Abstracts
Objective:
To analyze and relate the registration of information and content of checklists with the objectives of the Safe Surgery Saves Lives Program.
Methods:
Documentary study with 257 checklists from orthopedic surgeries performed between 2011 and 2012 in a Brazilian hospital. The 12,629 items related to surgical safety were entered into an Excel spreadsheet and were analyzed using the Statistical Package for the Social Sciences.
Results:
99.8% of the checklist items were checked and the content of the records showed, through documental checks, no guarantee of safety elements relative to the correct surgical site (objective 1), blood loss (objective 4), allergic reaction (objective 5) retention of instruments/compresses (objective 7), identification of surgical specimens (objective 8) and communication (objective 9).
Conclusion:
The high adherence to completing the checklists allowed potential surgical risks arising from unconfirmed safety actions to be identified, requiring actions seeking to qualify the care.
Checklist; Patient Safety; Surgical Procedures, Operative
Objetivo:
Analisar e relacionar o registro de informações e conteúdo dos checklists com os objetivos do Programa Cirurgias Seguras Salvam Vidas.
Métodos:
Pesquisa documental com 257 checklists de cirurgias ortopédicas realizadas de 2011 a 2012 em hospital brasileiro. Os 12.629 itens relativos à segurança cirúrgica alimentaram planilha do programa Excel e foram analisados com auxílio do programa Statistical Package for the Social Sciences.
Resultados:
99,8% dos itens do checklist foram verificados e o teor dos registros evidenciam não garantia, por meio da checagem documental, de elementos de segurança relativos ao local cirúrgico certo (objetivo 1), perdas sanguíneas (objetivo 4), reação alérgica (objetivo 5), retenção de instrumentais/compressas (objetivo 7), identificação de espécimes cirúrgicos (objetivo 8) e comunicação (objetivo 9).
Conclusão:
A alta adesão ao preenchimento do checklist permitiu identificar potenciais riscos cirúrgicos decorrentes de ações de segurança não confirmadas, exigindo ações em busca da qualificação da assistência.
Lista de Checagem; Segurança do Paciente; Procedimentos Cirúrgicos Operatórios
Objetivo:
Analizar y relacionar el registro de informaciones y contenido de checklists, con los objetivos del Programa Cirugías Seguras Salvan Vidas.
Métodos:
Investigación documental con 257 checklists de cirugías ortopédicas realizadas en 2011 y 2012, en hospital brasileño. Los 12.629 ítems de seguridad quirúrgica fueron inseridos en una hoja de cálculo del Programa Excel y analizados en el Programa Statistical Package for the Social Sciences.
Resultados:
El 99,8% de los ítems fueron verificados, pero el contenido de los registros demuestra no garantías, por medio de la comprobación, de elementos de seguridad acerca del local quirúrgico correcto (objetivo 1), perdidas de sangre (objetivo 4), reacción alérgica (objetivo 5), retención de instrumentales/gasas (objetivo 7), identificación de muestras quirúrgicas (objetivo 8) y comunicación (objetivo 9).
Conclusión:
La adhesión al completar el checklist ha permitido identificar potenciales riesgos quirúrgicos resultantes de acciones de seguridad no confirmadas, exigiendo acciones para la calificación de la asistencia.
Palabras-clave:
Lista de Verificación; Seguridad del Paciente; Procedimientos Quirúrgicos Operativos
INTRODUCTION
Deaths by errors or complications from the assistance in health care have contributed to the beginning of a worldwide movement in order to promote patient safety, defined as the reduction to the minimum of the acceptable risk associated to health care11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009..
In the context of care to the surgical patient, global estimate showed that half of
postoperative complications were avoidable22 Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR
et al. An estimation of the global volume of surgery: a modeling strategy based on
available data. Lancet [on line]. 2008 jul;[citado 2014 mar 17];372(9633):[aprox.6
telas]. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/18582931.
http://www.ncbi.nlm.nih.gov/pubmed/18582...
,
highlighting the potential level to prevent damages. In this context, in 2009, the
World Health Organization (WHO) launched the program "Safe Surgeries Save Lives",
which is part of the second Global Patient Safety Challenge. The program includes 10
key objectives presented in Chart 111 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009..
As a strategy to achieve the proposed objectives, the WHO recommends health institutions to use a Checklist to be filled in at three stages or moments: before anesthetic induction, before the surgery and before the patient leaves the operating room.
