Rotating through the OR, during my second year of nursing school, I can remember being amused. It was like a theatrical production; the main drama happening between patient and surgeon while the nurses, techs, and anesthesiologist made everything flow seamlessly back-stage. Everyone had a role that included a set of specialized tasks like gathering supplies and setting up a sterile field. I thought to myself, this sums up the meaning of teamwork! Well, actually not so much. After about ten minutes I realized something, they all operated like androids. No one talked, their bodies tense as logs and I don’t think the surgeon could have been anymore stone-faced. Even though the procedure executed well, as far as I know, it certainly brought up some questions in my mind about communication.
Every year, thousands of near misses and surgical mistakes, occur all over the country. Many of them happen due to miscommunication from surgeons or other team members. The biggest factor, not speaking up after noticing something messy about to take place. Operating room teams are not the only ones to single out when it comes to lack of communication. Various medication errors and other mistakes occur because of communication breakdown which can then lead to an unraveling team.
One of the creepiest examples of this happened on the psychiatric inpatient ward I worked a couple years ago. I witnessed a floating nurse receive a verbal order from a psychiatrist who was in a hurry, involving a patient who needed an antihypertensive med. The nurse was shuffling herself to take care of something else on the unit and didn’t immediately write the order down. She scanned it to the pharmacy which then processed it. In a strange proceeding of events, later in the evening, the nurse asked if I could help out and give the patient her meds. I agreed but felt weird about it, especially with all the rushing I’d seen. As I reviewed the order in the patient’s chart, two things raised warning flags. The dose was incredibly higher than average and it happened to be a drug discontinued for the patient a week earlier due to plummeting blood pressure at night. The nurse had written a verbal order with the wrong dose for a med the patient couldn’t take in the first place and pharmacy didn’t even catch it! Fortunately, I brought the mistake up to everyone involved, corrections were made and no harm done. This represents a great example of how miscommunication and not paying attention, can cause a chain reaction that sometimes leads to great detriment.
So I began to wonder, how can we work to improve such outcomes on the floor and among the “multi-disciplinary team?” It really comes down to the basic skill yet at times difficult to do; listening. It’s easy to have a million things going on in your mind at once while in a hurry and then not truly hear the person yapping away at your ear. Also, we can’t allow ourselves to fall into the mindset of doctors or surgeons being God. They make mistakes too and sometimes we have to pay attention and speak up. Long gone are the days when “doctors knew best.” As part of a medical team, we all work together in making sure patients are safe. All of us truly make up the chain and if one link is broken, everything can fall apart.