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Preventing Operating Room Fires Requires Anesthesia, Surgeon Coordination

March 21, 2008
Written by: , Filed in: Practice Management
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Flash fires occur in the operating room when there is a pooling of oxygen due
to the anesthesia technique and the Bovie (instrument used for electrosurgical
dissection and hemostasis) being used simultaneously by the surgical team.

In any health care facility, environmental errors can result in serious
patient injury or death. Several environmental errors are listed on the
National Quality Forum’s list of 28 ‘never events.’ One of these items is that
of patient death or disability associated with a burn incurred from any source
while being cared for in a health care facility.

The first source of burns is from fires in the operating room (OR). A great
deal has been written about OR fires, and there are some incredible trainers
who will educate you about OR fires, how they happen, and how you can prevent
them. These trainers can give a little pyrotechnic show to demonstrate exactly
what can happen and how to prevent certain types of fires. Nonetheless, OR
fires continue to occur.

Consistently, the situation is the same for these fires. A patient who
presents for head and neck surgery is placed under moderate anesthesia care
rather than under general anesthesia. Because there is a drape over the
patient’s face, there is pooling of oxygen. When someone in the OR uses the
Bovie (instrument used for electrosurgical dissection and hemostasis), you
suddenly have a flash fire.

To prevent Bovie-related fires in the OR requires coordination between the
surgeon and anesthesiologist. When the Bovie goes on, the oxygen must be
turned off. When the Bovie is switched off, the oxygen can be turned on. There
are many ways to prevent these fires, and most people have read about those
things but do not apply them to their practice unless they have, in fact, been
involved in an OR fire. Fortunately, these Bovie-related fires are rare, but
OR staff members need to be aware of these issues and preventive measures.

In addition to OR fires, use of the Bovie can also be associated with serious
burns. If someone does not return the Bovie to the holster or if there is an
inadvertent use of the Bovie, someone will probably get burned. Usually it is
a surgical team member who gets burned in these situations. These burns do not
happen frequently, but following protocol should help avoid this error.

Reference
Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events: OR
Fires and Burns Resulting From Inappropriate Use of Bovie.

Flash fires occur in the operating room when there is a pooling of oxygen due to the anesthesia technique and the Bovie (instrument used for electrosurgical dissection and hemostasis) being used simultaneously by the surgical team. In any health care facility, environmental errors can result in serious patient injury or death. Several environmental errors are listed on the National Quality Forum's list of 28 'never events.' One of these items is that of patient death or disability associated with a burn incurred from any source while being cared for in a health care facility. The first source of burns is from fires in the operating room (OR). A great deal has been written about OR fires, and there are some incredible trainers who will educate you about OR fires, how they happen, and how you can prevent them. These trainers can give a little pyrotechnic show to demonstrate exactly what can happen and how to prevent certain types of fires. Nonetheless, OR fires continue to occur. Consistently, the situation is the same for these fires. A patient who presents for head and neck surgery is placed under moderate anesthesia care rather than under general anesthesia. Because there is a drape over the patient's face, there is pooling of oxygen. When someone in the OR uses the Bovie (instrument used for electrosurgical dissection and hemostasis), you suddenly have a flash fire. To prevent Bovie-related fires in the OR requires coordination between the surgeon and anesthesiologist. When the Bovie goes on, the oxygen must be turned off. When the Bovie is switched off, the oxygen can be turned on. There are many ways to prevent these fires, and most people have read about those things but do not apply them to their practice unless they have, in fact, been involved in an OR fire. Fortunately, these Bovie-related fires are rare, but OR staff members need to be aware of these issues and preventive measures. In addition to OR fires, use of the Bovie can also be associated with serious burns. If someone does not return the Bovie to the holster or if there is an inadvertent use of the Bovie, someone will probably get burned. Usually it is a surgical team member who gets burned in these situations. These burns do not happen frequently, but following protocol should help avoid this error. Reference Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events: OR Fires and Burns Resulting From Inappropriate Use of Bovie. [text_ad]
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