The instrument aims at checking the items that could compromise patient safety11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009., regardless of the team's memory fallibility.
It strengthens the scan memory and encourages the discipline of high performance33 Gawande A. Check list: como fazer as coisas bem feitas. Rio de Janeiro:
Sextante; 2011.; its application have showed a decrease from
11% to 7% of surgical complications and 1.5 to 0.8% of deaths associated to surgical
procedures44 Haynes AB, Weiser TG, Berry WR. A surgical safety checklist to reduce
morbity and mortality in a global population. N Engl J Med [on line]. 2009;[citado
2013 nov 13];360(5):[aprox.9 telas]. Disponível em:
http://www.nejm.org/doi/full/10.1056/NEJMsa0810119
http://www.nejm.org/doi/full/10.1056/NEJ...
. In Brazil, the Ministry of
Health instituted in 2013, the Safe Surgery Protocol, which calls for the systematic
use of the Checklist55 Agência Nacional de Vigilância Sanitária - ANVISA. Segurança do paciente
Publicações. Protocolos básicos de segurança do paciente. 2013;[citado 2014 fev 24].
Disponível em:
http://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes
http://www20.anvisa.gov.br/segurancadopa...
, and constitutes the
National Program for Patient Safety66 Portaria nº 529, de 1º de abril de 2013. Institui o Programa Nacional de
Segurança do Paciente (PNSP);[citado 2013 set 16]. Disponível em:
http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt0529_01_04_2013.html
http://bvsms.saude.gov.br/bvs/saudelegis...
.
As part of institutional actions to promote quality of care, and following the WHO recommendations11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009., in 2010 a university hospital in the south of Brazil implemented the Checklist, initially in orthopedic surgeries, and adapted it to the reality of the institution. This instrument is distinguished from the model proposed by the WHO11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009. for it includes a verification step during the patient reception at the surgical center, making it a total of four stages.
Orthopedic surgeries involve multiple and bilateral structures, such as arms and
legs, fingers, ribs and vertebrae, and present higher risk of surgical error. Those
can be preventable through the surgical site demarcation prior to surgery77 Motta Filho GR, Silva LFN, Ferracini AM, Bahrc GL. Protocolo de cirurgia
segura da OMS: o grau de conhecimento dos ortopedistas brasileiros. Rev. Bras. Ortop.
[on line]. 2013;[citado em 2014 jun 29];48(6):[aprox.8 telas]. Disponível em:
http://www.scielo.br/scielo.php?pid=S0102-36162013000600554&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S010...
. A study carried out in 2012 with 502 Brazilian
orthopedists showed that 65.3% of them reported partial or total unawareness of the
WHO Program; 72.1% said they had not received training for the application of the
Safe Surgery Protocol, although 63.5% did the site demarcation prior surgery. Only
37.1% of the participants recognized that the protocol is important for the safety of
the patient.
From the principle that situational diagnoses contribute to the process of improvement actions11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009., this study aimed at analyzing the information record and the content of the Checklists, and relate their results with the objectives of the WHO Safe Surgeries Save Lives program11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009..
METHODS
Quantitative approach, documental, held in 2013, at the central operating room of a university hospital in the south of Brazil. Orthopedic surgeries were pioneers as for the use of the Safe Surgery Checklist, which justifies its choice for this research.
Inclusion criteria in this study comprise documents characterized as Checklists related to orthopedic surgeries performed from January 2011 to June 2012, in that surgical center and available in the hospital file. In this period there were three different models at use as checklists in accordance with the modifications made by the institution to the originally adopted model. There was no exclusion criteria, since all checklists, partially or totally filled in were considered.
The variable considered (record of checklist items) refers to the filling, or not, of the instrument items, patient identification, booking of the surgical site, blood supply, allergic patient identification, documentation and communication, among others. Each item to be checked allowed the registration of the answer yes, no and in some cases, not applicable, and indicated the completion of a single alternative.
For data collection a spreadsheet was created in the Microsoft Excel® 2007 version program containing all items to be checked of the three models adopted in the period of this research, and the responses were recorded through number codes established by the researchers. Invalid response was applied when filling was unreadable, double or blurred. Data were checked by double typing and the discrepancies were corrected; the analysis was done using descriptive statistics, using the computer program Statistical Package for Social Sciences, the blue version 20.0. The results, presented in relative and absolute frequencies, were organized according to the steps of checking and associated with the corresponding objectives of the WHO program11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009..
