1 García-París et al. Patient Safety in Surgery (2015) 9:29 DOI /s RESEARCH Open Access Implementation of the WHO Safe Surgery Saves Lives checklist in a podiatric surgery unit in Spain: a single-center retrospective observational study Jaime García-París *, Manuel Coheña-Jiménez, Pedro Montaño-Jiménez and Antonio Córdoba-Fernández Abstract Background: The Surgical Safety Checklist (SSC) is a tool developed by the World Health Alliance for Patient Safety, to assist health professionals in improving patient safety during surgery. Numerous specialties have incorporated this into their clinical practice. The purpose of this study is to adapt and implement this tool within the field of podiatric surgery and to evaluate its impact upon safety standards and post-surgical complications. Methods: An analytical, observational, longitudinal study has been performed retrospectively. The implementation of the Surgical Safety Checklist in podiatric surgery took place over a 10-month period. The sample is made up from the medical histories of patients who were operated on (n = 134) in the University of Seville s podiatric clinic. The sample was divided into three groups: those prior to the implementation process (65 subjects), those after the implementation process: without the SSC (35 subjects) and those with the SSC (34 subjects). The safety standards included in the tool were analysed in conjunction with the results and post-operative complications. Results: An improvement was seen in compliance with the Prophylaxis Protocol and the correct completion of the Informed Consent (p = 0.00), as well as a statistically significant relationship between the correct use of antibiotic prophylaxis and the use of the Surgical Safety Checklist (p = 0.049). The results demonstrate a reduction in the number of post-operative days (p = 0.012). No cases of surgery being performed in the wrong place were found in this study. Conclusions: The Surgical Safety Checklist allows us to improve compliance with the safety protocols recommended by the scientific community, and consequently to reduce the incidence of complications related to surgery and to improve patient safety during elective podiatric surgery. Background Patient Safety has been discussed since the Aristotelian principle primum non nocere but it is still highly relevant today and has gained strength since the creation of the World Alliance for Patient Safety . Finding the cause of adverse events in healthcare and a means of reducing their occurrence is a cause for concern for healthcare professionals and managers. The first publication that highlighted healthcare-related adverse events, and as such, sparked interest in offering safer * Correspondence: Equal contributors Departament of Podiatry, University of Seville, Avicena Street, Seville, Spain healthcare and correctly identifying any adverse events in the sector was the Institute of Medicine s (IOM) 1999 publication To err is human: building a safer health system . This estimated that between 44,000 and 98,000 people die every year as a result of medical errors in the United States. Other studies suggest that the incidence rate is between 2.9 and 16.6 [3 6]. The highest incidence of adverse events is registered in surgical specialities . Given these figures, the World Alliance for Patient Safety outlines specific bi-annual goals. The Surgical Safety Checklist (SSC) has been developed from two projects which they have carried out: Clean Care is Safer Care  and Safe Surgery Saves Lives . It is 2015 García-París et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
2 García-París et al. Patient Safety in Surgery (2015) 9:29 Page 2 of 7 an easy-to-use, measurable set of safety checks, adaptable to different healthcare settings. It is well-known that fatigue, stress and the development of complex procedures reduces the precision and speed of the human memory [9, 10]. These studies demonstrate the utility of checklists as a safe and useful tool to help minimise human error. De Vries  introduced a checklist encompassing a patient s complete medical history. This was later adapted by other authors, including Boscá et al.  for use in interventional radiology, and Perea et al.  to dental surgery. There are few studies related to patient safety in the field of podiatry. Jones y Levy (2012)  refer to the need to improve the educational model for podiatrists in terms of patient safety and in regards to error disclosure to improve professional development. Other publications in the field of podiatry address some patient safety standards, such as those related to antibiotic prophylaxis [15, 16], the incidence of thrombosis-embolism [17, 18], the surgical preparation of the skin [19 21] and the prevention of surgery in the wrong site [22, 23]. To date, the majority of the bibliography refers to isolated cases or short series on which empirical evaluations have been performed. Coheña et al.  are pioneers in this issue in podiatry, having proposed an adapted version of the SSC for podiatric surgery, without results. The purpose of this study is to evaluate the impact of the SSC proposed by Coheña et al. in regards to safety standard compliance and the reduction of surgical complications in podiatric surgery. Methods Setting Based on the SSC implementation guide in the Safe Surgery Saves Lives  programme, in order to implement the SSC in podiatric surgery there are 10 phases, these are identified in the Gantt chart, where each activity is recorded together with the time required for their implementation, (Table 1 Implementation phases). This process took ten months and took place in the Podiatric Clinic at the University of Seville (ACP). Around 150 surgical podiatric procedures are carried out at this centre on an out-patient basis, from nail surgery to osteoarticular surgery with orthopaedic fixation devices under local anaesthetic. As a new tool in the field of podiatry and as recommended by other authors [25 27], an intensive training programme was undertaken during the implementation process before any data was collected. This programme included the development of a handbook, briefings and practical workshops. Evaluation focused on identifying changes that occurred in patients as a result of using the SSC, comparing the three groups which the sample had been divided Table 1 Implementation phases Phases 1. Need for implementation and creation of a working group 2. Definition of purpose of the checklist and the bibliographic review Process - Identification of the problem and precision of the verification checklist as a solution - Creation of a team that will develop the implementation. - Identification of the people to whom the checklist is performed and the type of activity to which this tool is aim to be related to. 3. Analysis of the situation - Observation of the context where the implementation will be developed. -Evaluation of the strengths and weaknesses. 