Research Paper: Risk Assessment of Surgical Procedures in a Referral Hospital (original) (raw)
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Strategies for Preventing Adverse Events in the Surgical Center
The study aims to identify the strategies used to prevent adverse events in surgical centers. The method used was a systematic literature review, based on the LILACS, MEDLINE, BDENF, Science Direct, PubMed/MEDLINE databases. The following descriptors were crossed: “Medical errors AND Surgical Centers”, “Patient Safety AND Surgical Centers”. 841 publications were found in the databases, of these, 709 were in MEDLINE, 56 in LILACS, 38 in BDENF, 11 in Science Direct and 27 in PubMed. Only 2 articles were included in the review, which included strategies such as: implementing an incident reporting system and a formal event analysis program, perioperative checklist, morbidity and mortality conferences, identification bracelets, training or systematic education in the introduction of new devices. To reduce adverse events, it is necessary to identify them, because the perception of failures in the different phases of care, allows the identification of recurrent errors and a critical assessment for decision making, which contributes to the prevention of subsequent errors and more effective interventions.
Risk assessment in eye surgery: A hospital in Iran
International Journal of Health System and Disaster Management, 2013
Introduction: Clinical risk management and medical errors have become a basic part in every hospital management. The critical complexity that controls the conditions of very ill patients in some specialized units like the operating room may increase the number of errors in providing healthcare services. Using failure mode and effect analysis (FMEA) method, the present study attempts to identify, assess and provide appropriate actions to control, reduce and eliminate the potential risks in the operating room in Feiz hospital in 2012. Materials and Methods: The present study is a qualitative research conducted in 2012 through direct observation, interview with the officials and authorities in the operating room, and available document review. The participants include the authorities in hospital units and those aware of processes in the operating room. To collect the data, the standard worksheet of the FMEA technique was used. Findings: Based on the authorities' point of view, eight main actions were selected to analyze the potential errors. The finding suggested that 35 failure modes were identified in the operating rooms at the Feiz hospital in Isfahan from among which seven potential failure modes were related to injection and transfusion, four to prechecking the apparatuses, 14 to the cares before and during the surgery, four to the cares after the surgery, one to the sterilization of the apparatuses, three to admitting the patients in the operating room, one to checking the blood glucose, and one to checking the doctors' instructions and prescriptions. Discussion: Based on the results presented, the following priorities were found to eliminate or reduce the identified errors: teaching the Haemovigilance system and an identification guideline of the patient to the personnel, full awareness of drugs and their possible side effects, teaching fluid therapy, controlling the operation of the apparatuses, teaching the health processes and controlling infection, and so on. Hospitals can easily provide a list of the required specific errors reported in the centers and introduce some approaches to deliver the services and enhance their quality, by performing a simple comprehensive technique and analysis, like the one presented in this study in all units.
Nature, causes and consequences of unintended events in surgical units
British Journal of Surgery, 2010
Background: Several studies have shown that the rate of unintended harm is higher in surgical than in non-surgical care. To improve patient safety in surgery, information about the underlying causes is needed. This observational study examined the nature, causes and consequences of unintended events in surgical units, and the completeness of event reporting.
Patient Safety; Interventions to Reduce Hospital Errors
Pakistan Armed Forces Medical Journal, 2020
Objective: To evaluate practices regarding prevention of factors compromising patient safety such as drug errors, never events and critical incidence reporting. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Dec 2019 to Apr 2020. Methodology: Methodology constituted of a paper-based and web-based questionnaire. A pilot study carried out at 15-20 participants for questionnaire validation and reviewed by independent experts for face validity, a final questionnaire comprised of 26 multiple-choice questions. The minimum sample size required for the study was 383, where the prevalence of medical errors related to surgery and anaesthesia was considered to be 48%. Results: Total 1470 participants participated in the study and data was extracted from their responses. Out of 1470, 814 (55.4%) were anaesthesiologists while 656 (44.6%) were surgeons. Majority of the participants 1308 (89.0%), declared that critical in...
