patients safety in operating theatre

8/20/2019 Patients Safety in Operating Theatre

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PATIENT SAFETY in the

OPERATING ROOM

Joy E. Luat-Inciong, MDSt. Luke’s Medical CenterPhilippines


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Effective Communication

in the OR

sophisticated instruments

transfer of critical information

changing nature of patient’scondition

uncertainty inherent in surgery


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Communication failure is

the root cause of nearly70% of sentinel events.


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Ways to Establish

Communication

Providing the staff access toleadership

Eliminating hierarchy

Encouraging a team approach tocare


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Addressing Patient-Associated Risks

Preventing Wrong-Site, Wrong-Procedure, Wrong-Person Surgery

Preventing Medication Errors


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Wrong-Site, Wrong-

Procedure, Wrong-PersonProcedure Surgery


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Causes of Wrong-Site, Wrong-

Procedure, Wrong-PersonSurgery

Ineffective/Inadequate communication amongmembers of the surgical team

Lack of patient involvement in site marking

Lack of procedures for verifying operative site

Inadequate patient assessment


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Causes of Wrong-Site,

Wrong-Procedure, Wrong-Person SurgeryInadequate medical record review

Exclusion of certain surgical team membersin verification process

Illegible handwriting

Use of abbreviations related to surgicalprocedure, site or laterality


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Causes of Wrong-Site,

Wrong-Procedure, Wrong-Person Procedure

More than one surgeon

Multiple procedures

Time pressure

Unusual patient characteristics


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Universal

Protocolfor Preventing Wrong-Site,Wrong-Procedure, Wrong-

Person Surgery

Preoperative verification process

Marking of the surgical site

Time-out before start of procedure


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Preoperative Verification

Processat time procedure is scheduled

at time of admission into facility

anytime responsibility for care of patient

is transferred to another caregiverbefore patient leaves preoperative areaor enters procedure room


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Marking the

Surgical SiteWrite “Left” or “Right” or “Yes”

Mark should be visible afterpatient has been prepped anddraped

Do not mark any non-operative site

Do not write “X”


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Mark all cases involving:

Laterality

Multiple structures

Multiple levels


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Sites Exempt from

Surgical Site Marking

Single organ

Interventional cases

Teeth

Premature infants


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Time-Out

Correct patient identity

Correct side and site

Agreement on procedure to be performed

Correct patient position

Availability of correct implants, specialequipment or requirements


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Addressing OR-

Associated RisksEnsuring Fire SafetyEnsuring Infection Control andPrevention

Maintaining Proper Hand Hygiene in

the OREnsuring Sharps Safety

Preventing Overbooking of ORs


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Ensuring Fire SafetyThe Fire Triangle

Fuel source

Ignition sourceOxygen source


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Minimizing Risks Associated

w/ Fire TrianglePreparing patients appropriately

Using equipment safely

Maintaining equipment

Controlling excess oxygen

Engaging staff in fire prevention


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Responding to OR Fire

Shut down medical gases

Pour saline into surgical site

Remove burning material

Ventilate with air instead ofoxygen


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Ensuring Infection

Control and Prevention

Air quality and ventilationEffective OR cleaning

Effective medical equipment cleaningEffective laundry cleaning


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Air Quality and VentilationCenters for Disease Control and

Prevention Guidelines

Maintain positive pressure ventilation

Maintain 15 air changes per hour

Filter air

Introduce air from ceiling and exhaustnear floor

Keep OR doors closed


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Reducing Risk of TB

Patient should be intubated in AII roomor in OR

Use surgical N95 respirator or a PAPR

Use bacterial filter with anesthesiaequipment


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Reducing Risk of TB

Extubate and allow recovery in AIIroom

Schedule as last surgical case of

the day


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Cleaning the OR Effectively

Terminal cleaning onceevery 24 hours

Use wet vacuum or

single use mop


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Cleaning Equipment

Effectively

Which?When?

How?How often?


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Classification to Determine

Cleaning Strategy forEquipment

Critical Cleaning

Semicritical Decontamination

Noncritical Disinfection

Sterilization


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An antiseptic made up of acombination of 2 antiseptics

with different mechanisms ofaction can be better atfighting bacteria than a

single antiseptic.


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Guidelines in

Selecting ProtectiveApparel

Type of materialSafety

Performance characteristicsAppropriate care

Proper disposal


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Reducing Surgical Site

InfectionsUsing prophylactic antibiotics

Removing hair appropriately

Ensuring glycemic control

Preventing hypothermia

Providing supplemental O2 during surgery


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Infection Control Emergency

Limit OR traffic

Designate specific rooms and routes

Monitor staff’s health

Use disposable equipment


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Reducing Sharps

Injuries

Use a neutral zone

Practice double-gloving

Regularly change surgical gloves

Stay out of the way


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Preventing Overbooking

of ORs

Managing block time effectively

Separating urgent and elective

casesImproving on-time starts


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Managing Block

Time Effectively

Set clear rules

Consider utilization as a guideline

Regularly review block time

Add an urgent room


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Emergent - 30 minutes

Priority - 30 minutes to an hour

Urgent - 4 to 24 hours

Nonurgent - after 24 hours


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Risk Factors for Retaining

Foreign Bodies After Surgery

Emergency surgeriesComplex procedures

Surgeries with unplannedprocedures


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Risk Factors for

Retaining Foreign BodiesAfter Surgery

Surgeries on off hours

Sponges used for packing

or retractorsPatients with high bodymass index


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Strategies for PreventingRetention of Forei n Bodies

Reviewing counting policy

Educating staff

Ensuring effective communication


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Strategies for Preventing

Retention of Foreign Bodies

Performing x-ray on all high-riskpatients

Minimizing rush

Minimizing distractions


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Nowhere, perhaps, is itmore important to

preserve the safety ofthe patients than in the

OR.....Lives often depend on it.

patients safety in operating theatre

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