This study was approved under registration CEP/SD 1102.027.11.04 and met the principles of the Ethics Committee.
RESULTS
257 filed checklists were consulted; among the 12,629 items checked, 8.5% (n = 1,071) were not answered. Among the 11,558 (91.5%) responded items, 99.8% (n = 11,537) were understandable and 0.2% (n = 21) were not understandable. The results were related to the objectives of the WHO11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009. program and are presented in accordance to each checking step tables. In table 1, data of the first step of the check list is presented and is related to the reception of the patient to the operating room.
Completion of items related to the reception of the patients to the operating room and to the corresponding objectives of the WHO program "Safe Surgeries Save Lives". Curitiba, from 2011 to 2012
Table 2 presents data from the checking stage carried out before anesthetic induction, with the patient in the operating room.
Completion of items related to the step before induction of anesthesia and corresponding objectives of the Surgery Program Secure Saves Lives WHO. Curitiba, from 2011 to 2012
Table 3 shows the checking of the elements before the surgical incision, also called surgical step or time out.
Completion of items related to the step before surgical incision and corresponding objectives of the WHO program Safe Surgeries Save Lives. Curitiba, from 2011 to 2012
In table 4 items related to the fourth and the final verification step before the patient leaves the operating room are presented.
Completion of items related to the stage before the patient leaves the operating room and corresponding objectives of the WHO program Safe Surgeries Save Lives. Curitiba, from 2011 to 2012
DISCUSSION
In this study 91.5% of the items of the checklists were filled in, 0.2% were invalid,
such result is similar to other studies88 Fourcade A, Blache JL, Grenier C, Bourgain JL, Minvielle E. Barriers to
staff adoption of a surgical safety checklist. BMJ Qual Saf [on line].2011
nov;[citado 2013 nov 20];21(3):[aprox.7 telas]. Disponível em:
http://qualitysafety.bmj.com/content/early/2011/11/07/bmjqs-2011-000094.full/.
http://qualitysafety.bmj.com/content/ear...
,99 Freitas MR, Antunes AG, Lopes BNA, Fernandes FC, Monte LC, Gama ZAS.
Avaliação da adesão ao checklist de cirurgia segura da OMS em
cirurgias urológicas e ginecológicas, em dois hospitais de ensino de Natal, Rio
Grande do Norte, Brasil. Cad. saude publica [on line].2014 jan;[citado 2015 abr
17];30(1):[aprox.12 telas]. Disponível em:
http://www.scielo.br/scielo.php?pid=S0102-311X2014000100137&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S010...
and evidence the
challenge of the adherence to practices of checking and registering elements that are
essential to the safety of the surgical patient.
The lack of completion of the records directs to actions that include reorientation and team motivation, identification and understanding of factors that hinder the full verification, as well as elucidation and discussion of ethical and legal aspects that involve professional performance. The checking items aim at preventing adverse events and ensuring the safety of the surgical patient. They are based on the objectives pre-established by the WHO11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009., which guide the discussion of the results presented in this research.
Considering the first objective11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009., which refers
to guaranteeing that surgeries are performed on the correct patient at the anatomic
site, the results presented emphasize the importance of the conference of patient
identification, since it ranged from 89.1% to 98%. Identifying the patient is an
essential task to ensure that assistance is given to the correct person through the
possibility of switching patients1010 Avelar AFM, Salles CLS, Bohomol E, Feldman LM, Peterlini MAS, Harada
MJCS et al. Cartilha 10 passos para a segurança do paciente. São Paulo: COREN-SP,
REBRAENSP; 2010.. In this
context, the Patient Identification protocol is recommended by the Brazilian Health
Ministry for all institutions that provide health care55 Agência Nacional de Vigilância Sanitária - ANVISA. Segurança do paciente
Publicações. Protocolos básicos de segurança do paciente. 2013;[citado 2014 fev 24].
Disponível em:
http://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes
http://www20.anvisa.gov.br/segurancadopa...
. Besides the patient identification, the surgery at the correct surgical
site is essential once surgeries on correct patients, but wrong surgical site11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009. are evidenced by the WHO as one of the
challenges to be faced.
