3 R D N O R D I C C O N F E R E N C E O N R E S E A R C H I N PAT I E N T S A F E T Y A N D Q UA L I T Y I N H E A LT H C A R E Effects of implementing a systematic surgical safety checklist system on morbidity, mortality and length of hospitalisation. A protocol. Anette Storesund, MCCN, PhD student Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway BACKGROUND Adverse events in surgery • AE’s and complications pre, intra, post Griffen et al. (2007), Greenberg et al. (2007) • Adverse events are associated with ↑ mortality (1.0% vs 8.3) and longer hospital stay Wang et al. (2014) 2 3 BACKGROUND Effects of surgical safety checklists’ on morbidity and mortality 3733 BEFORE/ 3955 AFTER Morbidity 11 - 7% (P<0.001) Mortality 1.5 - 0.8% (P=0.003) 3760 BEFORE/3820 AFTER Morbidity 15.4 – 10.6% (P<0.001) Mortality 1.5 - 0.8% (P=0.003) 4 OBJECTIVE Study effects on 30 days’ in-hospital morbidity and mortality and length of stay after implementing a system of individual patient safety checklists in surgery. 5 Identifyer: NCT01872195 6 METHOD Transfer moments Preadmission A0 Pre-admission Surgeon: 10 items Anaesthesiologist: 12 items Nurse: 4 items Planner: 7 items Ward Holding Recovery/ ICU OR Ward Home A1 B C D E Preparation in OR Time out Postoperative instructions Transfer to ward Discharge Operating assistant: 4 items A Ward Ward doctor: 9 items Surgeon: 6 items Anaesthesiologist: 10 items Nurse: 10 items Surgeon, anaesthesiologist, OR assistant: 16 items together Surgeon: 5 items Anaesthesiologist: 4 items Anaesthesiologist: 7 items Ward doctor: 10 items Nurse: 10 items METHOD Checks Preop: Surgeon – Operation site discussed with patient and marked Anaesthesiologist – Allergies registered in patient records Ward nurse – Name tags on both arms Operating theatre: Team check – Patient id, team member introduction, postop instructions Postop: Recovery - Reported on blood pressure, respiration, pain management Ward doctor/nurse - Instructions concerning complications at home, wound care 7 8 DESIGN Stepped wedge trial Brown et al. (2006), Brown et al. (2008) 2013 Ja 2014 F M Ap Ja 2015 F M Gyn & Obs BASELINE OT Neur Thorax INTERVENTION CONTROLS Førde Haug Gyn & Obs = Department of Gynaecology and Obstetrics, OT = Orthopaedical Clinic, Neur = Neurosurgery Department, Thorax = Thoracic Department, Førde = Health Trust Førde, Haug = Health Trust Fonna, Haugesund Baseline: 3700 patients Intervention: 3700 patients Controls: 7400 patients Ap M Ju Jul Au S O N D Ja F M 9 PRELIMINARY RESULTS Compliance Neurosurgery & Orthopaedic % 100 90 80 70 60 50 40 30 20 10 0 Surgeon Anaesthesiologist Ward nurse Recovery nurse 10 DISCUSSION Implementation success factors Early engagement of staff Active leadership and identification of local champions Extensive discussion, education and training Multidisciplinary involvement Ongoing feedback Modifying the Checklist Show how, explain why Conley et al. (2011), de Vries et al. (2012), WHO (2014) DISCUSSION Challenges Electronic programs 11 checklists per patient Nurses (Ward, Theatre nurse, Team check, Recovery, Discharge) Doctors (Ward, Surgeon, Anaesthesiologist, Team check, Discharge) 11 12 SUPERVISORS*, COLLABORATORS *Eirik Søfteland, MD, PhD, Department of Anaesthesia and Intensive Care, Haukeland University Hospital (HUH) *Arvid S. Haugen, RN, MSc, PhD, Department of Anaesthesia and Intensive Care, Haukeland University Hospital (HUH) *Monica W. Nortvedt, RN, Professor, Research Centre for Evidence Based Practice, Bergen University College *Hans Flaatten, MD, Professor, Department of Anaesthesia and Intensive Care, Haukeland University Hospital (HUH) Rupavathana Mahesparan, Jonas M. Fevang, Line Bjørge, Marja Boermeester, Nick Sevdalis, Charles Vincent, Geir Egil Eide, Hanne Klausen, Stig Harthug, Torhild Vedeler, Hilde Valen Wæhle, Rune Haaverstad, Dagny Strand Klausen, Hans-Johan Breidablik, Øyvind Thomassen, Guttorm Brattebø
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