
Risk Prevention
Increased patient safety in and around the operating room
Perioperative morbidity and mortality still exist despite advances in surgical care.
Despite many advances in the surgical environment, there is still much to improve patient safety in the operating room and throughout pre- and post-operative care.
Deaths and illnesses still arise as a direct result of superficial incisional infections, while highly complex and misused technology leads to errors, including patient misidentification, surgical site misidentification, medical failures and malpractice.
The consequent advance can only emerge when the causes – especially those related to human error – are exposed, and ways to address them are debated. To prevent damage and death of patients undergoing surgical procedures, it is important to confront these taboo subjects and implement actions to minimize superficial incisional infection, increase team work and communication.
The evolution of the perioperative care process is a multifaceted task, taking into account the uniqueness and challenge of the surrounding environment.
The operating room is a stressful place to work, and teams need to rely on each other to maintain hygiene standards. When designing plans to increase patient safety, it is necessary to take into account the time and cost pressure felt by professionals during the patient's hospitalization.
Recommendations should address, among others, the complexities of clinical treatment, sophisticated technologies that are excellent for their intended purpose but unable to synchronize with others, and the wide range of supplies and instruments that must be managed by clinical teams.
Key factors for managing change include:
Team work
Currently, beyond a quick assessment of the facts relating to an individual procedure, physicians and perioperative professionals have little time to spend individually with their surgical patients. Due to this lack of familiarity, there is an increased risk of errors with patient identification, with communication of the elaborated procedure, and failures in recording important information, such as allergies.
Administration and organization
Surgery involves considerable planning and coordination, which means multiple medical professionals and healthcare teams work together – not just to share patient information, but also to integrate their work into the larger care process.
Considering the number of people involved, there are a number of types of equipment, instruments, medications, blood solutions, and supplies that need to be planned and prepared to be available at the same time and in the same place. Specifically, a Service or group manages each item (eg, central supply, instrument sterilization processing, patient transport, pharmacies, blood banks, surgical pathology, and other Services). The more people involved, the greater the risk of human error.
Finally, OR professionals must also integrate their work with different units, such as: recovery, radiology, laboratory, urgency, intensive care, surgical clinics, and others.
Since 2008, the WHO promotes the “Surgical Safety Checklist” in order to increase patient safety. It was developed after extensive consultation with medical professionals. Its aim is to minimize errors and adverse events, and to increase teamwork and communication in surgery. Despite the evidence showing a significant reduction in morbidity and mortality, the checklist is not used by a large number of professionals around the world. Each country is encouraged to adapt it to its specific needs to ensure optimum benefit.
Link: http://www.who.int/patientsafety/safesurgery/checklist/en/
Technology
There is a growing focus on the importance of using technology in the healthcare sector, and on access to certified software design approaches and standards. However, all too often, technological modernization efforts in the national health sector have failed, both in their visions and in their priorities, in terms of recognizing unique requirements in perioperative care.
If the focus is on the specific challenges in the perioperative environment, the healthcare sector can become an important catalyst for transforming surgical care. Health care standards need revision to ensure full support of perioperative requirements.
Products
Simple, effective products and solutions can play a vital role in increasing patient safety by offering a holistic level of care, facilitating and shortening treatment time and effort, and being intuitive to use.
Recommendations to increase patient safety
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Foster a safety culture and establish other perioperative objectives in operating rooms.
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Provide sufficient break times for doctors so as not to overwork them.
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Accurately comply with evidence-based practices and standards for infection prevention.
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Commit to following guidelines that improve routines.
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Make performance transparent in key measures.
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Improve care transitions from the OR to the intensive care unit through a structured delivery process that ensures care teams exchange vital information about the patient.
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Simulation should be used to enhance teamwork and communication between caregivers, in order to assist them in practicing new procedures on mannequins.