Outpatient Surgery Magazine

Special Edition: Staff & Patient Safety - October 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 35 of 43

Surgeons (SAGES) and the Association of periOperative Registered Nurses (AORN) called FUSE: the Fundamental Use of Surgical Energy (fuseprogram.org). The free curriculum, developed over the last decade, is intended to bridge the elec- trosurgery knowledge gap in ORs. They encourage clinicians to get FUSE certifica- tions, which involves a supervised test. In fact, such certifications are mandatory for surgeons and OR nurses in France. "In the United States, many pro- grams are encouraging it or requiring it as a trainee," says Dr. Jones. "We're making a little head- way. For example, in our program, all residents have to take the FUSE certificate before graduating. They've got five to seven years to get it done. Our faculty are also encouraged to get certified." "It's a question of raising awareness," says Dr. Robinson, who chairs the FUSE committee. "We're saying, 'Look, you can perforate the bowel because you have a sharps injury with the scissors or a knife, or you can have stray energy burning in the tissue unintentionally. These are the patterns to electrosurgery injuries, and FUSE is teaching sur- geons to recognize these patterns with the goal of avoiding high-risk situations." FUSE certification is a lot of work, however, and many clinicians and health systems bristle at the program's density. Dr. Robinson says many mid-career surgeons just don't have the time to invest. In response, an abbreviated, down- loadable version of the curricu- lum called the FUSE Hospital Compliance Module just became available this year. To highlight the current issues with electrosurgical safety and the positive effects of formal training, Dr. Jones recalls an OR fire safety test of almost 200 sur- geons, anesthesiologists, nurses and techs at Beth Israel Deaconess using a virtual reality simulation. "Only five percent of all surgeons, nurses and anesthe- siologists did it correctly the first time," he says. "But by the time they've done these scenarios five times, pretty much everyone got it down. If you just go into an OR today like we did and test people, they're woefully unprepared to deal with these rare events." Dr. Jones says surgical professionals don't under- stand proper placement of dispersive electrodes with monopolar cautery. They're not thinking about the heat transfer at the tip of the instrument that may burn the bowel or the stray energy that may burn it. In fact, when they take the FUSE course, they realize several of the decisions they make may not be good ones, adds Dr. Jones. Facilities often don't address electrosurgery safe- ty until after the fact. When there's an adverse event like an OR fire, surgical leaders and surgeons seek information about how the incident could have been prevented. "We use those opportunities to get FUSE curriculum into those centers," says Dr. Robinson. "The issue is that electrosurgery burns are uncommon events that may impact surgeons once in their careers, so their awareness isn't as height- ened as it is, say, for surgical site infections," he adds. "But while an electrosurgery mishap is rare, when it does happen, the outcomes for the patient are catastrophic. A bowel perforation is a huge deal to a patient." It's also a stain on the safety record of your facility. OSM 3 6 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 2 0 INSULATION BREACH The most common safety issue with electrosurgical laparoscopic instruments is breached insulation, which isn't always as obvious to identify as it is here.

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