Biggest challenge: “It’s been a process getting everybody on board,” Dixon said. “But because it was labor and management together, it was a lot easier than it could have been. As a manager going in and saying, ‘OK, let’s do it this way, it’s harder to get the buy in—but labor sees this as something they did.”

What would they do differently next time: “It would have been great if we could have gotten everybody together in one room at one time to go over these changes,” Godard said. “But we have three different departments—Pre-op, Operating Room and Recovery. We all work closely together but we can’t always meet at the same time.”

Background: Surgeons would electronically enter pre-op antibiotic orders for their patients, often at the last minute and without notifying the nurses. If the pre-op nurse had already admitted and prepped the patient, chances were the order would be missed.

“We haven't had any infection,” Dixon said. “But it just takes one. You don’t want anybody to get an infection from surgery.”

In February, the team audited orders for general surgery, orthopedics and urology and discovered that of 203 patients, there were 22 orders entered after the patient was admitted or that could have been missed for some other reason.

Initially, they tried asking surgeons to let the nurses know when they entered orders at the last minute. When that didn’t work, the unit-based team members came up with another solution. Now nurses spend a little time before each procedure going over the consents, site marking and reviewing the patient’s chart for any additional or missed orders. They also triple-check with the surgeon once they are in the operating room.

Taking the time to meet before each procedure isn’t always easy for the nurses, but the pay off is worth it, Godard said. “It’s about patient safety—no matter what.”