In 2009, Atul Gawande, MD, published The Checklist Manifesto: How to Get Things Right1 in which he argued that a standardized list of essential actions combined with accountability would assist in decreasing patient injury in medical settings. His opening chapter acknowledges the concept he was promoting came from the pretake-off checklist successfully used by the aviation community.
I am trained in nursing and hold a license as a private pilot. I also am a federally licensed airframe and powerplant aviation mechanic. I am intrigued that medicine would turn to another high-risk industry to look for methods to minimize risk. With this in mind, I would like to offer an aviation descriptor to address a real and ongoing danger to the integrity of a patient’s skin.
The acronym FOD (foreign object debris2) is in current use in the aviation industry. FOD has been widely recognized as a major contributor to aircraft accidents and resulting loss of aircraft and passengers. As examples, the famous “Miracle on the Hudson” resulted from the ingress of wild geese into the engines of the jet, which then lost all power. Fortunately, the aircraft was placed quite gently on the river’s surface with no loss of life. The loss of Air France Flight 4590 and all souls aboard was the result of the destruction of the turbine engines (and subsequently, the airframe) that blew apart after taking in metal debris on the runway that had fallen from another airliner. The Federal Aviation Administration has recognized FOD as a serious and ongoing threat to aircraft; a nationwide, if not worldwide, program is in place to address this issue.2
Currently, the National Database of Nursing Quality Indicators is using the term medical device-associated injury to describe the hazards of patients developing issues from being in planned and unplanned contact with debris. While working as a wound care nurse (WCC) at a major Seattle metropolitan hospital, I collected the various pieces of medical equipment (eg, pens, syringes, bits of plastic; see Figure) I removed from patients’ beds. Most if not all items were left behind by clinical staff.
I would like to offer use of the term FOD to the medical community to describe debris that has been let fall into the patient care area (medical device or not) and has caused injury to the patient through our own (albeit, unintentional) negligence. Perhaps “Check for and clear FOD” could be placed in all patient charts as a reminder to pick up after ourselves and eliminate one risk for skin injury that we can control.
Popularizing the potential for injury from FOD gives us the power to conceptualize and quickly communicate with our peers the hazards such garbage poses in the patient care area.