4. Elaboration of an activity checklist 5. Design of the verification checklist - Creation of a sequential list of the actions that are being performed and on which interventions are required. - Creation of a preliminary format with the help of an activity list. 6. Revision of the checklist - Periodic review of the checklist with members of the team and participants of the implementation. 7. Proof of the functionality of the verification checklist - A small-scale evaluation of the checklist. - Training for professionals. - Analyses of the experience through the direct observation or questionnaires 8. Approval of the checklist - Performs of the necessary modifications. 9. Training for professionals - Training through workshops, talks, live simulations. 10. Regular re-assessment of the checklist - Analyses of changes on the context of functioning - Performs of readjustments according to the changes in the situation. The process of implementation lasts 10 months and it has 10 different phases into: the pre-implementation group/the group without the SSC and the group with the SSC. A retrospective quantitative review was made from certain documents from the medical histories as an indicator of the level of compliance to the safety standards established by the WHO. Following the same protocol as this study, the researchers are Doctors in Podiatry and experts in management and quality of care. Study design This analytical, observational and longitudinal study was retrospectively evaluated. Simple random sampling was used and the sample size calculated using a formula where n is the sample size, N
3 García-París et al. Patient Safety in Surgery (2015) 9:29 Page 3 of 7 The sample consisted of 134 patients, divided into the previously described groups. (Fig. 1 Distribution of study groups). The main variable is the degree of patient safety during surgery, in relation to compliance with the SSCdefined safety standards. Independent variables are shown in Table 2. (Table 2 Definition of the independent variables). Fig. 1 Distribution of study groups. Retrospective group 65 subjects; Without SSC group 35 subjects; With SSC group 34 subjects is the population size, Z is 0.05 y p is the reference variable. n ¼ N Z 2 p q d 2 ðn 1ÞþZ 2 p q Results The average age of the sample group was years old, with a standard deviation of In terms of gender, 73.9 % were female and 26.1 % male. In regards to the Surgical Risk Calculation, 51.5 % of patients were classed as ASA I, 47 % were classed as ASA 2 and only 1.5 % as ASA 3. In terms of the type of surgery carried out, the highest percentage involved nail/skin surgery (66.4 %), followed by osteoarticular surgeries with implants (23.1 %) and osteoarticular surgeries without implants (10.4 %). Correct compliance with the deep venous thromboembolic prophylaxis protocol (DVTPP) Through the use of Pearson s Chi-square Test, p = 0 (>0.05) a significant relationship is observed between the WITH checklist group and the correct practice of DVTPP. (Table 3A-B Comparison chart: Correct compliance with the DVTPP risk assessment and Chi-square test). The protocol was proposed by Autar R.  and was incorporated into podiatric surgical care at the ACP. Table 2 Description of the independent variables Independent variables Surgeon Sociodemographic variable American Society of Anesthesiologists (ASA) Type of surgery Fulfillment of the Informed Consent Identification of the surgical site Fulfillment of the DVT Prophylaxis Protocol (DVTPP) Correct use of the antibiotic prophylaxis Infection of the surgical site Postoperative days Definition Professional that performs the surgery. This includes the age and the gender. The surgical risk that a patient can experiment according to the measuring scale of the American Society of Anesthesiologists. The ordinal scale from ASA I to ASA V. Osteoarticular surgeries with or without implants and nails or skin surgery. It measures the correct fulfillment of the informed consent, codified in complete, incomplete or nonexistent. It measures the correct identification of the anatomical site where the surgical procedure is going to be performed in the medical history. When the identification is correct, it is codified with a YES, or NO when it is incorrect. The reasons of a NO codification can be an inconsistency of the identification of the surgical site between the documents, or the anatomical site of the operation is not identified, or a surgery has been performed in the wrong site. This is applied to patients undergoing surgery and assesses the risk of a thromboembolism. On the other hand, it measures the level of compliance of the protocol. A Secure codification is given to the patient when the assessment page of DVTPP risk is completed, when a DVT prophylaxis is required or when the assessment is completed and the patient does not require it or prophylaxis is not established as a treatment. The rest of the variations are considered insecure practices. Antibiotic prophylaxis is require when the patient presents 3 or more risk factors ( 65 years, Diabetes Mellitus, malnutrition, obesity, ASA 3, smoking habits, coexistence of the infection in other locations, immunosuppression and radiotherapy treatment) in the cases of surgery with osteosynthesis materials. It is considered a secure practice when the subjects require antibiotic prophylaxis and it is established as a treatment; or when, on the contrary, the antibiotic prophylaxis is not required or established. This happens when clear signs of infection are described in the medical history (such as pain, swelling, suppuration, erythema, redness) or when a local or oral antibiotic is prescribed during the postsurgical process. From the days of the operation till the date of discharge.
