the best practices for patient positioning and appropriate equipment (Sevdalis, Hull, and Birnbach, 2012). Additionally, it is essential to establish standardized procedures, embrace the use of technology, such as specialized positioning devices, and conduct a regular review of patient positioning procedures and outcomes to identify areas for improvement.

Aims

The Smart plan approach helps ensure the plan is well-defined, measurable, and achievable within a specific timeframe.

• Specific: lessen the likelihood that surgical positioning will result in patient harm

• Measurable: A decrease in the number of reported instances of patient damage brought on by positioning for surgery will serve as a benchmark for the plan.

• Achievable: Standardized practices will be implemented, along with other essential methods, to make the plan a success.

• Relevant: the plan is pertinent to the healthcare organization's goal of giving patients high-quality care.

• Time-bound: Plan will be implemented in a fixed period of six months.

QI tools Problem Analysis.

QI tools can help identify the root cause of the problem associated with patient positioning and provide insight into possible solutions. The essential QI tools are necessary for developing a deeper understanding of the information regarding the improvement strategy.

• Pareto chart: This tool might help determine the most frequent reasons patients are injured while being positioned for surgery.

• Run Charts: they are essential for tracking the changes in data over time.

• Cause and effect diagram: logically organize the possible causes for injuries due to patient positioning (Picarillo, 2018).

• Process flowchart: This tool would help review the patient positioning procedure and see where improvements could be made.

Using QI tools such as problem analysis, change management tools, stakeholder analysis, communication matrix, and force analysis is essential in the improvement plan as they can identify the critical areas needing improvement. Additionally, they are essential in the implementation of the changes as well as being attributed to enhancing effective communication with the stakeholders, which is essential in reducing patient injury due to surgery positioning.

Impact of Improvement on Patient Safety

The improvement had a significant positive impact on the efforts to provide quality healthcare. First, it is essential to identify the fact that poor positioning of the patient during surgery has a detrimental impact on offering quality healthcare. However, with the implementation of a SMART goal change plan, healthcare quality has improved. The impact of the improvements was quite evident in the improved patient satisfaction. According to Pękacz et al., (2019), the competencies of the medical staff are a significant factor in patient satisfaction in improved healthcare quality. Additionally, the changes implemented reduced the propensity of a patient experiencing injuries due to positioning.

Role of Human Factors in Perioperative Practice

Patient safety is among the most significant aspects of providing quality care. In order to ensure patient safety in perioperative practice, a complex system of interactions involving medical staff, equipment, and the environment must be in place. This is in due consideration of the fact that Errors in healthcare that may jeopardize patient safety are frequently caused by human reasons (Sevdalis, Hull, and Birnbach, 2012). Among the significant aspects of patient safety is the pre-procedure verification process. The team must identify and address the missing information before proceeding with the task. Another significant aspect of patient safety is the essential Marking of the correct operative site. Additionally, the team should evaluate to identify the right patient and technique.

Human factors play a significant role in upholding patient safety in perioperative practice. A friendly and productive working environment among all theatre team members is essential to the safety of patients in the operating room. The essential human factors are the OR setting, collaboration and communication, technology and apparatus, task and workload considerations, and organisational characteristics (ElBardissi & Sundt, 2012). There is a need to address discrepancies arising in human factors for adequate patient safety in preoperative practice.

Patient Safety

Preoperative patient safety refers to the actions taken, and protocols followed to ensure patient safety is not threatened before surgical operations.

Main Theories of Safety

Among the most significant theoretical hypothesis of inpatient service is the essential Human Factors Theory, which captures the heart of the fact that errors in healthcare frequently result from interactions between individuals and the systems in which they work (The University of Bedfordshire, 2023). Another critical theoretical perspective is the Person and Systems Approach, which is grounded on the perspective that errors in healthcare often result from the interaction between individuals and the systems in which they work. Furthermore, according to the perspective of Normal Accident Theory, there is a consensus that systems are prone to errors, hence the need to design them efficiently.

Safety 1 and Safety 2

These are among the most effective approaches to enhancing the safety of patients within a healthcare environment. The primary objective of Safety 1 is to reduce harm by preventing errors from happening in the first place. Safety 1 focuses on recognizing and lowering the possibility of adverse occurrences based on the premise that errors and failures are inevitable in complex systems and ensuring that very few things go wrong (MacKinnon et al., 2021). Furthermore, MacKinnon et al. (2021) also affirm that Safety 2, which highlights the importance of creating a robust and flexible system, acknowledges the significance of understanding why things happen correctly and badly.

My improvement is safety 2 because it is grounded on the need to understand and leverage the strengths of a system to prevent harm. This is quite essential in maintaining patient safety in a healthcare environment.

Safety Culture and its Effects on Patient Safety

Patient safety culture is the degree to which a healthcare provider culture encourages and supports patient safety via the use of shared values, principles, and conventions that affect the actions and behaviours of healthcare professionals and other staff members across the organization (NHS England, 2022). It significantly impacts the patient's safety as it develops a framework for the healthcare organization to approach risk and manage errors and failures.

Impact of Human Factors on Preoperative Practice

Human factors have a significant influence on upholding the safety of the patient in the preoperative practice. Good communication is essential as it establishes rapport with the surgical team. However, poor communication can increase the risk of harm, so excellent patient teamwork is required. Additionally, teamwork is required to ensure that everyone is working together to offer the patented. Teams are delivering care. Therefore the calibre and efficiency of group communication and synchronization are crucial for safety and convenience (Sevdalis, Hull, and Birnbach, 2012). Also, it significantly impacts patient safety because it is commonly acknowledged that healthcare professionals with excellent training and experience are more likely to give patients safe and effective care.

Managing the Effects of Human Factors

It is essential to employ a multifaceted approach to managing human factors by applying essential strategies. Healthcare practitioners can get training on the effects of human factors on patient safety and the tools and strategies required to lessen these effects. Additionally, Sevdalis, Hull, and Birnbach (2012) recommend standardizing skills and team assessment procedures, investing in educational leadership workshops and quality testing to educate and coach capabilities and teams, and incorporating simulations into medical training and practice, which ultimately are all urgently needed. Furthermore, there is a need to embrace a more considered and scientific method of choosing healthcare providers (Sevdalis, Hull, and Birnbach, 2012). Hence, applying the above strategies promotes patient safety in preoperative practice.

Conclusion

Patient safety due to preoperative positioning is among the healthcare sector's most significant challenges. The leaders in the operating room have a significant responsibility to protect the patients from any dangers. Considering the detrimental impact of poor patient positioning during surgery on the patient's health, there is a need to embrace a multifaceted improvement approach to ensure that the patient's safety is not compromised. One such improvement strategy is the application of systematic instruction and instruction on the proper use of the equipment and the best techniques for patient positioning. In order to discover areas for improvement, it is also crucial to establish standard operating procedures, adopt technology such as specialized positioning devices, and perform regular reviews of patient positioning methods and results. Additionally, it is essential to embrace standardizing the methods used to evaluate abilities and teams, investing in educational leadership workshops and quality testing to educate and coach teams and abilities, and integrating simulations into medical education and practice to manage human factors.

References.

Patient Positioning During Surgery| Preoperative Preparation.

Cyrus Njoroge Mungai.

University of Nairobi.

Kenya.

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