144 / Preoperative path analysis of elective orthopedic patients by the use of a proactive method of risk analysis: FMEA

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Analysis of risk and harm
Identification of risk and harm There is no specified text here
Topic of the reported practice
Clinical risk management
Aim and the benefit of the Patient Safety Practice
 
The aim of the practice is to identify the risks a hospitalized patient can run into when undergoing elective surgery in a orthopedic department and define the actions to be carried out in order to prevent the risks identified. The actions to be carried out are the following: - Inform the patient for a proper preparation for intervention; - improve the management of medical records; - ensure compliance of activities with safety procedures; - reduce the risk of inadequate communication between ward staff and operating room; - reduceconflict between units.
Description of the Patient Safety Practice
 
The study was conducted in the SC (struttura complessa- department) of Orthopaedics/Traumatology at Hospital Santa Maria degli Angeli in Pordenone, and consisted of a group work during September/October 2011.
The SC of Orthopaedics and Traumatology provides 24 hours orthopaedic trauma
emergency care, and diagnostic and / or therapeutic services on an outpatient basis for
the catchment area of the province. "Ordinary" admittance to the wards can only be made
following a referral by an SC specialist in the outpatient area, and is on a "waiting list"
basis.
The improvement plan developed has taken into account the following criteria, to identify
the necessary corrective actions:
- High IPR
- Real possibility of intervention in a timely fashion and in accordance with available
resources
- Actions that could include more than one improvement simultaneously
More detailed information in the document attached.

Total number of person days required to implement this Patient Safety Practice Clinical staff: 12 p/d External consultants: Support staff: 6 p/d Managerial staff: 2 p/d Others: Not relevant:
Attachment of relevant written information and/or photos, as appropriate
102_WP4_AOPN DESCRIPTION.pdf
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Administrative support (secretary, clerk, receptionist etc.)
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/practices.aspx
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Regular data feed back to involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
Yes
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 12
External consultants: -
Support staff: 6
Managerial staff: 2
Others: -
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Nicola Delli Quadri - Alessandra Santarossa
Country: ITALY
Organisation: Azienda Ospedaliera Santa Maria degli Angeli - Pordenone
E-mail: nicola.delliquadri@aopn.fvg.it
Phone: 0039 - 0434399744
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