4 García-París et al. Patient Safety in Surgery (2015) 9:29 Page 4 of 7 Table 3 Comparison chart Correct Fulfillment of the DVTPP risk assessment A. DVTPP Assessment Secure Insecure Types of data With SSC Recount 28 6 % in the DVTPP security 47.5 % 8.0 % Revised residues Without SSC Recoaunt % in the DVTPP security 28.8 % 24.0 % Revised residues Retrospective Recount % in the DVTPP security 23.7 % 68.0& Revised residues B. Chi-square test Value gl Sig. Asymptotic (bilateral) Pearson chi-square Number of valid cases 134 A significant relation has been observed between the group WITH checklist and the secure practice of the DVTPP assessment (>0.05) The results of this study demonstrate that the SSC helps to improve compliance with the DVTPP. Truran , in his pre-post SSC implementation study, compares the compliance rates with the DVTPP, noting that non-compliance fell from 6.9 % to 2.1 %. This study found that the non-compliance rate was 68 % in the period prior to the implementation of the SSC, a figure that decreased to 24 % in the without SSC group and to 8 % in the with SSC group. It could be argued that this difference is due to the increased awareness of patient safety after the implementation period. The high levels of non-compliance found during this study in comparison to that of other studies could be explained by a failure to adhere to the protocol. This is likely because cases of thromboembolic complications in podiatric surgery are much fewer than in general surgery where these types of complications are common and stricter protocols exist. Table 4 Correlation between the use of SSC and correct use of the Antibiotic prophylaxis A. Antibiotic prophylaxis Required, established treatment Required, not established treatment Not required, but established treatment Not required and not established treatment Types of data With SSC Recount % in the antibiotic prophylaxis 36,6 % 4,3 % 37,5 % 24,2 % Revised residues 2,0 2,5,8 -,3 Without SSC Recount % in the antibiotic prophylaxis 14,6 % 30,4 % 12,5 % 33,9 % Revised residues 2,0,5 -,9 1,9 Retrospective Recount % in the antibiotic prophylaxis 48,8 % 65,2 % 50,0 % 41,9 % Revised residues,0 1,8,1 1,4 B. Chi-square test Value gl Sig. Asymptotic (bilateral) Pearson chi-square 12, Number of valid cases 134
5 García-París et al. Patient Safety in Surgery (2015) 9:29 Page 5 of 7 Table 5 Comparative analyses of data about infection on the surgical site Authors Retrospective Without SSC With SSC Present Study 9.2 % 4.6 % 1.5 % Bliss et al.  3.4 % 2.8 % 1.4 % Tillman et al.  1.7 % % Haynes et al.  6.2 % % Correct antibiotic prophylaxis pratice Antibiotic prophylaxis is a controversial issue among health professionals, including podiatrists; nonetheless, the correct use of antibiotic prophylaxis reduces the risk of post-surgical complications, offering patients health benefits and an increased quality of care, as well as having financial repercussions . This study makes use of the recommendations made by Córdoba et al.  and Mosquera et al.  in their reviews as a means of assessing the usefulness of antibiotic prophylaxis. The results of this study demonstrate a significant relationship between the use of the SSC and the correct usage of antibiotic prophylaxis (p = 0.049). (Table 4 Correlation between the use of the SSC and correct use of antibiotic prophylaxis). Similarly, other authors  also note a significant improvement in the correct usage of antibiotic prophylaxis (57 % in the period prior to the SSC and 77 % in the period post). Rydenfält  observed that the standard associated with antibiotic prophylaxis in the SSC was one of the easiest to comply with. Surgical site infection rate De Vries  and Tillman  indicate that surgical site infection is the most frequent postsurgical complication and one with the highest impact upon the health/illness process of the patient, satisfaction levels and healthcare spending. According to Butterworth  and Zgonis  an infection rate of between 0.5 and 6.5 % is accepted as normal in elective foot-ankle surgery amongst podiatric surgeons. This study found a much higher total surgical site infection rate (15.3 %) than that accepted as normal by these authors. This can be explained by the teaching nature of the centre where this study was undertaken and the inherent bias of the medical histories involved. In the Table 5 (Table 5 Comparative analyses of data on surgical site infection) shows the comparative figures between this study and the research of Bliss , Tillman  and Haynes . A reduction in the surgical site infection rates between the different groups are observed, reflecting lower infection rates in the groups where the SSC was used. Furthermore, a significant relationship is observed between the reduction in surgical site infection rate and antibiotic prophylaxis (p = 0.019) (Table 6 A-B Relationship between surgical site infection and the correct usage of antibiotic prophylaxis). This is something which leads us to believe that an indirect correlation exists between the use of the SSC and the reduction in the surgical site infection rate. Correct completion of informed consent Numerous authors [39, 40] highlight the importance of patient-surgeon communication and consider the inclusion of the patient in their treatment the fundamental premise of healthcare. The informed consent form is a scientifically endorsed tool available to evaluate this