patient safety- human factors in surgery

Question 1

What is Crew Resource Management? How is it used in medicine ?

Answer 1

• obligation - joint aviation requirements
• coaching - instead of autocratic leadership
• leader- follower roles
• cross checking - briefing/debriefing
• intervision/peer assessment - blame free reporting

Question 2

How do errors occur in the surgical arena? list

The Person Model

Answer 2

• judgement (defective/impaired - fatigue stress emotion)
• concentration lapse (habit/boredom- interuptions)
• behaviour/personality
• ill health (physical/emotional)
• inexperience
• carelessness

Question 3

Before induction of anasethesia, what should the sign in process include?

Answer 3

• patient confirm identity
• site marked
• anaesthesia safety check
• pulse oximeter on patient and functioning
• does patient have any allergies?
• Difficult airway/aspiration risk?
• risk of blood loss?

Question 4

What should be included in the ‘time out’ checklist before the skin incision in surgery?

Answer 4

• confirm all team members have introduced themselves by name and role
• surgeon, anaesthesia professional and nurse verbally confirm- patient, site and procedure
• surgeon review - what are the critical or unexpected steps operative duration, anticipated blood loss?
• anaesthesia team review - are there any patient-specific concerns?
• nursing team reviews - has sterility been confirmed?
• has antibiotic prophylaxis been given within the last 60 minutes?

Question 5

Before patient leaves the operating room, what is on the sign out form?

Answer 5

• nurse verbally confirms with the team- name of procedure recorded, instruments etc are counted for, how specimen is labled, and whether there are any equiptment problems to be addressed
• surgeon, anaesthesia professionals and nurse review the key concerns for recovery and management of patient

Question 6

What are the 10 essentials for safe surgery?

Answer 6

1. the team will operate on the correct patient and correct site
2. team will use methods known to prevent harm from anaesthetic administration, while protecting the patient from pain
3. recognize and effectively prepare for life-threatening loss of airway or respiratory function
4. recognize and effectively prepare for risk of high blood loss
5. avoid inducing any allergic or adverse drug reaction known to be a risk
6. consistently use methods known to minimize risk of surgical site infection
7. prevent inadvertent retention of instruments or sponges in surgical wounds
8. secure and accurately identify all surgical specimens
9. effectively communicate and exchange critical patient information for the safe conduct of the operation
10. establish routine surveillance of surgical capacity volume and results