1. SAFE SURGIES CHECKLIST A PATH TO PATIENT SAFETY Rola Hammoud, MD,DA,MHM

2. Safety in Healthcare Amalberti, R. et. al. Ann Intern Med 2005;142:756-764

3. Adverse events Causes Rarely due to lack of knowledge of care givers 1. Lack of organisation ( time, resources ) 2. Lack of verification 3. Lack of coordination ( Human – Machine interface) 4. Lack of communication = Lack of SAFETY CULTURE

4. Adverse Events Individual Factors Limited memory capacity Memory decreases with : - Fatigue -Stress -Hunger – Sickness – Cultural and language barriers – Hazardous attitudes

5. Establish a Culture Best Security Management Practices Develop a Safety Culture Best Safety practices Decrease AE

6. Strategies to improve Patient Safety 1.Improve systems Leadership Standardization Technology Human factor engineering 2.Improve communication: language standard, checklists, debriefings 3. Team Work 4. Other interventions: staffing et RH, training & education 5.Learn from our errors : M&M, RCA, Incident reporting, medical record review 6.Just Culture

8. HOW to Standardize Checklists Protocols Clinical Guidelines Pathways

9. CHECKLISTS

10. Checklist An algorithmic listing of actions to be performed in a given clinical setting Goal : ensure that no step will be forgotten. Has a sound theoretical basis in principles of human factors engineering human factors engineering Play a major role in some of the most significant successes achieved in the patient safety movement.

12. JCI Patient Safety Goals 1.Patient Identification 2.Improve Communication among caregivers 3.Improve the safety of using medications 4.Reduce the risk of healthcare associated infections 5.Avoid Wrong patient-wrong site- Wrong surgery 6.Reduce the risk of patient harm resulting from falls

13. SAFE SURGERIES When a patient is wheeled in to an Operating Room, the single biggest worry before losing consciousness is ….. that the surgeon will mix him up with another patient, or perform a wrong surgery.. It's a reality. In many cases, mistakes happened

14. SAFE SURGERIES IATROGENIC SURGICAL ERRORS Identification errors Site errors Retained sponges & instruments Surgical site Infections Unanticipated major bleedings Failure of equipments Anesthesiology mishaps & medication errors Burns due to cautery misuse Neuropathies due to bad positioning

15. SAFE SURGERIES UNIVERSAL PROTOCOL 1. Preoperative verification process 2. Marking of the operative site 3. “Time Out” immediately before starting the procedure.

16. SAFE SURGERIES Preoperative verification process Verify the correct procedure, person and site: 1. At the time surgery is scheduled. 2. Upon admission to the hospital. 3. On transfer of the responsibility of care between caregivers. 4. with the patient involved, awake and aware.

17. SAFE SURGERIES Preoperative verification checkilst 1. Relevant documentation ( eg.H&P and consents) 2. Relevant images properly labelled and displayed 3. Any required implants and special equipments.

18. SAFE SURGERIES Operative Site Marking Purpose: To identify unambiguously the intended site of incision or insertion. Process: For procedures involving right/left distinction, multiple structures (such as 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.

19. SAFE SURGERIES TIME OUT JCI Universal Protocol calls for a "time out" immediately before starting a surgical procedure. Prior to draping the patient and prepping the site. During the time out, the surgical team verifies the procedure, site, side, and patient identification for accuracy

21. WHO Surgical Safety Checklist Improved interdisciplinary communication: Relaying the information in a loud voice Introducing each other to the rest of the team

22. WHO Surgical Safety Checklist Factors facilitating the use of the checklist 1.Structured training 2.Exemplary implementation by team leaders

23. WHO Surgical Safety Checklist Can be completed in about two minutes Improves safety and patient outcomes when adhered to in the operating room, according to an analysis of 20 studies.

24. WHO Surgical Safety Checklist Surgical outcome study indicated a decrease of 47% in perioperative mortality, from 56 deaths in 3733 cases (1.5%) to 32 deaths in 3955 cases (0.8%). A second study showed a decrease of 62%, from 31 deaths in 842 cases (3.7%) to 13 deaths in 908 cases (1.4%). These 2 studies also showed a more than a one third decrease in perioperative morbidity outcomes. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al: A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499, 2009

25. Surgical Safety Checklist Training surgical teams in communication and using a procedure checklist before, during, and after surgery may significantly decrease 30-day postoperative complications such as surgical site infections and bleeding requiring transfusions. study conducted at 2 Connecticut medical centers

26. Surgical Safety Checklist

27. NSQIP : Reduction in adverse events Reduction of 30 days morbidity rates

28. Surgical Safety Checklist This study demonstrates a considerable improvement in risk-adjusted 30-day postoperative morbidity. The implementation of team training and accountability measures, such as the comprehensive checklist, are inexpensive interventions that can contribute to cost savings in the expanding environment of pay for performance and increase patient satisfaction with the perioperative experience.

29. Other Surgical Safety Checklists SURPASS Neurosurgery checklists QRS : Quality Rounds Checklists "Sign, Mark and X-ray" program

30. Spine surgery wrong-level checklist developed by NASS*

33. SAFE DELIVERIES

34. WHO Estimations on deliveries More than 130 million births each year Nearly 287 000 result in the mother’s death, 1 million in an intrapartum related stillbirth, 3 million death during the neonatal period.

35. WHO Estimations on deliveries The greatest burden of maternal and perinatal mortality is clustered around the time of birth, with the majority of deaths occurring within the first 24 hours after childbirth.

36. WHO Safe Childbirth Checklist Program Established in consultation with General practitioners Obstetricians Anesthetists Nurses Midwives Patient safety Experts and patients around the world

39. Surgical and Delivery Safety Checklists Makes sure that a TEAM is advocating for the PATIENT

40. THANK YOU