A 15-year-old adolescent female was scheduled for two surgical procedures on a Monday morning. The surgeon for the second procedure uses a harmonic scalpel. The OR nursing coordinator discovered on the previous Friday that the OR had no harmonic scalpels in stock and escalated this to hospital materials management. The nurse coordinator was assured that the harmonic scalpels would be delivered over the weekend. Pt taken to the OR and the first procedure completed. It was then noted that the harmonic scalpels were not available and materials does not have weekend staff to confirm delivery. This should have been checked prior to bringing the patient back to the OR. Pt remained asleep under anesthesia for over an hour until we could secure a harmonic scalpel from a nearby hospital.

This report highlights a series of gaps/errors resulting in an avoidable incident where a patient had to remain under anesthesia...

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