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M A R C H 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
In our minds, the conventional rating system isn't effective
enough. Staff are too quick to classify a procedure and don't
address the reasons behind the score. What makes a case high-
risk? What elements gave it a high rating? The reasons are rarely
discussed and almost never challenged. That way of doing things
makes it too easy to check off the fire safety box on the time-out
checklist without addressing specific causes for concern.
We've gotten away from using the fire-risk rating system.
Instead, the surgical team talks about the specific risks for the
case and discusses what preventative measures will help lower
those dangers. Anesthesia, surgeons, scrub techs and nurses par-
ticipate, taking turns leading the conversation, because each disci-
pline is responsible for managing various elements of the fire tri-
angle. Here are 5 factors that will help guide the conversation:
Fuels. A nurse notes if flammable liquids are on the field and
alerts the team if an alcohol-based prep was used. If it was,
she confirms that enough time passed for it to dry.
Timing of use. A nurse indicates if flammable agents will be
introduced later in the case (see "Store Flammable Agents in
Red Bins").
Ignition sources. The surgeon identifies ignition sources he
plans to use. The scrub person will confirm that a holster for
the device is present and simple saline is on the field. They both
discuss precautions that will prevent any sort of ignition-source-
related incident.
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