This study showed that less than 80% of surgical sites were set, allowing adverse
events. In a study carried out in Sweden only 25% (n = 24) of the observed surgeries
had their site previously set by the staff1111 Rydenfält C, Johansson G, Odenrick P, Åkerman K, Larsson PA. Compliance
with the WHO surgical safety checklist: deviations and possible improvements. Int J
Qual Health Care [on line]. 2013;[cited em 2014 jun 28];25(2):[aprox.6 telas].
Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/23335056
http://www.ncbi.nlm.nih.gov/pubmed/23335...
.
The identity of the patient was confirmed in 83% of the opportunities. It is noted
that where the surgical specialties involve double handedness, such as orthopedics,
the possibility of error is even higher.
The confirmation of the patient's identity is also associated with safety in
medication administration, including pain killers. It is evidenced then that the use
of methods in preventing the damage in this context, is one of the check items that
concern to the pre-anesthetic evaluation, gives opportunity to unfavorable conditions
for surgery to be identified beforehand; the surgery should not be performed if there
is any disagreement11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009.,1212 Schwartzman UP, Batista KT, Duarte LTD, Saraiva RA, Fernandes MCBC.
Complicações anestésicas em cirurgia plástica e a importância da consulta
pré-anestésica como instrumento de segurança. Rev. Bras. Cir. Plast. [on line].
2011;[citado 2014 abr 24];26(2):[aprox.o telas]. Disponível em:
http://www.sciencedirect.com/science/article/pii/S0034709414000361
http://www.sciencedirect.com/science/art...
. In this sense, the results of the survey show
that in 88% of the procedures the evaluation was carried out; and validates a study
that highlighted the importance of this evaluation and demonstrated the low incidence
of anesthetic complications after their systematic adoption1212 Schwartzman UP, Batista KT, Duarte LTD, Saraiva RA, Fernandes MCBC.
Complicações anestésicas em cirurgia plástica e a importância da consulta
pré-anestésica como instrumento de segurança. Rev. Bras. Cir. Plast. [on line].
2011;[citado 2014 abr 24];26(2):[aprox.o telas]. Disponível em:
http://www.sciencedirect.com/science/article/pii/S0034709414000361
http://www.sciencedirect.com/science/art...
.
Another safety feature is the verification of the preoperative fasting, linked to the objective 3 which calls for the preparation of staff for air loss or respiratory function. Fasting wasn’t confirmed in all surgeries (96.1%) although it is a key element to ensure gastric emptying, avoiding aspiration, complications due to occlusion of airway11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009..
The reserve of blood and intravenous access, with fluid planning, are items related
to the objective 4 - the preparation of the team for the risk of major blood
loss11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009.. The national protocol for Safe
Surgery calls for a previous discussion by the team on risk of critical events during
the procedure, and recommends a review of surgical planning, with inclusion of
checking the condition of equipment and prediction of fluid replacement and blood
components reserves55 Agência Nacional de Vigilância Sanitária - ANVISA. Segurança do paciente
Publicações. Protocolos básicos de segurança do paciente. 2013;[citado 2014 fev 24].
Disponível em:
http://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes
http://www20.anvisa.gov.br/segurancadopa...
. The survey data show
that in 51.8% of the procedures there was reserve of blood. Researchers emphasize the
importance of blood transfusion in order to maintain hemoglobin levels, blood volume
and favorable clotting factors for a safe surgical procedure1313 Grando JPS, Azevedo EMM, Souza VO, Couto JD. Análise crítica das
indicações de transfusões sanguíneas em cirurgias. Semin., Cienc Biol. Saude [on
line]. 2005;[citado 2014 mai 11];26(1):[aprox.6 telas]. Disponível em:
http://www.uel.br/revistas/uel/index.php/seminabio/article/view/3615
http://www.uel.br/revistas/uel/index.php...
, This item must be contemplated before the operation when the
risk of blood loss is greater than 500 ml in adults, or 1 ml per kilogram of body
weight for children11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009..
Given the objective 5 - the team will avoid the induction of adverse reaction to
drugs or allergic reaction known as a risk to the patient, the results of this
research express checking of 90.6%, similar frequency to another Brazilian study in
2012 that showed that the conference of allergies in 94% of cases99 Freitas MR, Antunes AG, Lopes BNA, Fernandes FC, Monte LC, Gama ZAS.
