Please help with the question below, thank you

Common teamwork barriers that can lead to a sentinel event include these problems:

– Inconsistency in team leaders

Lack of time to meet and interact as a team

Hierarchy

Defensiveness

Not speaking up

Conventional thinking

– Varying communication styles

Unresolved conflict

Distractions

Fatigue

Heavy workload

Misinterpreting cues

Lack of role clarity

1. Considering the list of teamwork barriers in question 1, describe which barriers existed in this case and how the barriers contributed to the eventual adverse event

2. Suggest ways the process can be changed to improve teamwork and thus reduce the likelihood another event of this type will occur

Case study:

An orthopedic clinic phones the hospital to schedule a left-knee arthroscopy procedure for a 66-year-old man. On receipt of the procedure reservation, the hospital sends an electronic copy of the surgery booking back to the clinic for verification. According to procedure, the clinic is to confirm the accuracy of the information, but this confirmation is not done. It is later discovered the surgeon's medical assistant had incorrectly scheduled the procedure for the left knee when the patient's right knee was to be operated on. One week later the patient arrives at the hospital's outpatient surgery unit. The operating room (OR) schedule and the patient's registration information indicate he is scheduled for a left-knee arthroscopy. The patient's history and physical (H&P) from his primary care physician indicates his right knee is to be operated on. The patient's H&P from the orthopedic surgeon indicates the procedure will be done on the left knee. Throughout the entire stay, no one notices the inconsistencies in laterality present in the two H&Ps. The patient is taken to the preoperative area, where a nurse obtains routine information from the patient and asks the patient to state the surgery he is having. The patient says he has been having pain in both knees but thinks it is his left knee that will be operated on today. This statement is confirmed by the nurse by comparing what the patient said to the procedure listed on the OR schedule. The anesthesiologist scheduled to participate in the case is running behind schedule with another procedure, so a covering anesthesiologist conducts the patient's preoperative anesthesia assessment. During the assessment, the anesthesiologist notices the patient seems to be confused about which knee is to be operated on, but this observation is not documented in the assessment notes nor is it communicated to the surgeon. The covering anesthesiologist only notes “knee arthroscopy” in the patient's record and does not indicate which knee. In the preoperative area, the surgeon talks with the patient and discusses the right-knee arthroscopy he will be doing. The patient agrees and signs the consent form for a right-knee procedure, and the surgeon marks the patient's right knee as the correct surgery site. The circulating nurse witnesses the patient's signature on the consent form. The OR room is set up for the procedure. The anesthesiologist scheduled to participate in the case reads the preoperative anesthesia assessment done by the covering anesthesiologist to determine what is needed for the procedure. The patient is brought in to the OR. The patient's identity is validated and documented on the time-out form. Although the patient's right knee has markings indicating it is the site for surgery, the surgeon places the patient's left knee in a stirrup for prepping. The circulating nurse preps the patient's left knee and the surgeon drapes the left knee. The circulating nurse verbally initiates the time-out and receives verbal confirmation of the planned surgery and surgery site from the technical staff. Although no verbal responses are received from the surgeon or anesthesiologist, the nurse documents completion of all time-out steps. The surgeon proceeds with the arthroscopy, which is performed on the patient's left knee. When the patient awakens from the procedure he asks why his left knee is painful as he expected to have surgery on his right knee. The surgeon immediately discusses the mistake with the patient and family.