"Minimising complications in soft tissue surgery - recent advances" authored by Dr Tim Charlesworth MA, VetMB, Cert SAS (ST), MRCVS, RCVS specialist discusses that although technical skills are obviously extremely important to minimising complications, non-technical skills (NTS) actually account for more complications than lack of technical skills. Non-technical skills, what are these? 1 – Team work.
The "IM SAFE" checklist can be instituted prior to procedures allowing staff to opt ‘out’. IM SAFE is code for Illness, medication, stress, alcohol/drugs, fatigue, eating. Sometimes it is better to wait until the following day for a procedure if this lowers the risk to the patient. I am really proud of our recently instituted morning rounds checklist at VSS. The checklist covers; a) challenges for the day, including any equipment challenges b) how is everyone doing c) are there any announcements. This happens every single day and takes only a few minutes.
2 – Handover.
A high risk period identified, is patient ‘handover’, when patients are being transferred. Handovers need to be formalised using a checklist or form and identify key areas of concern for recovery + what still needs to be done e.g. post-op oxygenation, blood pressure monitoring, drain activation. The presentation of information is important and so is the system known as ‘check-back’. Check-back is a simple system that aims to avoid patient harm due to misheard communication. The receiver repeats the message from the sender who acknowledges it has been heard. This system can completely avoid mis-dosing and misheard instructions. All team members need to be onboard. 3 – Never Events
Events that should never occur (called ‘Never Events’) are events eg. wrong side, wrong patient etc that can be completely avoided with the use of a checklist. Checklists should be designed to take 30 SECONDS! They are typically held at induction, pre-incision and wound closure.
Berenholtz 2004 found that a checklist for a certain procedure (placing a central line) reduced the infection rate from 11% to 0%.
Bergstrom et al 2016 showed a reduction in SSIs after implementation of a checklist into a vet hospital.
There are multiple other examples now in the literature of how checklists can be beneficial.
There is sadly often an element of resistance to change. However, it is the busiest surgeons and general practitioners that will benefit from checklists the most, and a 30 second checklist has been shown to reduce patient morbidity by 30% and mortality by 48%. Team education is key and nurses should be empowered to enforce the checklist.
Charlesworth concluded that although surgeons concentrate on developing their technical skills, most errors that result in patient harm arise from errors of communication and failure of team work.
The above information is from the article "Minimising complications in soft tissue surgery - recent advances" by Dr Tim Charlesworth MA, VetMB, Cert SAS (ST) MRCVS DSAS(ST), RCVS specialist. Thank-you again Dr Charlesworth for allowing me to share this key information.
Comentários