Avaliação da adesão ao checklist de cirurgia segura da OMS em
cirurgias urológicas e ginecológicas, em dois hospitais de ensino de Natal, Rio
Grande do Norte, Brasil. Cad. saude publica [on line].2014 jan;[citado 2015 abr
17];30(1):[aprox.12 telas]. Disponível em:
http://www.scielo.br/scielo.php?pid=S0102-311X2014000100137&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S010...
. It implies that the items better filled in at
checklist are the ones related to risk of death. Therefore, the previous knowledge of
this condition results in promoting security, prevention of complications and reduced
risk of death11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009..
Another study highlighted that nearly half of the adverse events in hospitalized
patients was preventable, most of them related to surgery and use of medications1414 Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The
incidence and nature of in-hospital adverse events: a systematic review. Qual Saf
Health Care [on line]. 2008 Jun; [cited 2014 fev 05];17(3):[aprox.8 telas].
Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/18519629
http://www.ncbi.nlm.nih.gov/pubmed/18519...
. Thus, investigating the status of the
clinical conditions and the allergic status of the patients, through the proper
evaluation and surgical planning, is an effective measure for the safety of the
patient. As a member of the institutional checklist, the nursing assessment,
performed preoperatively includes such research, and was performed in 89.5% of the
procedures.
In order to minimize the risks of infection of the surgical site, corresponding to
the objective 6, the team should confirm the use of antibiotic prophylaxis in the
60-minute period before the surgical incision55 Agência Nacional de Vigilância Sanitária - ANVISA. Segurança do paciente
Publicações. Protocolos básicos de segurança do paciente. 2013;[citado 2014 fev 24].
Disponível em:
http://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes
http://www20.anvisa.gov.br/segurancadopa...
; This time coincides with the largest therapeutic level of the antibiotic
at the time of tissue exposure to microorganisms11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009.,55 Agência Nacional de Vigilância Sanitária - ANVISA. Segurança do paciente
Publicações. Protocolos básicos de segurança do paciente. 2013;[citado 2014 fev 24].
Disponível em:
http://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes
http://www20.anvisa.gov.br/segurancadopa...
. This study showed
the antibiotic prophylaxis was confirmed in 85.2% of the surgeries. It should be
noted, also, the importance of established protocols to be applied and known by the
teams, since improper use can induce resistance of microorganisms, rather than
provide protection11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009..
The objective 7 refers to checking items before the patient leave the operating room,
to make sure that all materials used were not retained in the operative field,
avoiding damages to patients. The institutional checklist includes counting the
surgical instruments and needles, bandages and gauze; however, checking ranged from
47.9 to 77.4%, which corroborates to a study conducted at the same institution, in
which there was no significant application of checking those items1515 Maziero ECS. Avaliação da implantação do programa cirurgia segura em um
hospital de ensino [dissertação]. Curitiba (PR): Programa de Pós-graduação em
Enfermagem, Universidade Federal do Paraná; 2012.. The inadvertent retention of materials
results in hospitalization, surgery, hospital expenses and even death, stressing the
importance of counting the materials, as well as the adoption of additional measures,
such as taking x-rays when the count is uncertain11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009.,1616 Gümüs M, Kapan M, Önder A, Tekbas G, Baç B. A serious medicolegal
problem after surgery: gossypiboma. Am J Forensic Med Pathol [on line]. 2012; [cited
2014 jul 02];33(1):[aprox. 4 telas]. Disponível em:
http://www.ncbi.nlm.nih.gov/pubmed/21562399
http://www.ncbi.nlm.nih.gov/pubmed/21562...
.
Regarding security and identification of surgical specimens by the team, the
objective 8 of the WHO program, the study noted that 27.6% of the samples were
identified and in 12.1% of the instruments this item wasn't answered. The use of a
system of requisition of tests and identification of samples contribute to the
reduction of error in samples, adverse events and damages to patients, which may
incur a misdiagnosis and delays in treatment11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009.,1717 Kim JK, Dotson B, Thomas S, Nelson KC. Standardized patient
identification and specimen labeling: a retrospective analysis on improving patient
safety. J Am Acad Dermatol [on line]. 2013 jan;[cited 2014 fev 07];68(1):[aprox.4
telas]. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/22841126
http://www.ncbi.nlm.nih.gov/pubmed/22841...
.
