1. Dr. ABDULLAH ABDU ALMIKHLAFY Assistant professor & Head of community medicine department Presented By University of Science & Technology Sana’a – Yemen

2. SAFETY IS PARAMOUNT  PRIMAM NON NOCERE (FIRST DO NO HARM)  PATIENT SAFETY IS COMPROMISED BY ERRORS

3. Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often lead to adverse healthcare events. It is a serious global public health issue. Estimates show that in developed countries as many as one in 10 patients is harmed while receiving hospital care.

4. In developing countries, the probability of patients being harmed in hospitals is higher than in industrialized nations. The risk of health care- associated infection in some developing countries is as much as 20 times higher than in developed countries. In recent years, countries have increasingly recognized the importance of improving patient safety. In 2002, WHO Member States agreed on a World Health Assembly resolution on patient safety.

5. Preventable Harm 25% in-patient surgeries followed by complication 7 million disabling complications / yr 50% of all hospital adverse events linked to surgery  At least 50% of adverse surgical events are avoidable 0.5 – 5% deaths following surgery 1 million deaths / yr 230 million surgeries / yr worldwide. More common than births ( 36 million / yr). 1 in 25 people.

6. CRISIS IN HEALTH CARE

7. 2 nd Global Patient Safety Challenge: Safe Surgery Saves Lives Pilot site for surgical checklist

8. “ Hospitals not using a surgical safety checklist are endangering patient safety. If I were to need an operation, I would want to be treated somewhere using a surgical checklist. ”

9. 3 central problems in surgical safety 1.Unrecognized as a public health issue. 1.Lack of data on surgery and outcomes. 1.Failure to use existing safety know-how.

10. Problem 2: Lack of data on surgery and outcomes

14. B S A E L I N E A N A L Y S I S C H E C K L I S T 3733 cases 3955 cases

15. Safe surgery is a public health priority Surgical care has been an essential component of health care worldwide As the incidences of traumatic injuries, cancers and cardiovascular disease continue to rise the impact of surgical intervention on public health systems will grow. An estimated 234 million major operations are performed around the world each year, corresponding to one operation for every 25 people alive. While surgical procedures are intended to save lives, unsafe surgical care can cause substantial harm

16. Five facts about surgical safety Complications after inpatient operations occur in up to 25% of patients. The reported crude mortality rate after major surgery is 0.5–5%. In industrialized countries nearly half of all adverse events in hospitalized patients are related to surgical care. At least half of the cases in which surgery led to harm are considered to be preventable. Known principles of surgical safety are inconsistently applied even in the most sophisticated settings.

17. System-wide approach to improved surgical safety There is no single remedy that will improve surgical safety. It requires reliable completion of a sequence of necessary steps in care, not just by the surgeon, but by a team of health-care professionals working together within a supportive health system for the benefit of the patient.

18. Safety of Surgical Care Four areas in which improvements could be made in the safety of surgical care.  Surgical site infection prevention.  Safe Anesthesia.  Safe Surgical teams.  Measurement of surgical services.

19. 1. Operate on correct patient at correct site. 1. Using methods known to prevent harm from administration of anesthetics, while protecting the patient from pain. 1. Recognizing and effectively preparing for life - threatening loss of airway or respiratory function.

20. 1. The team will recognize and effectively prepare for risk of high blood loss. 1. To avoid inducing an allergic or adverse drug reaction for which the patient is known to be at significant risk. 1. The team will consistently use methods known to minimize the risk for surgical site infection. 1. The team will prevent inadvertent retention of instruments or sponges in surgical wounds.

21. 1. The team will secure and accurately identify all surgical specimens. 1. The team will effectively communicate and exchange critical information for the safe conduct of the operation. 1. Hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results.

22.  A Good Surgeon Knows When Not To Operate.  Big Surgeons Make Big Incisions.  Use Of Drains.  Use Of Nasogastric Tubes.  Colon Preparation.  Antibiotics. To improve patient safety in surgery in developing countries

23. Surgery without proper resources is bad practice, potentially dangerous and unacceptable.