572 / Procedure for safe admission and management of patient in the operating room

ITALY
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Surgical / Invasive procedures
Documentation There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
Errors related to the stage of admission of the patient, management of instrument and principals sterile (textile devices, needles and surgical instruments) are the most prevalent cause of adverse events affecting the patient.
Description of the Patient Safety Practice
 
With a view to improving the organization and implementation of the Recommendation on safety of care in operating rooms, the following activities were standardized. 1. compiling the operating list 2. admission of the patient to the operating room; 3. proper management of surgical instruments; 4. count devices textile and needles; 5. security requirements for the opening and closing of the operating room. For this purpose, has been developed a special check-list whose build process follows the path of the surgical patient. The check-list, together with the card count of surgical instruments and devices textile / needle is an integral part of the medical records of the patient received with the certification function of the transposal Subs-procedure oriented to patient safety operating in the path.The items in the checklist are defined by levels of professional responsibilities.Surgeon preoperatively:• Enter the patient in the operating list and inform he of the date of the intervention • Provide the patient with a correct and complete information for the acquisition of informed consent, which must contain at least the following information:Name of patient; Name and description of the procedure; Surgical site; Reasons for which the surgical procedure is performed (diagnosis or clinics condition); Complications. • Report on the checklist risk class (VTE) VTE deep assigned according to the way they organize their paths surgical and evaluation criteria recommended in the scientific literature • Mark the surgical site in situations characterized by: Laterality intervention; Involvement of multiple structures or multiple levels; Prescribes the pre-operative antibiotic prophylaxis. • Evaluate the possible need of blood transfusion and request consent Anesthesiologist preoperatively • Inform the patient about the type of anesthesia that will be performed and request consent • Ensures a history of allergies (allergies reported). Operator surgeon in the operating room: • Check the presence of informed consent for surgery • Check the correspondence between the indication for surgery reported in the folder and list provided in the operating • Check the correct marking of the side in case of bilateral organ of interest of multiple structures (fingers, multiple lesions) or multiple levels (vertebrae, ribs) • Confirm the patient's identity and the accuracy of the surgical site through the control of radiographic images along with another team member. Anesthetist on Operating Room: Check for informed consent to anesthesia and blood transfusion Nurse, Midwife of the room: • Asks the personal data of the patient and compares the compliance with the indicated in the medical and surgical list • Check the correct preparation of the patient preoperative fasting, shaving, dentures, clothing, jewelry, piercing, hygienic condition and dressing • Apply the neutral electrode and connect electrosurgery in relation to the seat intervention • In preparing the patient on the operating table, put in place preventive measures against injury from positioning • Count out loud, along with nurse / midwife instrumentalist, principals and irons surgical and returns them to use the appropriate forms when updating intervention • Affix the sticker certifying the sterilization process appropriate field in • Check the successful completion of the checklist and report to the surgeon for clearance at the beginning of surgery • Executes hen prescribed, antibiotic prophylaxis. Nurse Midwife instrumentalist: • Check and count surgical instruments, the pieces, balls with gauze, the longish, needles and dictates the number nurse / midwife of the room. • When opening the containers and packages of surgical principals of metal work and a sterility control by checking the color change of the reactive thermal Implementation The check list must be used in all paths operators of hospitals wards and for all types of surgery. We carried out two surveys of the correct compilation of the checklist for the admission of the patient to the operating room. The first data collection provided for the detection of compilations do not conform to the professional respect of 1315 surgical procedures performed from 01/2007 to 07/2007. Results: lack of commitment to the project to reduce surgical risk by all operators, the percentage of non-compliance is significantly higher in the medical (surgeons 91%, anesthesiologists 60%) compared to the welfare (room nurse 23 %, nurses instrumentalist 4%). The second data collection involved the adoption of checklists for surgical operating unit for the second quarter of 2009. Overall 70% of the surgical procedures performed under the emergency, has been accompanied by checklists. TEV risk assessment was performed in only 40% of patients. Failure to adhere to the project, remains higher in the medical area (57% of surgeons, anesthesiologists, 45%) compared to the medical (11% room nurse, nurse instrumentalist 14.5%)
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
No
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
Health care assistants
Pharmacists
Clinical manager
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Not relevant
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/practicesdetail.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.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
Lack of sharing of progress information among involved staff
No motivation among staff
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Yes
Description of used incentives, if any.
.....
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
No
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
Not relevant
Total number of person days required to implement 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 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: EGIDIO SESTI
Country: ITALY
Organisation: ASL ROMA B
E-mail: egidio.sesti@aslromab.it
Phone: 3205796109
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