Presentation (5).pptx a topic on safe surgery

Medical topic

1. Medicine will never be risk-free. According the Hippocratic oath from 5th century: "Never do harm to anyone“

2. Safer Surgery can be defined as a reduction in avoidable harm to a surgical patient

3. Surgical safety has broadly included in different phases:
Preoperative (Diagnosis, investigation) Intraoperative
Postoperative (Up to discharge)

4. Why do patients suffer avoidable harm?

1. Patients themselves.

2. Healthcare professional

3. System failure.

4. Medical complexity

5. Patient themselves A variety of presentation. 2. Differing co-morbidities

3. Differing response to treatment

4. Patients are reluctant to speak up.

5. Refuse to co-operate

6. Healthcare professional Inadequate patient assessment(delay or error in Diagnosis)
Failure to use or interpret appropriate test
Error in performance of an operation and test.
Inadequate monitoring or follow-up.
Deficient training or experience
Fatigue, overwork or time pressure.
Personal or psychological factor i.e. drug abuse or depression.
Lack of recognition of the danger of medical errors.

7. System failure Poor communication between healthcare providers.
Inadequate staffing level
Overreliance on investigation
Lack of coordination at handover
Drug similarities.
Equipment failure due to lack of skilled operators.
Inadequate system to report and review patient safety incident.

8. Medical complexity Advance and new technologies (laparoscopic, robotic surgery)
Potent drug and their side effects and interaction. Working environment- Surgical ICU, HDU and Operation theatre

9. The errors diagnostic and management errors resuscitation errors prophylaxis errors prescription/parenteral administration errors situation awareness, identification and teamwork errors technical and operative errors.

10. Situation awareness: identifying teamwork errors Potential errors include: the wrong patient in the operating theatre surgery performed on the wrong side or site the wrong procedure performed failure to communicate changes in the patient’s condition disagreements about proceeding retained instruments or swabs All these occur due to lack ofcommunication .

11. Technical and operative errors Failures in operative technique include: - Cognitive errors of judgement , such as late conversion of a difficult laparoscopic procedure into an open one Procedural , when the steps of an operation are not followed or are omitted Executional , when, for example, too much force is used, which may result in damage that may or may not have consequences; - Misinterpretation of anatomy/pathology, which is compounded by minimal access surgery with the limitations of a two-dimensional image; - Misuse of instrumentation, such as with energised dissection modalities (e.g. diathermy); - Missed iatrogenic injury either at the time of surgery or diagnosed late

12. Understanding patient safety incidents Errors can be viewed from a person-centered or a system approach The majority of near misses or adverse events are due to system factors Understanding why these errors occur and applying the lessons learnt will prevent future injuries to patients It is important to report all near misses or adverse events so that we can constantly learn from mistakes Examining what works well may be an additional constructive approach to defining safe patient pathways

13. How can surgery be made “SAFER” Right surgeon, Right place, Right time:

Right surgeon- a surgeon of adequate training and experience.

Trained surgeons require updating in current techniques and training in new one.

Right time is applicable for emergency surgery

14. Goals of safer surgery can be achieved by: A. Standardisation B. Communication

C. Learning from incidents.

15. Standardisation of process: It based on research evidence or best practice i.e.

Pre-op investigation

Optimization of co morbidity

Optimization of malnutrition

DVT prophylaxis

Antibiotic prophylaxis

16. Communicating openly with patients and their carers and obtaining consent:

Details and uncertainties of the diagnosis
The purpose and details of the proposed surgery
Known possible side effects and potential complications
The likely prognosis
Other options for treatment, including the option not to treat
Explanation of the likely benefits and probabilities of success for each option
The name of the doctor who will have overall responsibility
A reminder that the patient can change his or her consent

17. Learning from incidents:

Incidents in which patients have or potentially could have been harmed should be reported locally and a system in place whereby these are analysed and appropriate action decided and implemented, in order to reduce the risk of the same event happening again.

18. Unfortunately, learning from incidents is not as effective as it could be for many reasons-

-many incidents are not reported,

-the number reported is so great that it can be difficult to prioritise appropriately.

-analysis is not always correct and there can be difficulty in implementing action

19. All doctors should be trained in analysis of incidents since this will improve their ability to learn individually from incident.

Complaints from patient are another potential source of patient safety incidents to be analysed Consideration should be given to the most appropriate way to introduce patient Safety initiative.

20. Implementation of safer surgery initiatives Implementing changes in healthcare can be difficult- the system is complex and has many people involved in each pathway, getting agreement can be difficult and time consuming. In 2009, WHO has introduced, Safe surgery Saves Lives

21. Briefing It Is carried out at the start of the operation before the patient is anaesthetised .

Role of briefing:

A. To ‘walk through the list and anticipate any problems that might occur, such as equipment, test results, patients not ready, ICU bed availability etc and resolve them so that the operation runs more efficiently to develop contingency plans.

B. To come together as a team for that list.

C. To open communication between different team members to ensure everyone is on the same page’,

D. To flatten hierarchy & allow anyone with concerns to speak out.

22. Sign in: (before induction of Anaesthesia ) A) Confirming: identity of patient, site of surgery.procedure , consent.

B) Marking the site of surgery.

C) Completion of anaesthesia safety Checklist.

D) Checking equipment functional status.

E) Allergic history of patient

F) Difficult airway/ risk of aspiration.

G) Blood loss anticipation.

23. Time out: (before skin incision) A)Introduction of all members (names of operating surgeon, anaesthetist , scrub nurse, technician)

B)Surgeon, anaesthetist and nurse verbally confirm patient, site of surgery and procedure.

C)Anticipated critical events:

1. Surgeon reviews: critical steps of the procedure, duration, and anticipated blood loss

II. Anaesthesia team reviews: Any patient specific concerns.

III. Nursing team reviews: Confirm count and sterility of instruments, functioning of equipment, etc.

24. D) Preoperative antibiotic (60min prior to incision)

E) Essential imaging being displayed ( xray films, ct / mri scan films etc )

25. Sign out: (before patient leaves operating room) Nurse verbally confirms:

a. Name of procedure recorded

b. Counts- instruments, sponge. Needles

c. Labelling of specimen if any.

D. Any equipment problems to be addressed

e. Key concerns for recovery and management post operatively

26. Debriefing: Carried out at the end of the operation. a) To learn what went well and what went wrong, so that problems can be addressed and avoided in future procedures.

B) To thank team members for what went well.

27. Thank you.