Safety Basic Science December 22 nd, 2009

Safety Attitudes Questionnaire (SAQ) I am encouraged by my colleagues to report any patient safety concerns I may have. The culture in this clinical area makes it easy to learn from the mistakes of others. Medical errors are handled appropriately in this clinical area. I know the proper channels to direct questions regarding patient safety in this clinical area. I receive appropriate feedback about my performance. I would feel safe being treated here as a patient. In this clinical area, it is difficult to discuss mistakes.

Operating Room Briefings preprocedure discussion of requirements, needs, and special issues of the procedure locally adapted to the specific needs of the specialty associated with an improved safety culture, including increased awareness of wrong- site/wrong-procedure errors, early reporting of equipment problems, and reduced operational costs

Preoperative "time-out" Verifying the patient's identity Marking the surgical site Using a preoperative site verification process such as a checklist Confirming the availability of appropriate documents and studies before the start of a procedure All members of the surgical team actively communicate and provide oral verification of the patient's identity, surgical site, surgical procedure, administration of preoperative medications, and presence of appropriate medical records, imaging studies, and equipment

Surgical Specimen Errors Error in verbal communication and transcription In one study, this type of identification error occurred in 4.3 per 1000 surgical specimens 182 mislabeled specimens per year

Sign Outs verbal or written communication of patient information help to ensure the transfer of pertinent information during these handoffs in patient care, such as when taking a patient from the OR to the recovery room, or when a patient is being transferred from one physician to another during shift changes

The Surgical Care Improvement Project Measures established in 2003 by a national partnership of organizations committed to improving surgical care by reducing the occurrence of surgical complications stated goal of reducing the incidence of preventable surgical complications by 25% nationally by the year 2010 By achieving high levels of compliance with evidence- based practices to reduce SSIs, venous thromboembolism events, and perioperative cardiac complications, the potential number of lives saved in the Medicare patient population alone exceeds 13,000 annually

National Surgical Quality Improvement Program credited with measuring and improving morbidity and mortality outcomes at the VA, reducing 30- day mortality rate after major surgery by 31%, and 30-day postoperative morbidity by 45% in its first decade risk-adjusted ratio of the observed to expected outcome (focusing primarily on 30-day morbidity and mortality) to compare the performance of participating hospitals with their peers

The Leapfrog Group improving nationwide standards of health care quality, optimizing patient outcomes, and ultimately lowering health care costs. patient referral, financial incentives, and public recognition for hospitals that practice or implement evidence-based, health care standards. These include hospital use of computerized physician order entry systems, compliance with 24-hour ICU physician staffing, evaluation using a 30-point composite Leapfrog Safe Practices Score, and evidence-based hospital referral (EBHR) standards for five high-risk operations

Surgical "Never Events" Surgery performed on the wrong body part Surgery performed on the wrong patient Wrong surgical procedure performed on a patient Unintended retention of a foreign object in a patient after surgery or other procedure Intraoperative or immediately postoperative death in an ASA Class I patient

Retained Surgical Items one case per 8000 to 18,000 operations one case or more each year for a typical large hospital 1500 cases per year in the United States

Risk Factors for Retained Surgical Sponges Emergency surgery Unplanned changes in procedure Patient with higher body-mass index Multiple surgeons involved in same operation Multiple procedures performed on same patient Involvement of multiple operating room nurses/staff members Case duration covers multiple nursing "shifts"

Surgical Counts "falsely correct count," in which a count is performed and declared correct when it is actually incorrect, occurred in 21 to 100% of cases in which a retained surgical item was found

What is the medical definition for a retained surgical sponge?

Gossypiboma

Wrong-Site Surgery Wrong-site surgery is any surgical procedure performed on the wrong patient, wrong body part, wrong side of the body, or wrong level of a correctly identified anatomic site. ranging from one in 112,994 cases to one in 15,500 cases Communication errors are the root cause in more than 70% of the wrong-site surgeries reported to the Joint Commission

Risk-Factors time pressure emergency surgery abnormal patient anatomy incomplete preoperative assessment inadequate procedures in place to verify the correct surgical site organizational culture that lacks teamwork or reveres the surgeon as someone whose judgment should never be questioned

Common Causes of Lawsuits in Surgery Positional nerve injury Common bile duct injury Failure to diagnose or delayed diagnosis Failure to treat, delayed treatment, or wrong treatment Inadequate documentation Inappropriate surgical indication Failure to call a specialist Cases resulting in amputation/limb loss