AST Guideline - Use of Mobile Information Technology in the Operating Room

4 seeing another perfusionist distracted by cell phone use or texting during surgery. However, 78.3% expressed the opinion that cell phone distraction can be a potentially significant safety risk to patients. 32 B. OR personnel should never access a cell phone either directly or using a wireless headset during perioperative care of the patient. 31 Additionally, OR personnel should never use the OR computer for personal use, e.g., browsing through Internet sites, checking and/or posting on social networking sites. The activities of OR personnel should be solely focused on the perioperative care of the patient in order to avoid medical errors. 33 OR personnel who are focused on a device’s screen rather than focused on the patient may miss indications of the patient’s condition and/or indications of an impending medical emergency, e.g. cardiac arrest during surgery. 1) The following serves as an example of the level of safety risk a patient is placed when OR personnel are not focused on the procedure. The New York Times published a report of a neurosurgeon who was distracted during an operation while making personal phone calls using a wireless headset and the patient was left partially paralyzed. 2 2) Dr. John Halamka wrote up a case study that illustrates how distractions by mobile devices place patients at risk and further emphasizes that the patient should be the center of attention. A resident physician was using a smartphone to enter an order to stop anticoagulation therapy for a patient in the HDO’s EHR system as ordered by the attending physician. Before completing the order the resident received a personal text message about a party that was soon to be held. The resident responded to the text message, but never resumed finishing the patient order. The patient continued to receive anticoagulation therapy for several days resulting in conditions that required emergency open-heart surgery. 34 3) A recommendation is for the HDO in conjunction with the information technology department to create a priority list of phone numbers and/or email addresses that would be allowed to alert the user during work. All other numbers and email addresses not on the priority list would automatically enter the “do not disturb” mode. 16 C. The ring tone of mobile devices can be a source for interrupting the care of the surgical patient. 1) The ring tone of a cell phone, or noticeable vibration, can disrupt the communication of the team in the OR. Alarm tones on medical equipment may be overlooked by the OR team if confused with cell phone ring tones. 2) The OR team should remember the strongest sense that the patient experiences in the OR is hearing, in particular just prior to general anesthesia taking full effect or if the procedure is performed under local sedation. The patient may be startled and experience unnecessary anxiety by a ring tone or vibration.