Transcript Presentation title - Canadian Patient Safety Institute

Safe Surgery Saves Lives
Winnipeg Regional
Health Authority
April 2010
Operating Room Nurses Association of Canada
Canadian Anesthesiologists’ Society
Royal College of Physicians and Surgeons of Canada
Safety Stories
• Example: aviation tragedy
Korean Airlines
• Cockpit culture stopped the first officer (from
alerting the pilot to asserting and arguing) about the
imminent danger .
• Suggestions and clues are not clear messages.
• An example from your facility where the
lack of communication was a risk for
patient safety?
Close Calls?
Actual Adverse Event?
Surgical Safety is a Serious Issue
• Canadian Adverse Events Study (Baker et al. 2004)
 More than 50% of adverse events involved surgery.
• The Healthcare Insurance Reciprocal of Canada reports
that since inception (20 years, with most claims occurring in
the last 7-8 years).
 Surgical claims account for $27 Million, 40% could have been
prevented with the checklist or approximately $10 Million.
 Claim types:
• 210 retained foreign body;
• 94 wrong body part; and
• 9 wrong patient.
WHO Safe Surgery Saves Lives Meeting Geneva
The Faces of Harm
Evidence that checklist works
The Checklist and Communication
The WRHA Surgical Safety Checklist
The WRHA Surgical Safety Checklist
 Adapted from WHO and CPSI – Surgical Safety
Checklists
 Tool to promote patient safety in the
perioperative period
 Intended to give teams a simple, efficient set of
priority checks for improving effective teamwork
and communication.
 Intended to encourage active consideration of
the safety of patients in every operation
performed.
 Includes elements of other patient safety
initiatives for example Safer healthcare now!
VTE, SSI, and Time-out
What issues does this checklist address?
• All important safety elements are reviewed by ALL
OR teams, for ALL patients, at ALL times
• Promote teamwork and communication
– Communication is a root cause of nearly 70% of the events
reported to the Joint Commission from 1995-2005.
• Preparedness for the unexpected
• Promotes an environment that allows anyone on
the team to speak up if patient safety is at risk.
– Correct patient, operation and operative site
– Safe Anesthesia and Resuscitation
– Minimize the risk of infection
Doors closed? Checked!
Findings published on January 2009
Strengths of the Surgical Safety Checklist
 Deployable in an incremental fashion
 Supported by scientific evidence and expert
consensus
 Evaluated in diverse settings around the world
 Ensures adherence to established safety
practices
 Minimal resources required to implement a farreaching safety intervention
The View from Aviation
“The estimate that up to 23,000 people died in 2004
in Canadian hospitals because of preventable
adverse events is staggering. Checklists have been
used in aviation to standardize and increase the
reliability of systems.”
“One wonders whether such checklists would have
been introduced much earlier in medicine
if surgeons shared the fate of their patients,
as pilots share that of their passengers.”
Adrian Boelen, retired pilot, Dorval, Que
Objectives of Safe Surgery
1.
The team will operate on the correct patient at the correct site.
2.
The team will use methods known to avoid harm from the
administration of anesthesia, while protecting the patient from
pain.
3.
The team will recognize and effectively prepare for life
threatening loss of the patient’s airway or respiratory function.
4.
The team will recognize and effectively prepare for the
possibility of high blood loss
5.
The team will avoid inducing any allergic or adverse drug
reaction known to be a significant risk for the patient.
6.
The team will consistently use methods known to minimize
the possibility of surgical site infection.
7.
The team will work to avoid the inadvertent retention of
instruments or sponges in surgical wounds.
8.
The team will secure and accurately identify all surgical
specimens.
9.
The team will effectively communicate and exchange critical
patient information for the safe conduct of the operation.
10.
Hospitals and public health systems will establish routine
surveillance of surgical capacity, volume, and results.
The Checklist in Canada
• CPSI in collaboration with the University Health Network in Toronto
partnered with the following organizations to adapt and implement the
checklist:
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Accreditation Canada
Canadian Anesthesiologist’s Society
Canadian Association of Pediatric Health Centres
Canadian Medical Association
Canadian Nurses Association
GreenDot Global
Nova Scotia Department of Health
Operating Room Nurses Association of Canada
Ottawa Heart Institute
Patients for Patient Safety Canada
Regina Qu’Appelle Health Region
Royal College of Physicians and Surgeons of Canada
Society of Obstetricians and Gynecologists
Suresurgery
University of Calgary
Why should your hospital adopt it?
• Significant commitment needed, but …
• Insignificant costs to implement yet there is clear evidence of
improved safety
• Issues and omissions are being picked up!
• Takes 3-4 minutes but can save time over the course of a day
• A great team-building opportunity!
• You will be a leader in patient safety in Canada and the world
• What is required to implement?:
• Ongoing vigilance
• A champion (or better, champions) at all levels!
• Commitment from senior management and the board
Completion of the Checklist
• Verbal tool.
• Not intended to be part of the patient’s health record.
• Value is not reflected in the completion of a form.
• Important to avoid the phenomenon of “tick and flick”.
• Responsibility for implementing and ensuring adherence to all
components rests with one or more representatives from
surgeon, anesthesiologist, and nursing.
• Responsibility to carry out the checklist lies with ALL members
of the team.
• Every team member must feel comfortable in initiating the
process.