relationship. Yet, in clinical practice is not always employed correctly, impacting upon communication, safety and affording the patient a grounds for claim . Table 6 Relationship between Surgical site infecion and the secure use of the antibiotic prophylaxis A. Antibiotic prophylaxis security Secure Insecure Surgical site Infection Yes Recount 11 9 % in the Antibiotic prophylaxis security 11,0 % 29,0 % Revised residues 2,4 2,4 No Recount % in the Antibiotic prophylaxis security 89,0 % 71,0 % Revised residues 2,4 2,4 B. Chi-square Pearson test and Fisher s exact stadistical test Value gl Sig. Asymptotic (bilateral) Sig. Exact (bilateral) Sig. Exact (Unilateral) Pearson chi-square Fisher s exact statistical test Number of valid cases 134 (When it use the antibiotic prophylaxis security correctment, the surgical site infection decrease to stadistical significative way)
6 García-París et al. Patient Safety in Surgery (2015) 9:29 Page 6 of 7 The results of this study demonstrate a connection between the use of the SSC and higher levels of compliance and completion of the informed consent in the surgical process. De Vries  analysed 294 complaints made to Dutch health professionals, he indicated that 100 % of the 23 complaints registered in relation to the informed consent could have been avoided through the use of the SSC. Indeed, Cavallini , through incorporating the SSC into the quality programme at the centre where his study was undertaken, increase the informed consent completion rate to %. Number of post-operative days The Kruskal-Wallis test for independent samples was used to associate the post-operative days independent variable to the study s different groups, establishing a significance level of This study found a significant relationship between the use of the SSC and the reduction of post-operative days, as is shown in Fig. 2 (Fig. 2 Comparative graphic on the number of postsurgical days) and Table 7 (Table 7 Statistical data on number of postoperative days). This result confirms that the SSC affords the surgical team a visual and verbal reminder of the recommended safety measures, thereby reducing reliance on memory and improving compliance with basic safety standards [32, 39 43], consequently reducing the post-surgical period. A retrospective analysis of medical histories was used in this study. The quality of the data collected was dependent upon the quality of the documentation in the medical and legal records. Given that compiled data may not directly reflect clinical practice, and therefore, as Panesar et al.  suggests, an infra-supra register might exist, Soria-Aledo  acknowledged this as a limitation in their studies. This study was able to minimise the With SSC group postoperative days Table 7 Statistical data to number of postoperative days With SSC- Retrospective Statistical test Standard error Deviation Statistic test Sign Hawthorne effect by dividing the sample into three groups, as has been described by various authors [29, 46]. Conclusions Just as the attitude and motivation of professionals can change, so can clinical practice. It is therefore necessary to establish a monitoring process for the SSC, performing audits and re-editing where necessary in order to make it more efficient and effective for professionals. Significant improvements have been seen in the utilization of patient safety protocols such as the DVTPP and antibiotic prophylaxis, as well as a reduction in post-operative days. These changes improve, both directly and indirectly overall patient safety, reducing surgical complications such as surgical site infections. After analysing all of the tests used to evaluate the SSC implementation process in podiatric surgery, we believe the study s objectives have been fulfilled and confirm that the SSC is a useful and effective tool in the improvement of patient safety. We believe that further studies, over longer timeframes and in other podiatric surgical centres are necessary in order to gather further scientific evidence. Ethical considerations This investigation project meets with the approval and acceptance of the Ethical Committee of Experimenting of the University of Seville to investigate with human subjects and it adjusts to the current regulations in Spain and the European Union. To finish, informed consent was obtained of each participant after being completely informed before their participation in this study. Abbreviations WHO: World Health Organization; SSC: Surgical Safety Checklist; ASA: American Society of Anesthesiologists; IC: Informed Consent; DVTPP: Deep Venus Tromboembolic Prophylaxis Protocol. Adjoining sign The use of SSC decrease the postoperative days statistically significant (0,012) Competing interests The authors declare that they have no competing interests. Without SSC group postoperative days Retrospective group postoperative days Fig. 2 Comparative graphic on the number of postsurgical days. A with SSC in comparison with without SSC and Retrospective Authors contributions JGP, MCJ, and PMJ developed the study design. JGP and MCJ were responsible for the data collection. PMJ and ACF conducted the data analysis. JGP wrote the manuscript, with contributions from MCJ and ACF. All authors approved the final manuscript. Acknowledgements Thanks to all the professionals working in the Podiatric clinical area of the University of Seville for their dedication and full readiness.
