By Esther Espunyes, EORNA President
Last week, I reflected on the silent work of Sterile Services and the essential role of perioperative nurses in protecting patients beyond the operating room. This week, I want to bring that focus back into the OR, where multiple risks come together in a complex and constantly changing environment.
Risk management in the operating room is not about reacting when something goes wrong. It is about anticipating what could go wrong and acting before it does.
Every procedure involves potential risks: wrong-site surgery, retained surgical items, medication errors, equipment failure, fire, infection, positioning injuries, pressure injuries, hypothermia and communication failures. Preventing these events requires more than protocols. It requires systematic risk assessment, reliable processes and a team that remains vigilant throughout the entire surgical journey.
This is where perioperative nurses play a pivotal role. They are uniquely positioned to anticipate risks across the entire surgical pathway, from preparation and equipment checks to patient positioning, surgical counts, medication and specimen management, infection prevention and continuous monitoring. Their proximity to the patient and their understanding of the entire perioperative process allow them to identify subtle changes and potential hazards before they become adverse events.
But prevention also requires the confidence to speak up. A strong safety culture empowers perioperative nurses to question, challenge and stop unsafe practices when necessary—regardless of hierarchy.
Learning is equally important. Education and training should turn errors, near misses and sentinel events into opportunities for learning and improvement, rather than occasions for blame. Structured review, root-cause analysis, simulation and shared learning can help teams understand what happened, why it happened, and how systems can be redesigned to prevent recurrence. A mature safety culture does not hide mistakes—it learns from them.
Ultimately, patient safety is not achieved by correcting errors after they happen. It is achieved by anticipating risk, strengthening systems and empowering professionals to prevent harm.
Prevention is not an additional task. It is the foundation of safe surgery.
Next week, I will reflect on how we know whether the care we provide is truly safe and effective—and why measuring quality through meaningful perioperative indicators matters.
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