Patient Safety in Surgery, 2011
We need to know the scale and underlying causes of surgical adverse events (AEs) in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since then surgical technology and quality assurance have changed rapidly. The objective of this study was to provide more recent data on the incidence, consequences, preventability, causes and potential strategies to prevent AEs among hospitalized patients in surgical units. Methods: A structured record review study of 7,926 patient records was carried out by trained nurses and medical specialist reviewers in 21 Dutch hospitals. The aim was to determine the presence of AEs during hospitalizations in 2004 and to consider how far they could be prevented. Of all AEs, the consequences, responsible medical specialty, causes and potential prevention strategies were identified. Surgical AEs were defined as AEs attributable to surgical treatment and care processes and were selected for analysis in detail. Results: Surgical AEs occurred in 3.6% of hospital admissions and represented 65% of all AEs. Forty-one percent of the surgical AEs was considered to be preventable. The consequences of surgical AEs were more severe than for other types of AEs, resulting in more permanent disability, extra treatment, prolonged hospital stay, unplanned readmissions and extra outpatient visits. Almost 40% of the surgical AEs were infections, 23% bleeding, and 22% injury by mechanical, physical or chemical cause. Human factors were involved in the causation of 65% of surgical AEs and were considered to be preventable through quality assurance and training. Conclusions: Surgical AEs occur more often than other types of AEs, are more often preventable and their consequences are more severe. Therefore, surgical AEs have a major impact on the burden of AEs during hospitalizations. These findings concur with the results from previous studies. However, evidence-based solutions to reduce surgical AEs are increasingly available. Interventions directed at human causes are recommended to improve the safety of surgical care. Examples are team training and the surgical safety checklist. In addition, specific strategies are needed to improve appropriate use of antibiotic prophylaxis and sustainable implementation of hygiene guidelines to reduce infections.
Drug, Healthcare and Patient Safety, 2013
Background: With scientific and technological advances, the practice of orthopedic surgery has transformed the lives of millions worldwide. Such successes however have a downside; not only is the provision of comprehensive orthopedic care becoming a fiscal challenge to policy-makers and funders, concerns are also being raised about the extent of the associated iatrogenic harm. The National Reporting and Learning System (NRLS) in England and Wales is an underused resource which collects intelligence from reports about health care error. Methods: Using methods akin to case-control methodology, we have identified a method of prioritizing the areas of a national database of errors that have the greatest propensity for harm. Our findings are presented using odds ratios (ORs) and 95% confidence intervals (CIs). Results: The largest proportion of surgical patient safety incidents reported to the NRLS was from the trauma and orthopedics specialty, 48,095/163,595 (29.4%). Of those, 14,482/48,095 (30.1%) resulted in iatrogenic harm to the patient and 71/48,095 (0.15%) resulted in death. The leading types of errors associated with harm involved the implementation of care and ongoing monitoring (OR 5.94, 95% CI 5.53, 6.38); self-harming behavior of patients in hospitals (OR 2.14, 95% CI 1.45, 3.18); and infection control (OR 1.91, 95% CI 1.69, 2.17). We analyze these data to quantify the extent and type of iatrogenic harm in the specialty, and make suggestions on the way forward. Conclusion and level of evidence: Despite the limitations of such analyses, it is clear that there are many proven interventions which can improve patient safety and need to be implemented. Avoidable errors must be prevented, lest we be accused of contravening our fundamental duty of primum non nocere. This is a level III evidence-based study.
Jundishapur Journal of Health Sciences, 2020
Objectives: There are deficiencies in codifying and implementing the surgical safety guideline, which may result in decreasing its positive outcomes. The aim of the current study is determining the intervening conditions and the strategies for effectively implementing the surgical safety guideline in the hospitals. Data Sources: Content analysis was used for analyzing the 28 qualitative articles that were searched by the systematic review in English databases such as Science Direct, PubMed, Elsevier, EBSCOhost, and Google Scholar. Finally, 28 articles were entered into a research, and classified by the MAXQDA10 software. Results: The intervening conditions were categorized in 21 sub-categories and three categories as follows: technical factors, human factors, and managerial-organizational factors. The strategies were categorized in 19 sub-categories and three categories as follows: technical strategies, human strategies, and managerial-organizational strategies. Conclusions: It is necessary to consider the intervening conditions and strategies as a proper subset of factors related to safe surgical care.
This study evaluates the adherence and use of patient safety in the Operation Theater/ operating room/surgery. Operation errors are enormous and very frequent in a surgery. Though there is an encouragement to improve patient safety by the use of the safety checklist the study could also establish that these measures cannot satisfy or guarantee a free error environment. Findings indicate that safety protocols are being followed at various phases of surgery but there are a few aspects which are being neglected, the highest complaint was observed in pre-operative phase followed by intra phase then in post-operative phases. The study goes further to show that the post-operative complications are less even when the safety guideline is not being followed completely.