Safer Surgery

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Safer Surgery

• Joan Russell
• Head of Anaesthesia and Surgery NPSA

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Background

• About 234 million operations are done globally
  each year
• A rate of 0.4-0.8 deaths and 3-16 complications
  means that at least 1 million deaths and 7
  million disabling complications occur each year
  worldwide

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Correct site surgery

• Launched in 2005
• Collaboration with Royal College of Surgeons
• Multiprofessional endorsement

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Components of correct site surgery

• Standardisation of pre-op marking
• - To avoid confusion
• Use of a 4 point pre-operative checklist to
  ensure
• - Correct marking in place
• - Correct documents/imaging in place
• - Everything to hand/correct before anaesthesia
• - All team members content before surgery begins

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A standardised approach to marking

• How
• Indelible marker pen visible after skin
  preparation
• Arrow extending to, or near to incision site
• Visible after positioning theatre drapes
• Where involving side or multiple structures (eg
  fingers)
• Who Surgeon or deputy who will be present at
  operation
• With Whom patient, family members, significant
  others
• Where ward or day care area

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Pre-operative checklist
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Size of Problem

• 129,416 incidents relating to surgical
  specialities reported to NRLS
• -1Jan 2007 -31 Jan 2007,

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Size of problem
Total number of incidents returned by categorical
search 1,136
Source NRLS data (ART_C.Clean for incidents with
a value of ExportDt between 1 Jan 2007 and 31
Dec 2007)
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Source NRLS data 1 Jan 2007 31 Dec 2007
Size of problem
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Example of Incident

• Patient was admitted for elective surgery to
  right fossa/buttock area. During preparation for
  surgery the Consultant failed to mark the patient
  and subsequently operated on the left side of
  patient in error. The Consultant discovered this
  error when closing the wound.

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WHOs 10 Objectives for Safe Surgery

• The team will operate on the correct patient at
  the correct site.
• The team will use methods known to prevent harm
  from administration of anaesthetics, while
  protecting the patient from pain.
• The team will recognize and effectively prepare
  for life-threatening loss of airway or
  respiratory function.

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WHOs 10 Objectives for Safe Surgery (cont)

• 4. The team will recognize and effectively
  prepare for risk of high blood loss.
• The team will avoid inducing an allergic or
  adverse drug reaction for which the patient is
  known to be at significant risk.
• The team will consistently use methods known to
  minimize the risk for surgical site infection.
• The team will prevent inadvertent retention of
  instruments or sponges in surgical wounds.

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WHOs 10 Objectives for Safe Surgery (cont)

• 8. The team will secure and accurately identify
  all surgical specimens.
• 9. The team will effectively communicate and
  exchange critical information for the safe
  conduct of the operation.
• 10. Hospitals and public health systems will
  establish routine surveillance of surgical
  capacity, volume and results.

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Safe Surgery Alert

• Current duplication and potential confusion with
  two checklists
• Aim to contextualise WHO surgical safety
  checklist for NHS
• Launch planned for Jan 2009

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NPSA Rapid Responses

• Emergency support in surgical units Dealing with
  haemorrhage (Sep 2007)
• Risks of chest drain insertion (May 2008)

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Avoiding wrong side burr holes / craniotomy

• 15 incidents identified between Jan 2005 and Feb
  2008
• Supported by national audit of neurosurgical
  units - Jan 2008
• Lack of consistency in policies in preoperative
  marking

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Example of Incident

• Whilst performing the Burr Hole the Surgeon was
  informed the patient is consented for the Right
  side and that the procedure was being performed
  on the Left side

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Draft Rapid Response Report

• Standardisation of marking the side of intended
  surgery
• - Side of the forehead of back of the head for
  posterior approaches
• - Undertaken on the ward with imaging, notes and
  patient consent
• - By the surgeon
• Time out in theatre prior to final positioning

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• Joan Russell
• Head of Anaesthesia and Surgery
• 4-8 Maple Street
• London W1T 5HD
• Tel [phone]
• Email joan.russell_at_npsa.nhs.uk
• Website www.npsa.nhs.uk