Cautery Burns: A Clinical Audit

Anandhi Sathiyakumar¹,*, Deepa², Devika³, Stella Towncent⁴

¹Nursing Director, Kauvery Hospital, Alwarpet, Tamilnadu, India.

²Nursing Superintendent, Kauvery Hospital, Tamilnadu, India.

³OR Assistant Nursing Superintendent, Alwarpet, Tamilnadu, India..

⁴Clinical Nurse Educator, Kauvery Hospital, Alwarpet, Tamilnadu, India.

Objective

To assess the effectiveness of Long Absorbable Sheet in elimination of cautery burns among surgical patients in the operating room

Aim

To eliminate the incidence of cautery burns among surgical patients

Background

Cautery burn sustained at the hospital by IP patient is an adverse parameter. It is one of the quality indicators of patient safety; it increases the length of stay which results in additional burden – physically and financially, to both patient & family members. Consequently, that would lead to impaired quality of service and loss of hospital reputation. Hence, we chose to study this major problem.

An electrocautery burn is a clinical error which also has medico legal and ethical implications.

There is a long list of such errors, from simple misdiagnosis to more serious harm that may culminate in the patient’s death.

Initially, Cautery burns were identified as pressure injury.

In the month of March 2023, we found 01 cautery burn was misinterpreted as a pressure injury. So, we did a retrospective study, where we found, in the month of Oct 2022, out of 03 pressure injuries, 01 was cautery burn. Similarly, in the month of Nov 2022 and Jan 2023, out of 02 pressure injuries, 01 was cautery burn.

Analysis of possible causes of cautery burn using Gemba and data analysis. The findings are plotted using Ishikawa diagram

Case Presentation

After Root Cause Analysis, we found that the cautery burns were due to Non-absorbable surgical sheet, accidental direct contact with active electrode, and pool of antiseptic solution that was not absorbed (this was out of 8 probable causes).

As a counter measure long absorbable sheet size to be standardized after clinical trials.

Data Analysis

Analysis	Responsible person	Action Taken	Remarks
Checking of quality of cautery pad & product	Discussed with Company person	Cross -Verified about the brand. Requested the company to recheck the quality. Company rechecked with the productivity	Quality was not compromised
Checking of any electrical issues	Maintenance department	Preventive maintenance was done All Connections and power ports were re-checked for short circuit	There were no evidence of any electrical issues
Checking placement of cautery pad locations	OR Technician	Observed their practice on cautery pad placement	The pads were placed as per the surgical site
Checking of presence of jewels or metals	OR Staff & Ward Staff	Observed their practice in receiving patients. Counter checked by OR charge nurse	There were no patients received with jewel and it is confirmed using pre-operative checklist
Checking the pooling of solution in the surgical field	Ms.Devika (OR ANS)	Observed the pooling of solution in the operating field So trial implementation done using absorbable sheets	This was the significant cause and started to rule out the solution to eliminate the cautery burn

Trial Implementation

In old practice 70cm of Under pad used
As a trial 1 – 140cm of under pad placed (as a split in head end and foot end)
In trial 2- 300cm of absorbable sheet was placed and it noted there were no leakage

Regular Implementation

To ensure the usage of long absorbable sheet, regular audit was done. This assured the sustenance of practice.

Follow up

During the trial implementation itself, cautery burn was eliminated and achieved the target value 0.

Benefits

For the patient	For the Institution	For the Staff
Length of stay reduced Psychological Well being	Improved Quality of Care Good Brand Image Quality Indicators within Bench Mark Increased Customer Satisfaction	Employees burden reduced Employee morale improved

Conclusion

Problem: Cautery burns identified as pressure injuries

Observation & Analysis: Pool of antiseptic solution on the OT sheet as it was non-absorbable

Solution Development: Modification done by OT committee members

Action: Based on trials Implemented Absorbable OT sheets with Standard length

Result: 1) Eliminated Cautery burns

2) Patient length of stay reduced from 30 days to 5 days (Patient discharged as per plan).

References

Mir MR, et al. Electrocautery. Medscape 2017; Dec 14, 2017.
OverbeyDM, et al. Surgical Energy-Based Device Injuries and Fatalities Reported to the Food and Drug Administration. J Am Coll Surg. 2015;221(1):197-205.e1.
CDPH (California Department of Public Health). Complaint Intake Number CA00397790; August 31, 2017.
MundingerGS., et al. Full-thickness fore-head burn over indwelling titanium hardware resulting from an aberrant intraoperative electrocautery circuit. Eplasty. 2007;8:1-7.
SaaiqM., et al. Electrocautery burns: experience with three cases and review of literature. Ann Burns Fire Disast. 2012;25(4):203-206.
OlaskyJ. 10 Tips for Safer Electrosurgery. Use these guidelines to keep both patients and staff safe. Outpatient Surgery Magazine 2018.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664530/pdf/Ann-Burns-and-Fire-Disasters-25-203.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407433/pdf/jls130.pdf
http://www.outpatientsurgery.net/surgicalservices/electrosurgery/electrosurgery-safety-essentials–04-20
http://www.outpatientsurgery.net/_media/pop/print-article?id=15529
http://www.mdsr.ecri.org/summary/detail.aspx?doc_id=8271

Ms. Anandhi Sathiyakumar

Nursing Director

Ms. Deepa

Nursing Superintendent

Ms. Devika

OR Assistant Nursing Superintendent

Ms. Stella Towncent

Clinical Nurse Educator

Cautery Burns: A Clinical Audit