Newsletter
Surgical Fires: Electrosurgical Cases
Dec 31, 2011
Patient Safety Alert 5: Surgical Fires: Electrosurgical Cases (PDF)
The AMC PSO has identified a series of practices employed to address the factors that can contribute to surgical fires.
Safety Strategies: Prevention
- Interventions should be directed at the entire team rather than the provider wielding the electrosurgical unit (ESU).
- Each member of the team must be constantly aware of changing risks during the case (e.g., patient shifting causing tenting that creates an oxygen rich environment) and be empowered to identify and address these risks.
AMC PSO
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More AMC PSO Content
Publications such as whitepapers and guidelines derived from the AMC PSO convenings.
No Surgical Items Left Behind
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While the occurrence is rare, Massachusetts reported rising rates of retained surgical items over the past several years.
Medication Administration in the Ambulatory Setting
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Patient Safety Alert Issue 26: The AMC PSO convened a panel of nursing leaders to review risks in the medication delivery processes in the ambulatory setting and discuss potential interventions aimed at mitigating the risks associated with medication administration.
Patient & Visitor De-escalation
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Patient Safety Alert Issue 25: The AMC PSO convened a panel of safety leaders to review recent trends and discuss novel interventions to mitigate the risk for hospital workplace violence, especially from patients and visitors.
Electronic Health Record Risks in the Emergency Department
Newsletter
Patient Safety Alert Issue 27: The AMC PSO convened a panel of Emergency Medicine thought leaders to identify significant areas of concern and to explore potential mitigation strategies for use of electronic health record risks in the Emergency Department