Patient Awareness Education
• The nurse in the preoperative area shall review the
purpose of the Surgical Safety Checklist with the
patient during the preoperative assessment.
• Information reviewed with the patient should not be
new information as all of the elements of the checklist
should have been provided to the patient during the
Informed Consent process.
Components of the Checklist
• Checklist is divided into three (3) components:
 Briefing;
 Time-Out; and
 Debriefing
• Items on the Checklist that are not applicable to the
procedure being performed are not required to be
completed.
• A lead has been designated for each component as
indicated on the Checklist.
Briefing
• At a minimum, requires presence of
anesthesiologist and nursing.
• Performed before induction of
anesthesia.
• Performed with patient
awake/participation.
• Refusal of patient to participate requires
documentation.
Briefing
• Verbal confirmation with the patient:
Identity using two patient identifiers;
Consent for surgery;
Type of procedure planned; and;
Site (side and/or level of surgery).
• Site marked/not applicable
Confirm surgeon performing the surgery
has marked the surgical site according to
Policy
Briefing (cont)
• Allergies/Precautions
 Does the patient have any known allergies? If so
what are they? Latex allergy precautions required.
 Is the patient on any specific infection control
precautions? If so what?
• VTE prophylaxis
 Is the patient receiving/to receive chemical VTE
prophylaxis?
 Is the patient receiving/to receive mechanical VTE
prophylaxis?
 Confirm TEDs/SCDs have or will be applied as per
surgeon request &/or hospital policy.
Briefing (cont)
• Equipment, instrument(s) and/or implant(s)
concerns
 Equipment:
 Confirm availability of special equipment required;
 Confirm intended position; and
 Discuss any problems with equipment.
 Instruments
 Confirm availability of instruments;
 Nurse verifies sterility indicator/integrator; and
 Any particular concerns.
 Implants
 Confirm availability of implant(s) required; and
 Confirm availability of various sizes that could be used.
• Anesthesia safety checklist
 Confirm anesthesia equipment safety check has been
completed in accordance with local/departmental policies.
Briefing (cont)
• Difficult Airway/Anesthesia Risk?
 Confirm airway equipment is available; and
 Confirm if difficult airway anticipated or likelihood of
pulmonary aspiration of gastric contents.
• Risk of > 500ml of blood loss?
 May include PT/PTT/INR concerns;
 Medications or morbidities that may lead to complications
and any intention to transfuse blood products; and
 Confirm if blood products are required and if they are
available.
• Postoperative destination
 Confirm postoperative destination and any potential for
changes.
AT THIS POINT THE BRIEFING IS
COMPLETED AND THE TEAM MAY
PROCEED WITH INDUCTION OF
ANESTHESIA, FOLLOWED BY
POSITIONING, PREPPING AND
DRAPING.
Time-Out
Time-out
• At a minimum, requires surgeon, anesthesiologist, and nurse(s)
to be present.
• Performed after induction, prepping/draping immediately prior to
surgical incision.
• Completed in accordance with WRHA Policy “Correct site,
correct procedure and correct patient for surgical procedures
(identification of) #110.220.020.
• Team members are identified
 Team members are identified by name and role. If previously
introduced, it is not required to repeat this step.
• Team verbally confirms:
 Correct Patient;
 Correct Procedure; and
 Correct Site.
• Antibiotic prophylaxis given within the
appropriate time frame.
 Confirm antibiotic prophylaxis has been given within
60minutes (2 hours for Vancomycin and Fluoroquinolones)
and when next dose will be given;
 If not given, give before incision;
 If administered, when is next dose due; and
 Consider antibiotic circulation time and duration of tourniquet
time.
• Essential imaging displayed?
 Confirm essential imaging has been displayed and is
displayed correctly.
• Team communicates anticipated complications.
• STOP! Does everyone agree we are ready to go?
AT THIS POINT THE TIME OUT IS
COMPLETED AND THE TEAM MAY
PROCEED WITH THE SURGERY
Debriefing
• At a minimum, requires surgeon, anesthesiologist, and nurse(s)
to be present.
• Performed during or immediately after wound closure before the
patient is transferred from the operating room.
• Should be initiated when informing the surgeon that “Count is
Correct”
• Nurse verbally confirms with the entire team
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Confirmation of procedure performed as stated by surgeon;
Verbal confirmation of specimen details;
Verbal confirmation of surgical count; and
Identification of equipment problems.
• Surgeon reviews with the entire team
 Summary of important intra-operative events
 Indicate management plans
Debriefing (cont)
• Anesthesiologist review with the entire team
 Summary of important intra-operative events
 Confirm blood/fluid loss
 Recovery plans including concerns/issues related to
postoperative care
 Confirm normothermia
• Is there anything we could have done better?
 Must be asked for each procedure
 Team members must respond with either a negative or a
specific answer to the question
 Consider three (3) questions when answering:
 What did we do well?
 What did we learn?
 What could we do better/do differently?
HANDOFF TO PACU/RR, NURSING
UNIT OR ICU
SAFETY CHECKLIST IS NOW
COMPLETE
How not to complete the Surgical Safety
Checklist
how_NOT_to_use_surgical_safety_checklist.wvx
Completing Surgical Safety Checklist
how_to_use_surgical_safety_checklist.wvx
Completing Surgical Safety Checklist –
Complex Case
how_to_use_surgical_safety_checklist_complex.wvx
Your turn