Authors (including presenting author) :
Ho SC(1), Leung TF(1), Chu KW(1), Wong YH(1), Wong MN(1)
Affiliation :
(1)Operating Room, United Christian Hospital
Introduction :
Tourniquet application is a routine procedure performed daily in the Operation Room (OR). While there have been no reported cases of retained tourniquet occurrence in the OR, the prolonged placement of a tourniquet can lead to tissue ischemia and necrosis, posing a serious risk to patient safety. To prevent the inadvertent retention of tourniquet after performing intravenous (IV) access, and supported by the Kowloon East Cluster Quality and Safety (KEC Q&S) office, a “check-in and check-out counting” process was implemented.
Objectives :
To ensure the sustainability of the “check-in & check-out” counting process and documentation when applying tourniquets, as well as to establish a proactive control system for tourniquet supply in the OR.
Methodology :
1. Daily Stock-Taking and Recording: Tourniquets are stock-checked daily for each theatre, and their locations are recorded in the OR website by OR staff. 2. Each theatre is allocated 3 identifiable tourniquets, which are named and tracked. Tourniquets are replaced one by one to ensure control of over the supply. 3. A new item was added to the Anesthetic Clinical Information System (ACIS) to document tourniquet application and removal, which includes an electronic signature for accountability. 4. Check-in and check-out counting process: Tourniquet application and removal for IV access is verified by both the case anesthesiologist and OR staff. At the end of each procedure, the patient’s limbs are checked, the total number of tourniquets is counted, and the details are documented in ACIS before the patient leaves the theatre. 5. Established Standard of Procedure (SOP) for tourniquet safety and made available on the OR website to standardize the process across all staff. The process was reviewed and approved by KEC Q&S team.
Result & Outcome :
Out of 1300 anaesthetic procedure conducted over a 2-month period (September & October), 360 cases were randomly audited via the OR website. No missing tourniquets were reported during the daily routine checks, indicating effective proactive control of the supply. 2. Spot checks of 160 cases showed 100% of compliance with the “check-in and check-out” counting process. Both anesthesiologists and OR staff adhered to the documentation requirements in ACIS with e-signatures. 3. After implementation, no incidents of retained tourniquet have been reported in OR. Conclusion The longer a tourniquet is retained, the higher the risk of significant injury to the patient. The proactive control supply, check-in & check-out counting could be an effective strategy to mitigate these risks. This initiative has successfully reduced the likelihood of retained tourniquets, improved staff accountability, and enhanced patient safety.
