Colour coding scrubs as a means of improving perioperative communication.
Abstract: Effective communication within the operating department is essential for achieving patient safety. A large part of the perioperative communication is non-verbal. One type of non-verbal communication is 'object communication', the most common form of which is clothing. The colour coding of clothing such as scrubs has the potential to optimise perioperative communication with the patients and between the staff. A colour contains a coded message, and is a visual cue for an immediate identification of personnel. This is of key importance in the perioperative environment. The idea of colour coded scrubs in the perioperative setting has not been much explored to date and, given the potential contribution towards improvement of patient outcomes, deserves consideration.

KEYWORDS Communication / Colour coding / Scrubs
Subject: Communication in medicine (Analysis)
Perioperative care (Analysis)
Author: Litak, Dominika
Pub Date: 05/01/2011
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: May, 2011 Source Volume: 21 Source Issue: 5
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 272168014
Full Text: Background

It goes without saying that communication in the perioperative environment, whether between staff or between staff members and patients, is of crucial importance. There are numerous publications on communication in the perioperative setting which explain the various types of communication, how to become an effective communicator and how effective communication contributes to improved patient outcome (Taylor & Campbell 1999, Davies 2005, Seed 2006, HPC 2008, , Smith & Jones 2009, Wicker & O'Neil 2010). Consequently, as communication constitutes a key factor in achieving quality patient care and safety, operating departments are continuously aiming for an enhancement of communication skills among staff, whether verbal, non-verbal or written.

Verbal and written communication skills are quite easily defined, whereas non-verbal skills are much less tangible, but they are equally as important. Non-verbal communication skills are usually associated with the intra-operative phase when the scrub nurse interprets the surgeon's needs from their hand signals with no verbal exchange. However, non-verbal communication is not limited to the intraoperative phase, it plays an important role in the pre- and post-operative phases as well. Non-verbal communication can be expressed not only through body language, but also through 'object communication' e.g. through clothing (Burgoon et al 1996).

What we wear and more importantly, the colour of what we wear, has a potential for communicating messages through visual stimuli. Colour can send a message about our role in a millisecond. The message is conveyed much more quickly than via a badge, as a badge requires the observer to be in close proximity to the wearer.

The importance of role identification in the hospital setting should not be underestimated. Not only may coloured scrubs save precious time in identifying relevant professionals, but in the event of an emergency, they could potentially save a life. The colour coding of scrubs has been recently introduced in the wards in Wales and Scotland in response to a growing need for staff identification in the hospital setting (Ford 2009, NT 2010). Below I would like to present some arguments for introduction of a similar initiative in the perioperative environment. Having colour coded scrubs in the operating department could potentially improve the communication between staff and could positively impact the patients' experiences during their perioperative journey.

Benefits for patients

Hospitals are places which are designed to help the sick to become healthy again. However, the hospital's role is not limited to just providing medical help, but also entails making patients happier about the environment they are in. The simple use of colour coded scrubs could contribute to this. Communicating via the colour of scrubs allows for a quick identification of roles, whereby providing patients with a sense of reassurance and security that they need in an unfamiliar and stressful setting like a hospital.

Patients in the hospital, in particular in the operating department, are usually nervous and confused by the amount of unknown people surrounding them. They may recognise the surgeon and the anaesthetist, as they may have talked to them before, however in most cases they will not know the other people, for example operating department practitioners (ODPs), scrub nurses, circulating nurses, healthcare assistants, radiographers, students etc. This unfamiliarity can only increase an already elevated anxiety. Being able to distinguish between different caregivers based on the scrub colour is likely to make the patients feel more comfortable, easing their mind and allowing them to feel safer because they know who cares for them. It may reduce the apprehension about seeking out the correct staff member in the event that they have any questions or issues. Furthermore, it would also eliminate the incidence of situations where one individual is mistaken for somebody else, which may be distressing for both the patient and the professional involved.