In addressing the issue of effective team communication and the exchange of
information for operational security (objective 9), it was observed in this research
a low application to the related items. The presentation of the time immediately
before the surgical incision, along with the review of the surgical plan and of the
possible complications (time out), occurred only in 48.2% of the procedures, similar
to the Swedish study which showed that in 58% of the procedures the staff was
introduced by name and the function1111 Rydenfält C, Johansson G, Odenrick P, Åkerman K, Larsson PA. Compliance
with the WHO surgical safety checklist: deviations and possible improvements. Int J
Qual Health Care [on line]. 2013;[cited em 2014 jun 28];25(2):[aprox.6 telas].
Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/23335056
http://www.ncbi.nlm.nih.gov/pubmed/23335...
. This
measure provides greater familiarity among professionals, sense of personal
empowerment and knowledge of the attributes of each member; at an unexpected
situation it allows greater flexibility in the intervention11 Organização Mundial de Saúde - OMS. Segundo desafio global para a
segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência
Nacional de Vigilância Sanitária; 2009.,1111 Rydenfält C, Johansson G, Odenrick P, Åkerman K, Larsson PA. Compliance
with the WHO surgical safety checklist: deviations and possible improvements. Int J
Qual Health Care [on line]. 2013;[cited em 2014 jun 28];25(2):[aprox.6 telas].
Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/23335056
http://www.ncbi.nlm.nih.gov/pubmed/23335...
.
The tenth and final goal of the WHO program11 Organização Mundial de Saúde - OMS. Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas. Brasília (DF): Agência Nacional de Vigilância Sanitária; 2009. states that hospitals and public health systems should establish routine surveillance of the surgical capacity, volume and results. Documents such as the nursing preoperative evaluation and the pre-anesthetic, anesthetic and surgical description consist an important source of information related to the patient’s welfare and the quality of the services provided. These items were confirmed at 89.5%; 88%; 84.4% and 91.4%, respectively, requiring a greater movement to its filling, since they also consist of documents used in auditing and investigation of aggravation and post-operative death.
The written records contribute to the quality of care and correspond to evaluation
indicators, and in the present context, is an indicator of process and result1818 Donabedian, A. The definition of quality and approaches to its
assessment. Ann Arbor: Health Administration Press; 1980.. In health care institutions in Brazil, the
Patient Safety Center is responsible for the analysis of records of incidents66 Portaria nº 529, de 1º de abril de 2013. Institui o Programa Nacional de
Segurança do Paciente (PNSP);[citado 2013 set 16]. Disponível em:
http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt0529_01_04_2013.html
http://bvsms.saude.gov.br/bvs/saudelegis...
. Documents related to hospital care constitute
the record of relevant information in the chain of investigation of events, including
surgical procedures, infections, surgical errors and occupational exposure to
biological material. Thus, the records subsidize evaluation, revealing the conditions
under which health services are provided and direct them to the safer practices.
The limitations of this study are related to the approach of the local reality and the specific surgical specialty. However, considering that the initiatives of the WHO and the Brazilian Health Ministry may still be considered recent, the results presented, along with other national studies, can contribute to better understand the Brazilian reality in the investigated theme.
CONCLUSIONS
The results of the research allowed us to learn about the frequency of completion and the contents of checklists related to surgical safety in orthopedics. There was a high frequency of items answered reflecting the adoption by the team to the completion of the instrument, applying knowledge of the institutional program. However, the lack of completion of the records shows that safe actions, according to the documents, have been neglected by the surgical team.
The contents of the documents analyzed show that the surgical team failed to ensure, by means of documentary checks, several objectives established by the WHO, notably the security features for the correct surgical site (objective 1), preparation for major blood loss (objective 4), allergic reaction prevention (objective 5) and retention of instruments or swabs (objective 7), and identification of surgical specimens (objective 8), as well as effective communication between staff (objective 9).
The results can support the planning of institutional corrective actions in order to check and record all items of the checklist and thus contribute to the full implementation and excellence of the "Safe Surgeries Save Lives" program in the institution and, most importantly, to develop a professional practice focused on the patient. This study will be able to guide activities aimed at promoting the culture of safety and awareness of health professionals, leaders and managers and patient safety in the operating room; as well as serve as a parameter in relation to completing the checklist for further investigations.
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Publication Dates
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Publication in this collection
Apr-Jun 2015
History
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Received
14 July 2014 -
Accepted
27 Apr 2015