Week 3: Patient Safety 2

Question 1

What are examples of accountable items?

Answer 1

Swabs
Sponges
Haemostats
Towel clips
Sutures
Blades
Diathermy tips
Patties and peanuts

Question 2

What are common items left inside patients?

Answer 2

Swabs
Sponges
Scissors
Forceps
Retractors
Needles

Question 3

Where do RSIs commonly happen?

Answer 3

Abdominal cavity
Colorectal
Gyne

Question 4

What are contributing factors for RSIs?

Answer 4

Deep cavity
Multiple personnel (teams changing, people within teams handing over)
Poor count
Emergency --> blood loss
Poor surgical conscience
Poor visibility
Tired/fatigue

Question 5

What is a retained surgical item?

Answer 5

Any surgical item inadvertently left within the patient’s body at the completion of a surgical procedure

Question 6

What are risk factors for RSI?

Answer 6

Invasive surgery
Emergency surgery
Extended duration --> fatigue
After hours
Increased BMI
Multiple surgical teams

Question 7

Why do WSSs happen?

Answer 7

Communication issues: non-standard abbreviations, exclusion, handwriting
Organisational culture: systems, surgeon-led
Heavy schedules, workload pressures: no time for checking
Last minute changes
Site marking

Question 8

How can WWSs be prevented?

Answer 8

Verify surgical booking documents
Approved abbreviations only
Preop and holding: check consent, admissions or OR booking form, OR schedule
Site marking: as close to site and time as possible, in conjunction with patient, indelible marker
Time out for regional blocks

Question 9

What are the contributing factors for WSSs?

Answer 9

Multiple teams
Site markers removed during prep
Distractions, rushing, off-topic conversation
Inconsistent safety focus, lack of accountability
Passive staff

Question 10

What is IPH?

Answer 10

Core temp < 36 degrees C

Question 11

What is the rate of IPH?

Answer 11

40-70%

Question 12

How is heat lost intraop?

Answer 12

Convection: wind chill
Conduction: cold OR table
Radiation: ambient air
Evaporation: dry resp gases

Question 13

What are contributing factors to IPH?

Answer 13

Time > 1 hour
Exposed
Low BMI
High volume irrigation
Ambient air temp
Anaesthesia: can't shiver, vasodilation
Alcohol based prep solutions
Fasting --> dehydration: reduced perfusion --> heat distribution
Cool IV fluids

Question 14

What are the complications of IPH?

Answer 14

Cardiac --> ischemia, arrhythmias
Increased length of stay
Increased hospital cost
Thermal discomfort
Increased SSI
Impaired platelet function --> blood loss
Pressure injuries
Altered drug metabolism --> delayed emergence

Question 15

What are strategies to prevent RSI?

Answer 15

Count, document, aloud with 2 people (1 RN) and visualised
Minimum 2 counts: before incision, commencement of skin closure
Additional counts: closing a cavity
Missing: stop surgery, find item, x-ray
Count items away in groups of 5

Question 16

What are strategies to prevent WSS?

Answer 16

WHO Surgical Safety Checklist
Patient confirm site up to 5 times
Site marking
Time out in theatre
Correct imaging

Question 17

What are strategies to prevent IPH?

Answer 17

Actively pre-warm
Bair-huggers
Warm blankets postop
Monitor temp
Warmed fluids
Limited exposure
Patient education