Staff benefits--the intraoperative phase

The colour coding of scrubs may also improve communication between the perioperative staff members. Intraoperatively, some roles are easily recognisable provided people are present at their usual workstation. For example, the person next to the anaesthetic machine is the anaesthetist, the scrubbed people surrounding the operating table are the surgeons, the scrubbed person next to the mayo table is the scrub nurse. However, there may be confusion about the identities of other staff in the operating room, such as ODPs, students, healthcare assistants, circulating staff, unscrubbed medical personnel etc. Where teams know each other and are working together on a regular basis this would not be an issue, but it may become a problem in the event of the introduction of agency staff or new personnel for example. Additionally, in situations where all staff needs to wear masks (e.g. in orthopaedics) it becomes hard to recognise the person by their looks.

The recently introduced WHO surgical safety checklist allows for the role identification, as all team members have to introduce themselves during the de-briefing (NPSA 2009). Nonetheless, in cases where theatre traffic is dense and the atmosphere is intense (e.g. teaching hospitals, complex procedures, emergency procedures), the confusion with respect to unscrubbed theatre personnel may still arise. Such confusion may lead to situations where, for example, one person's role is mistaken for another's and the incorrect person may be asked to perform an unfamiliar task. In a case where there is no time for explanations, this can be a distressing experience for the individual involved, not to mention a risk to the patient's safety. Introducing colour coded scrubs could help reduce the occurrence of such incidences and overall could improve intra-operative communication by optimising role identification.

Staff benefits outside the theatre

Introduction of colour coded scrubs may also improve staff communication outside the operating room. For example, in the corridor of the hospital, role identification is much more difficult than inside the operating room. We are not performing our usual tasks from which our roles could be deduced. Furthermore, our roles blend due to all scrubs being same colour. The colour coding of scrubs creates the ability to instantly identify people's roles, without the need to look at their badge. It provides that visual cue regarding whom to ask for assistance, which is essential in time dependent and sensitive situations e.g. life threatening emergencies. It may also reduce the amount of time spent seeking the key staff member who is caring for the patient, thereby preventing delays in the patient's perioperative journey.

Conclusion

Colour coded scrubs have the potential to make perioperative communication more effective by making everybody's roles transparent. In a multidisciplinary environment where seconds can save lives, role transparency is essential as it reduces time spent identifying the right person. In the end, it leads to increased patient safety and is likely to boost patients' satisfaction. Given these potential benefits, the issue of using colour coded scrubs in the operating department definitely deserves recognition and should be subject to deeper consideration.

No competing interests declared

Provenance and Peer review: Unsolicited contribution; Peer reviewed; Accepted for publication February 2011.

References

Burgoon JK, Buller DB, Woodall WG 1996 Nonverbal Communication: The unspoken dialogue (2nd ed) New York, McGraw-Hill

Davies JM 2005 Team communication in the operating room Acta Anaesthesiologica Scandinavica 49 (7) 898-901

Ford S 2009 Roll Out Begins for National NHS Uniform in Scotland Available from: www.nursingtimes.net/whats-new-in-nursing/acutecare/roll-out- begins-for-national-nhs-uniform-in-scotland/5009485.article [Accessed March 2011]

Health Professions Council 2008 Standards of Proficiency - operating department practitioners Available from: www.hpc-uk.org/assets/documents/ 10000514Standards_of_Proficiency_ODP.pdf [Accessed March 2011]

National Patient Safety Agency 2009 WHO Surgical Safety Checklist Available from: www.nrls.npsa.nhs.uk/resources/?entryid45=59860 [Accessed March 2011]

Nursing Times 2010 Nurses in Wales get Colour Coded Uniforms Available from: www.nursingtimes.net/5013389.article [Accessed March 2011]

Seed J 2006 Reflection on action: Communication is key Journal of Perioperative Practice 16 (12) 581-584

Smith B, Jones C 2009 Perioperative communication Journal of Perioperative Practice 19 (8) 248-253

Taylor M, Campbell C 1999 Communication skills in the operating department British Journal of Theatre Nursing 9 (5) 217-222

Wicker P, O'Neil J 2010 Caring for the Perioperative Patient (2nd ed) West Sussex, Wiley-Blackwell

Correspondence address: Dominika Litak, Main Theatres, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH. Email: dominika_litak@yahoo.co.uk

by Dominika Litak

About the author

Dominika Litak

ODP

Anaesthetic ODP, Great Ormond Street Hospital for Children NHS Trust, London
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