Foundations in surgical care - Essay Example

? Foundations in Surgical Care Introduction Surgical care is an important aspect of health care. Statistics reveal that over 235 million operations are conducted annually on a global scale. Surgery is performed in various parts of the world and in various settings; rural or urban and for the rich and poor. Surgery is an important aspect in health care as it prolongs longevity in life by correcting various conditions and disabilities. Regardless of this fact, surgery is associated with various complications and death. Therefore, surgical care and its potential complications require noteworthy attention from all stakeholders in the health care sector (NPSA, 2008). The term ‘’intraoperative’’ denotes time that is spent during a surgical procedure. Intraoperative care on the other hand refers to care that is accorded to patients ancillary to an operation and during an operation. Intraoperative care entails various activities and aspects that include; monitoring of the patient’s vital signs (pulse rate, breathing rate, blood pressure and temperature), monitoring of oxygen levels, medication transfusion, fluid therapy, anaethesia, retrieving of laboratory test samples and radiography. Many medical practitioners provide intraoperative care; anaethesiologists, nurses, nurse anaethesists, surgeons, surgical technicians and residents. Therefore, all these work as a team so that the best medical care is accorded to patients and patients’ chances for faster recovery are boosted. This paper describes the WHO Surgical Checklist as an aspect of intraoperative care. The paper also highlights how this aspect of intraoperative care may be enhanced through educational, managerial and health care practice changes so that quality patient care is enhanced in surgical settings. In order to enhance quality patient care before, during and after a surgical procedure, three aspects have to be enhanced; educational aspects, managerial aspects and practice aspects. This is true because, intraoperative practice may be excellent but without the input of the hospital administration, patient care may be compromised. Furthermore, it is important that there is noteworthy planning and implementation so that surgical care accorded to patients is efficient, effective and achieves its required effects (NPSA, 2008). The principal purpose of intraoperative care is to ensure that comfort and safety are both provided to patients during surgical interventions. Goals of the procedure include; maintaining body homeostasis during the procedure, maintenance of sterility during the procedure so that chances of cross-infection are reduced during the procedure, ensuring that the patient being operated upon is secure while on the operating table and taking preventive measures against hematoma formation. Maintenance of homeostasis is one of the most important aspects of intraoperative care as it ensures that body components are not affected during the procedure (Haynes et al, 2008). A lot of blood may be lost during the procedure leading to hypovolaemic shock which may prove difficult to resuscitate. However, intraoperative care should not only be directed towards patients. Members of the operating team may also be affected in many respects during the procedure; hence, care should also be taken to ensure that they are safe during the surgical procedure. All members of the team need to guard themselves from surgical site infections that may result from accidental trauma and inhalation of pathogens in the operating room. As much as surgeons are trying their best to save lives on the operating table, their lives are of utmost importance. WHO Checklist The enhanced complexity of healthcare has led to an increased number of medical errors in surgical practice. About 10% of hospitalized patients in the UK experience safety incidents, but most of these incidents are largely preventable. This represents about 100,000 preventable deaths every year in hospital settings. Statistics have also shown that 1 in 8 British individuals undergo a surgical procedure every year. These surgical interventions normally bring them benefit, but they also subject them to considerable risks which are potentially avoidable (NPSA, 2008). Significant advances have been made on a global scale to reduce surgical risks and promote patient safety. The WHO’s international initiative, World Alliance for Patient Safety has enhanced safety considerations for patients in health care practice. Legislation has also enhanced focus on patient safety in hospital settings. Of highest priority is the establishment of patient safety reporting systems whose aim is to identify errors in medical practice and from this establish countermeasures and strategies. The UK has been in the frontline in advocating for patient safety agenda, and it is also the first nation in the globe to develop a national repository of patient safety affairs. This includes the Research and Learning Service (RLS) database which is operated by the National Patient Safety Agency (NPSA). Currently, the RLS database is the largest patient safety database in the world. Incidents in the database are arranged in a categorical manner. Over 3 million reports have been received by the NPSA, and of all these, about 500, 000 are surgically related (Taylor et al, 2004). The WHO in collaboration with the Harvard School of Public Health recently launched a Surgical Checklist whose aim is to check and combat all forms of surgical errors. The WHO Checklist is a one page document that has three columns outlining basic concepts in intraoperative care. The checklist has identified principal