Transcript Safe Surgery Checklist - Covenant Health Canada

Revised for 2013
Shannon Hein RN, CPN(C)
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published in the Canadian Medical Association Journal
in May 2004
Found an overall incidence rate of adverse events of
7.5%
Of the almost 2.5 million annual hospital admissions;
• about 185 000 are associated with an adverse event
• close to 70 000 of these are potentially preventable
(CMAJ May 25, 2004 170:1643)
Of 719 Events investigated 2004-2012:
Human Factors
Communication
Assessment
Leadership
Information Management
Operative Care
Physical Environment
Care Planning
Medication Use
Continuum of Care
(The majority of events have multiple root causes)
(The Joint Commission Sentinel Event Data; Root Causes by Event Type 2004-2012)
443
388
357
299
140
103
80
76
70
61
Of 928 Events investigated 2004-2012:
Leadership
Communication
Human Factors
Information Management
Operative Care
Assessment
Physical Environment
Patient Rights
Anesthesia Care
Continuum of Care
770
634
618
338
313
311
89
55
46
36
(The majority of events have multiple root causes)
(The Joint Commission Sentinel Event Data; Root Causes by Event Type 2004-2012)
Of 773 Events investigated 2004-2012:
Leadership
Human Factors
Communication
Operative Care
Assessment
Physical Environment
Information Management
Continuum of Care
Performance Improvement
Care Planning
614
502
496
436
195
174
127
21
13
8
(The majority of events have multiple root causes)
(The Joint Commission Sentinel Event Data; Root Causes by Event
Type 2004-2012)
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communication tool intended to be used by clinicians
to improve the safety and quality of patient care during
surgical procedures
shown to reduce (>30%) the number of preventable
complications / mortality associated with surgery by
ensuring critical information is shared with all
members of the surgical team (NEJM 2009;360:491-499)
Now >3900 hospitals worldwide (122 countries) …more
than 90% of the world’s population (WHO)
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“A Surgical Safety Checklist to Reduce Morbidity and Mortality in a
Global Population”
Between October 2007 and September 2008, eight hospitals in
eight cities collected data on 3733 patients “Pre” Safe Surgery
Checklist and 3955 “Post” Safe Surgery Checklist
The rate of death was 0.9% before the checklist was introduced
and declined to 0.6% afterward (high income sites Toronto,
Auckland, London, Seattle)
Inpatient complications occurred in 10.3% of patients at baseline
and in 7.1% after introduction of the checklist (at high income
sites)
Checklist adherence was measured and tight correlations were
found between the use of the checklist and achieving these
results.
A
modified version of the WHO Safe Surgery
Checklist was introduced to AHS in January
2010
 The
method of delivery has varied from site to
site, with compliance also varying
 Recognizing
sites………..
that many staff work at multiple
 The
Safe Surgery Checklist was modified and
standardized to ensure that all sites across
Alberta are completing the necessary steps
 After
2013, Safe Surgery Checklist becomes an
Accreditation Canada requirement
 The
Covenant Health Safe Surgery Checklist
Policy…….
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Safe Surgery Checklist Required for all surgical
interventions
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All steps must be completed by the appropriate
people
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Required to be documented on patient’s health
record
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If Briefing is not completed, the case does not
proceed
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Surgeon and Anesthesiologist: must be staff or Fellow
 The
Checklist Lead ensures the
completion of each section of the
Checklist.
 All steps in each section must be
complete before proceeding
 Briefing: Surgeon
 Time
Out: Nurse
 Debriefing: Nurse
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As soon as patient is
in the Operating
Room, before
Induction of
Anesthesia
• Patient or family
•
•
•
•
member
Anesthesiologist
Surgeon
Nurse
All MUST be present for
Briefing
 Immediately
before
incision
 Initial instrument
will be kept on back
table until Time Out
is complete
•
•
•
•
Anesthesiologist
Surgeon
Nursing
All MUST be present
for Time Out
 During Wound
Closure
 Cavity Count must
be complete
• Anesthesiologist
• Surgeon
• Nursing
• All MUST be present
for Debriefing
 Safe
Surgery Checklist will be part of the
chart
 Each section (Briefing, Time Out and
Debriefing) will be represented
 The Checklist Lead ensures these
sections are complete
 Each section is then signed off on the
chart
Where is it done?
All three sections will be done in the Operating Room.
In the event that a patient has an interpreter or cannot
represent themselves, the Briefing will take place in the Pre
Operative Holding area.
Why the changes?
To ensure that all hospitals across Alberta are doing the same
standardized Checklist.
Is this going to slow things down?
In the beginning, this may have its growing pains. But, it has
actually been proven to save time in many situations
Can a Resident do the Checklist in place of the Physician?
No. The AHS and Covenant Health policies require the Surgeon and
Anesthesiologist to be either Staff or Clinical Fellow.
Is this for all surgeries?
Yes
What are the other hospitals doing?
All hospitals in Alberta are doing the Safe Surgery Checklist and are
required to meet all of the steps and criteria.
Is this part of the patient chart?
Yes
Does the Checklist have to be done in an Emergency situation?
The Most Responsible Health Practitioner will use discretion in
determining which sections of the Checklist will be completed.
Documentation of this will go in the patient’s Health Record.
What if the patient is undergoing multiple procedures?
The Surgeon or alternative surgeon, Anesthesiologist or alternative
anesthesiologist and nurse must be present for Briefing and Time
Out for each distinct procedure.
Upon completion of all procedures, the most responsible surgeon,
the anesthesiologist and nurse must ALL be present for debriefing.
What if the patient needs an interpreter or cannot represent
themselves, how do we do the Briefing section?
If an interpreter or representative/family member is present,
complete the Briefing section in the Pre Operative Holding Area
with Circulating Nurse, Anesthesia, and Surgeon present.
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The Canadian Adverse Events Study
Baker GR, Norton P, Flintoft V, et al. The Canadian adverse events
study: the incidence of adverse events among hospital patients in
Canada. CMAJ. 2004; 170 (11): 1678 - 1686.
Impact of using the checklist at the eight WHO pilot sites
Haynes AB, Weiser TG, Berry WB, et al. A surgical safety checklist
to reduce morbidity and mortality in a global population. New
England Journal of Medicine. 2009 Jan 14; [Epub ahead of print].
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The Joint Commission Sentinel Event Data; Root Causes by
Event Type 2004-2012
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Alberta Health Services Safe Surgery Checklist Provincial
Measurement Strategy September 17, 2012