Patient Safety

Question 1

Name some never events.

Answer 1

Surgical errors such as wrong site surgery
Placement of the wrong implant/prosthesis
Retained foreign object post procedure
Mis-selection of a strong potassium solution
Administration of medication by the wrong route
Overdose of insulin due to abbreviations or the incorrect device
Overdose of methotrexate for non-cancer treatment
Mis-selection of high strength midazolam during conscious sedation
Transfusion or transplantation of ABO-incompatible blood components or organs
Misplaced naso or oro-gastric tubes
Scalding of patients
Failure to install functional collapsible shower or curtain rails
Falls from poorly restricted windows
Chest or neck entrapment in bed rails
Unintentional connection of a patient requiring oxygen to an air flowmeter

Question 2

What are the 3 checks of the WHO surgery safety checklist?

Answer 2

Sign In - before induction of anaesthesia

Time out - before surgical intervention

Sign out - before any member of the team leaves the operating room

Question 3

What checks are done on a patient before surgery whilst still on the ward?

Answer 3

4 essential details on a name tag
- Full name, DOB, Hospital number, NHS no

Consent form checked for…
- Name, Birthdate, Operation, Signature

Consent taken by surgeon capable of performing planned op
Pregnancy status recorded
Limb marked with non-washable marker

Anaesthetist

• Works alone and undisturbed to draw up drugs
• Syringes without labels must be discarded as cannot use safely

Question 4

What is included in the ‘sign in’ check of the WHO surgical safety checklist?

Answer 4

Has the patient confirmed his/her identity, site, procedure and consent?

Is the surgical site marked?

Is the anaesthetic machine and medication complete?

Does the patient have a known allergy?

Difficult airway/aspiration risk

Risk of bleeding >500ml

Question 5

What grade is used to assess sickness/physical state prior to giving anaesthetic?

Answer 5

ASA Grades

ASA 1 - normal, healthy patient
ASA 2 - mild systemic disease
ASA 3 - severe systemic disease + no immediate danger
ASA 4 - severe systemic disease + life threat
ASA 5 - not expected to survive 24 hours

Question 6

What is included in the ‘time out’ check of the WHO surgical safety checklist?

Answer 6

Have all the team members introduced themselves by name and role?

Surgeon, anaesthetist, and registered practitioner verbally confirm:

• Patient’s name,
• Procedure, site, position

Anticipated critical events:

• Surgeon
  
  • How much blood loss is anticipated?
  • Are there any specific equipment requirements or special investigations?
  • Are there any critical or unexpected steps that the team need to know about?
• Anaesthetist
  
  • Are there any specific patient concerns?
  • What is the patients ASA grade?
  • What monitoring equipment and other specific level of support are required e.g. blood
• Nurse/Operating department Personnel
  
  • Has the sterility of the instruments been confirmed?
  • Are there any equipment issues or concerns?

Has the surgical site infection (SSI)bundle been undertaken?

 - Antibiotic prophylaxis within the last 60 minutes
 - Patient warming
 - Hair removal
 - Glycaemic control

Venous Thromboembolism VTE prophylaxis undertaken?

Is essential imaging displayed?

Question 7

What is included in the ‘sign out’ check of the WHO surgical safety checklist?

Answer 7

Registered practitioner verbally confirms with the team – (to be read aloud before any member of the team leaved the operating room):

- Has the name of the procedure been recorded?
- Has it been confirmed that the instruments, swabs and sharps counts are complete (or not applicable)
- Have the specimens been labelled
- Have any equipment problems been identified that need to be addressed

Surgeon, anaesthetist, registered practitioner:
- What are the key concerns for recovery and management of this patient?

Question 8

What are WHO core standards for safe surgery?

Answer 8

The team will operate on the correct patient at the correct site.

The team will use methods known to prevent harm from anaesthetic administration, while protecting the patient from pain.

The team will recognise and effectively prepare for life-threatening loss of airway or respiratory function.

The team will recognise and effectively prepare for risk of high blood loss.

The team will avoid inducing any allergic or adverse drug reaction known to be a significant risk for the patient.

The team will consistently use methods known to minimise risk of surgical site infection.

The team will prevent inadvertent retention of instruments or swabs in surgical wounds.

The team will secure and accurately identify all surgical specimens.

The team will effectively communicate and exchange critical patient information for the safe conduct of the operation.

Hospitals and public health systems will establish routine surveillance of surgical capacity, volume, and results.