2. SURGERY
An estimated 234 million
major operations are
performed around the world
each year, which equals
one operation for every 25
people alive.
Each year an estimated 63
million people undergo
surgical treatment due to
traumatic injuries, another
10 million operations are
performed for pregnancy-
related complications, and
31 million more are
undertaken to treat
malignancies.
3. RAISING THE STANDARD TO MAKE SURGICAL
CARE SAFER WORLDWIDE
'Surgical care has been an essential component of
health systems worldwide for more than a century.
Although there have been major improvements
over the last few decades, the quality and safety of
surgical care has been dismayingly variable in
every part of the world. The Safe Surgery Saves
Lives initiative aims to change this by raising the
standards that patients anywhere can expect.’
4. 5 FACTS ABOUT SURGICAL SAFETY
1. Complications after inpatient operations occur in
up to 25% of patients.
2. The reported crude mortality rate after major
surgery is 0.5–5%.
3. In industrialized countries nearly half of all
adverse events in hospitalized patients are related
to surgical care.
4. At least half of the cases in which surgery led to
harm are considered to be preventable.
5. Known principles of surgical safety are
inconsistently applied even in the most
sophisticated settings.
5. WRONG-SITE SURGERY (WSS)
What is it? Top Causes
Wrong site 70% communication
Wrong patient failure
Wrong procedure 64% procedural non
compliance
46% leadership issues
6. WSS RISK FACTORS
Emergency cases
Multiple surgeons
Multiple procedures
Deformities
Obesity
Time pressures
Unusual equipment or
set up
Room changes
7. UNIVERSAL PROTOCOL - PREOPERATIVE
VERIFICATION PROCESS
Purpose Process
To ensure that all of the relevant An ongoing process of
documents and studies are
available prior to the start of the information gathering and
procedure and that they have verification
been reviewed and are
consistent with each other and Begins with the
with the patient's expectations determination to do the
and with the team's procedure, continuing
understanding of the intended
patient, procedure, site, and, as through all settings and
applicable, any implants. interventions involved in the
Missing information or preoperative preparation of
discrepancies must be the patient, up to and
addressed before starting the including the "time out" just
procedure.
before the start of the
procedure.
8. UNIVERSAL PROTOCOL - MARKING THE
OPERATIVE SITE
Purpose Process
To identify For procedures involving
right/left
unambiguously the distinction, multiple
intended site of incision structures (such as
or insertion. fingers and toes), or
multiple levels (as in
spinal procedures), the
intended site must be
marked such that the
mark will be visible after
the patient has been
prepped and draped.
9. UNIVERSAL PROTOCOL - "TIME OUT" IMMEDIATELY
BEFORE STARTING THE PROCEDURE
Purpose Process
To conduct a final Active communication
verification of the among all members of
correct the surgical/procedure
patient, procedure, site team, consistently
initiated by a designated
and, as
member of the team,
applicable, implants.
conducted in a "fail-safe"
mode, i.e., the procedure
is not started until any
questions or concerns
are resolved.
10.
11. FIVE STAGES OF THE ‘CORRECT PATIENT, CORRECT
SITE AND CORRECT PROCEDURE’ POLICY
Step 1: ensure that valid informed consent has
been obtained
Step 2: Confirm the patient’s identity
Step 3: mark the site of the surgery or invasive
procedure
Step 4: Take a final ‘team time-out’ in the operating
theatre, treatment or examination area.
Step 5: ensure the correct and appropriate
documents and diagnostic images are available
12.
13.
14. REFERENCES
Correct Patient, Correct Procedure and Correct Site Policy
and Guidelines for Western Australian Health Services.
(2006). Retrieved January, 2, 2012, from
http://www.safetyandquality.health.wa.gov.au/docs/correct_ps
p/Correct_Patient_Policy_and_Guidelines_Final.pdf
Mulloy, D., & Hughes, R. (2008). Wrong-Site Surgery: A
Preventable Medical Error. Retrieved January 2, 2012, from
http://www.ncbi.nlm.nih.gov/books/NBK2678/
Safe Surgery Saves Lives. (2008). Retrieved January 2, 2012,
from
http://www.who.int/patientsafety/safesurgery/knowledge_base/
SSSL_Brochure_finalJun08.pdf
Surgical Safety Checklist. (2009). Retrieved January 2, 2012,
from
http://whqlibdoc.who.int/publications/2009/9789241598590_e
ng_Checklist.pdf
Hinweis der Redaktion
(Safe Surgery Saves Lives,2008)
(Safe Surgery Saves Lives,2008)
(Safe Surgery Saves Lives,2008)
(Mulloy, & Hughes, 2008)
(Mulloy, & Hughes, 2008)
From Joint Commission on Accreditation of Healthcare Organizations based on WHOguideleies(Mulloy, & Hughes, 2008)
From Joint Commission on Accreditation of Healthcare Organizations(Mulloy, & Hughes, 2008)
From Joint Commission on Accreditation of Healthcare Organizations(Mulloy, & Hughes, 2008)
Before induction of anaesthia, before skin incision, before patient leaves operating roomAll require nurse to be present(Surgical Safety Checklist,2009)
From Western Australia Health DepartmentStep 1: ensure that valid informed consent has been obtainedCompliance with the Consent to Treatment Policy for the Western Australian Health System is mandatory. as a matter of policy, no surgical operation, medical, anaesthetic, radiology or oncology procedures may be performed without the consent of the patient, if the patient is a competent.Step 2: Confirm the patient’s identityPolicy recognises that the patient is an integral member of the team undertaking the verification process. When the patient is being prepared for their treatment/procedure, it is recommended that a ‘team time-out’ is taken, and that the patient is involved in the initial stages of the five-step verification process. Prior to the patient receiving any medication that could affect his/her cognitive function, a member of the clinical team will take ‘time-out’ to confirm the following details with the patient: the patient’s full name and date of birth; (the patient should be asked to state not confirm these details);the type of treatment/procedure being performed; the reason for the treatment/procedure; and the side and site of the treatment/procedure. Staff must check the patient’s responses against the patient’s identification band, consent form and other information provided in the patient’s medical record. The completion of this Step must be recorded on a checklist, which should be completed at the end of each stage of the five-step verification process and stored in Theatre management System or in the patient’s medicalStep 3: mark the site of the surgery or invasive procedure. The site of the surgery or invasive procedure should ideally be marked by the person performing the surgical or interventional procedure.. The intended site of incision or site of insertion must be unambiguously markedStep 4: Take a final ‘team time-out’ in the operating theatre, treatment or examination area., all members of the clinical team (e.g. proceduralist, anaesthetist, nurse) should participate in a final ‘team time-out’.The final ‘team time-out’ should be consistently initiated by a designated member of the clinical team. The success of the ‘team time-out’ process is totally reliant on active communication amongst all members of the clinical teamStep 5: ensure the correct and appropriate documents and diagnostic images are availableClinical errors caused by poor quality documentation or improperly labelled diagnostic images are a real vulnerability in the process. Clinicians and hospitals/health services alike have a responsibility to develop and implement policies and procedures to mitigate against this vulnerability. (Correct Patient, Correct Procedure and Correct Site Policy and Guidelines for Western Australian Health Services,2006)
Algorithm for assuring correct invasive procedures in all clinical settings(Correct Patient, Correct Procedure and Correct Site Policy and Guidelines for Western Australian Health Services,2006)
Pre-operative/pre-treatment verification checklistDocumented and signed on this official document which is kept in the patient file.(Correct Patient, Correct Procedure and Correct Site Policy and Guidelines for Western Australian Health Services,2006)
