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Surgical fires occur in a wide variety of medical settings, from solo practices to large hospitals. Surgical fire prevention depends mostly on fire risk awareness and communication among the members of the surgical team.

Surgical fires occur in a wide variety of medical settings, from solo practices to large hospitals. Surgical fire prevention depends mostly on fire risk awareness and communication among the members of the surgical team.

An unintended retained surgical item (RSI) is an item unintentionally left inside a patient¹ (in this case a cautery tip). Among surgical never events, RSI is the most frequently reported to the Joint Commission.² According to the Joint Commission, the most common causes of RSIs include the absence of policies and procedures, failure to comply with existing policies and procedures, and inadequate or incomplete staff education.³ In this case, the surgical staff’s unfamiliarity with new electrocautery units led them to disregarded the policy for counting tips and inspecting the units following use leading to the retained surgical item.

Surgical fires occur in a wide variety of medical settings, from solo practices to large hospitals. Surgical fire prevention depends mostly on fire risk awareness and communication among the members of the surgical team. Any team member can prevent or contribute to a surgical fire because elements of the fire triangle — air (oxygen), fuel (prepping solution, drapes, patient skin), and ignition source (electrosurgical units) — are generally controlled by different members of the surgical team. Therefore, all team members should think about how their actions might complete the fire triangle that leads to these surgical never events and should communicate with other team members about fire risk status throughout the surgery. Consider how the various surgical team members could have prevented the fire in the following case study.

In 2016, the CDC released a clinical practice guideline for primary care physicians prescribing opioids for chronic pain,¹ which was adopted by various entities, including Medicaid agencies and insurers.² However, according to the CDC and others, the guideline has been misinterpreted and misapplied. An example of a misapplication concern involves the management of patients with chronic pain, which are not intended to follow the same guidelines as those patients being initiated on opioids.

In the years since the 2016 Guideline came out, the CDC and others have published reports, commentaries, and guidelines intended to reduce some of the confusion surrounding pain management in patients for whom opioid therapy is appropriate. In November 2022, the CDC also released their new Clinical Practice Guideline for Prescribing Opioids for Pain, which updates and replaces the 2016 Guideline.