M A Y 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 5 1
Take the initiative to review prep manufacturers' directions and compare
them to what's actually being performed in the ORs. A culture of effectiveness
and improvement starts with leadership. In surgery, we have a tendency to rely
on authority. "Dr. Johnson showed me how to do this," we reason, "so this is
always the best way to do it." Well, maybe, or maybe not: How do we know?
Since members of the surgical team are often hesitant to question surgeons'
orders, you must step in to ensure skin prepping is being done correctly.
Create a culture of system improvement ("We failed this patient because we
didn't have a system in place for ensuring proper skin preparation") instead of
casting individual blame ("Our patient suffered a wound infection because you
didn't prep properly"). Work to educate and train the nurses, physician assis-
tants, techs and other frontline employees who are actually prepping the skin.
There is nothing complex about skin prepping, but there is a correct way to do
it and an infinite number of incorrect ways (see "Skin Antisepsis Done Right").
Standardizing practices is another key to improvement. The circulator who
preps patients probably works with several surgeons. As a result, she must
keep all of their orders and requested methods straight, for prepping as well
as for everything else. This not only risks utter confusion, it also increases
the likelihood that a member of the surgical team strays from manufacturers'
instructions for use and compromises the preps' effectiveness.
Speak with your surgeons about standardizing prepping products and tech-
niques to make the circulator's performance more consistent, to prevent cost-
ly SSIs, to provide better patient care and even to offer the financial incen-
tives of volume purchasing deals and simplified inventory management.
The great prep debate
Expert discussions have centered on which skin prep is the most effective. This
is an important issue that hasn't yet been adequately answered. The 3 most com-
monly used skin prep agents in the United States are (in no particular order) a