safety steps in intraoperative care which should always be accomplished in any operation no matter the type or surgical setting. The checklist focuses on noteworthy practice before administration of anaethesia, before the surgical incision is made and before the surgical patient is removed from the surgeon’s table (NPSA, 2008). The first column, Before Induction of Anaesthesia represents the sign in section of the document. It has the following aspects a) The surgical team needs to indicate whether the patient has confirmed identity. b) The surgical team indicates the surgical site, procedure to be used and consent for the operation. c) The anaesthesia safety check is completed d) A pulse oximeter is fixed on patient and is checked whether it is functioning e) The surgical team indicates whether patient has known allergies, difficult airway/aspiration risks and risk of more than 500ml blood loss. The second column, Before Skin Incision represents the time out phase of the surgical procedure. It has the following aspects; a) Team members introduce themselves by name and role b) The patient, site of surgery and procedure are all confirmed by the surgeon, anaethesiologist and nurse c) Anticipation of critical events and concerns by the surgical team; surgeon reviews, anaethesiologist reviews and nursing team reviews. d) Indicating whether antibiotic prophylaxis has been given in the last one hour The third column, Before Patient Leaves Operating room represents the sign out phase of intraoperative care. The nurse verbally confirms with the team these aspects; a) Name of procedure b) Whether sponge and needle counts are correct c) How specimen is labeled d) Whether there are any equipment problems that need to be addressed The surgeon, anaethesiologist and nurse review key concerns for recovery and management of the surgical patient Research has shown that use of the WHO surgical checklist during intraoperative care reduces deaths by over 40% and complications from surgery by over one third. Furthermore, the checklist promotes effective and efficient teamwork in the surgical room. The WHO Surgical Checklist has been adopted for use in Wales and England, and this is encouraging since it will enhance patient safety. The National Reporting and Learning Service (NRLS) has adapted the WHO checklist for use in the UK. This document contains core content; however, it is not intended to be comprehensive. It can be adapted and modified to fit local surgical practice or for specific surgeries. Statistics in the UK reveal that in England and Wales, about 130,000 incidents related to surgical specialties were reported to the NRLS in 2007, and of all these, 271 deaths were reported (NPSA, 2008). All health care organizations in the UK are expected to follow the following, concerning the WHO safety checklist; 1) Implement the surgical checklist within organizations fully. 2) Ensure that the checklist is completed for all patients who are undergoing surgical procedures even if it is those under only general anaesthesia. 3) Ensure that the use of the WHO checklist is electronically recorded by a member of the team or indicated in clinical notes. Educational aspects of intraoperative care In order to plan and implement surgical care that is experienced by the patient, the role of education cannot be underestimated. Constant education enlightens all members of the surgical team about the importance and benefits of intraoperative care. From the lowest ranked nurse to the highest ranked surgeon in the surgical team, constant education needs to be emphasized. All members of the surgical team need to be educated about the use of the WHO checklist and its advantages. Education is important as it ensures that every member of the surgical team masters his/her duty well for purposes of efficiency and effectiveness. Newer medical personnel and medical interns need to be thoroughly trained so that they are well versed with intraoperative care. Hospital managements are also encouraged to organize education clinics so that there is enlightenment concerning surgical matters. The difference with good doctors and excellent doctors is that the latter are always ready to learn. Therefore, medical personnel who are part of the intraoperative care need to constantly update their information so that they are more effective in their affairs. There are many more issues that pose challenges to medical personnel during intraoperative procedures; hence, education has become the best remedy because it is through constant education that people gather knowledge about various issues. However, education does not only apply to members of the surgical team, but, also it applies even to patients. Patients need to be educated concerning the surgery they are about to undergo; what they should expect during the day of the surgery and how they will be made ready for the surgery. For example, patients will need to be dressed in hospital attire during the day of the surgery and then they will be given an identification bracelet. Patients also need to be told about intravenous lines which may be fixed in their arms for medicine and anaesthetics administration. Patients will also need to be told about monitors that will have to be placed in their bodies for purposes of monitoring vitals like pulse rate, blood pressure and temperature. These vitals are really important as they monitor body homeostasis and ensure that nom marked derangements in vital signs occur. The patient may also be informed of any changes that may be seen during the operation procedure. Educating the patient about all this becomes important as the patient needs to be told about what will be conducted on their bodies and what to expect. Involving them is, thus, very important, and all members of the surgical team need to make the patient feel at home. This is an important aspect of intraoperative care. Involvement of the patient will ensure that they are cooperative in the exercise. For instance, as part of the requirement of the checklist, patients are expected to give consent, and they are expected to reveal whether they have any known drug allergies or any complications. This assists the surgical team to make adjustments throughout the exercise (Kohn & Corrigan, 1999). Another role of education in enhancing quality care is that, through constant education, members of the surgical team will come up with a local checklist that is flexible for their surgical practice. Members of the surgical team need to compare their own checklists with those in other organizations so that they come up with the best results. The role of managers Managers have an important role to play in organizations so that the WHO checklist usage is enhanced for purposes of enhanced patient care. Managers of organizations are required to ensure that the WHO checklist is implemented strictly within their organizations. Before implementation of the checklist, organizational managers need to ensure that an executive and a clinical lead are identified. Managers of organizations also need to ensure that the WHO checklist is completed for all patients who are undergoing surgical procedures, including those undergoing general anaesthesia. It is the role of an organization’s manager to monitor the surgical team to check whether they are working well as per the regulations of the National Reporting and Learning Service (NRLS) and the World Health Organization. It is also the role of managers of organizations to ensure that the WHO checklist is entered in clinical notes or is entered as electronic records by a registered member of the surgical team. This is important because all completed checklists are supposed to be stored well in a format that can allow for future references. Besides, in case the surgery goes wrong, members of the surgical team will be able to review the checklist so that they identify possible causes of death. This will assist them to make adjustments in future repeats of the same. Managers spearhead an organization’s policies and principles; hence they are key figureheads in ensuring that WHO policies including the surgical checklist are followed to the latter. Therefore, a manager who is not dedicated to his/her work will compromise intraoperative care in terms of implementing all WHO policies and guidelines. Conclusion Introduction of the WHO Surgical Safety Checklist in June, 2008 has brought about an increased improvement in surgical outcomes globally. Complications and deaths resulting from surgery have reduced markedly. The reduction in surgical complications and deaths in the operating room after implementation of the checklist is an indication that the checklist improves safety in surgical patients in various diverse economic and clinical environments. The mechanism of this improvement is multifactorial, and various stakeholders in health care must work together in order to achieve more success. Managers need to ensure that the checklist is implemented and used effectively in their respective institutions. Members of the surgical team are also expected to be competent and dedicated in ensuring that the checklist achieves its desired success in the operating room. Nurses, anaethesiologists, surgeons and their assistants will all need to be fill the checklists on a regular basis so that quality care is improvement. The role of education can also not ne undermined. Medical practitioners need to be educated about the checklist, and then they need to be encouraged to use it in practice. Bibliography Vincent C, Neale G, Woloshynowych M: Adverse events in British hospitals: preliminary retrospective record review. Kohn KT, Corrigan JM, Donaldson MS: To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999. National Patient Safety Agency. UK Surgical Organisations sign up to World Health Organisation Challenge: Safe Surgery Saves Lives [http://www.npsa.nhs.uk/corporate/news/safe- surgery-saves-lives/] Clinton HR, Obama B: Making patient safety the centerpiece of medical liability reform. N Engl J Med 2006, 354(21):2205-8. National Reporting and Learning System (NRLS). Organisation Patient Safety Incident Reports [http:/ / www.npsa.nhs.uk/ nrls/ patient-safety-incident-data/ organisation-reports/ organisation-patient-safety-inciden t-reports/ ] National Patient Safety Agency (NPSA). WHO Surgical Safety Checklist. 2008 [http://www.npsa.nhs.uk/checklist/] Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, et al.: A surgical safety checklist to reduce morbidity and mortality in a global population. 2009 N Engl J Med 2009, 360:491-9. Seiden SC, Barach P: Wrong-side/wrong-site, wrong-procedure, and wrong patient adverse events: Are they preventable? Arch Surg 2006, 141(9):931-9. Taylor JA, Brownstein D, Christakis DA, et al.: Use of incident reports by physicians and nurses to document medical errors in pediatric patients. Pediatrics 2004, 114:729-35. National Patient Safety Agency. Safe Surgery Saves Lives – moving forward [http:/ / www.npsa.nhs.uk/ nrls/ improvingpatientsafety/ anaesthesia-and-surgery/ whos-safer-surgery-checklist/ ] Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa0810119#Background=&t=articleBackground. Retrieved on November 9, 2011 Retrieved from http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59860. Retrieved on November 9, 2011 Read More