7 García-París et al. Patient Safety in Surgery (2015) 9:29 Page 7 of 7 Received: 24 May 2015 Accepted: 10 August 2015 References 1. Guidelines for Safe Surgery. World Health Organization. 1st ed Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press; Aranaz J, Aibar C, Vitaller J, Mira J, Orozco D. Estudio APEAS: estudio sobre la seguridad de los pacientes en Atención Primaria de Salud. Madrid: Ministerio de Sanidad y Consumo 2008; Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. Br Med J. 2001;322: Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000;38: Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in Australian health care study. Med J Aust. 1995;163: Ministerio de Sanidad y Consumo. Estudio nacional sobre los efectos adversos ligados a la hospitalización Pittet D, Allegranzi B, Boyce J. The World Health Organization guidelines on hand hygiene in healthcare and their consensus recommendations. Infect Control Hosp Epidemiol. 2009;30: Lorist MM, Boksem MA, Ridderinkhof KR. Impaired cognitive control and reduced cingulate activity during mental fatigue. Cogn Brain Res. 2005;24: Miller G. The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psychol Rev. 1956;63: De Vries E, Dijkstra L, Smorenburg SM, Meijer RP, Boermeester MA. The Surgical patient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis. Patient Saf Surg. 2010; Boscá-Mayans MR, Arana E, Sánchez-Aparisi E. Diseño de una lista de verificación para radiología intervencionista. Enferm Clin. 2012;22: Perea B, Santiago A, García F, Labajo E. Proposal for a surgical checklist for ambulatory oral surgery. Int J Oral Maxillofac Surg. 2011;40: Jones LJ, Levy LA. An Educational Model for Patient Safety and Disclosure of Medical Error in Podiatric Medicine. J Am Podiatr Med Assoc. 2012;102: Córdoba A, Ruiz G, Canca A. Algorithm for the management of antibiotic prophylaxis in onychocryptosis surgery. Foot. 2010;20: Fernández AM, Rey VS, Carrodeguas MV, Castro RG. Profilaxis antibiótica perioperatoria. Rev Int de Cien Pod. 2013;7: Lim W, Wu C. Balancing the risks and benefits of thromboprophylaxis in patients undergoing podiatric surgery. Chest. 2009;135: Felcher AH, Mularski RA, Mosen DM, Kimes TM, De Loughery TG, Laxson SE. Incidence and risk factors for venous thromboembolic disease in podiatric surgery. Chest. 2009;135: Becerro De Bengoa R, Losa ME, Cervera LA, Fernández DS, Prieto JP. Efficacy of intraoperative surgical irrigation with polihexanide and nitrofurazone in reducing bacterial load after nail removal surgery. J Am Acad Dermatol. 2011;64: Becerro de Bengoa R, Losa ME, Cervera LA, Fernández DS, Prieto J. Preoperative skin and nail preparation of the foot: Comparison of the efficacy of 4 different methods in reducing bacterial load. J Am Acad Dermatol. 2009;61: Ostrander RV, Botte MJ, Brage ME. Efficacy of surgical preparation solutions in foot and ankle surgery. J Bone Joint Surg. 2005;87: Beckingsale TB, Greiss ME. Getting off on the wrong foot: Doctor patient miscommunication: A risk for wrong site surgery. Foot Ankle Surg. 2011;17: Schweitzer KM, Brimmo O, May R, Parekh SG. Incidence of wrong-site surgery among foot and ankle surgeons. Foot Ankle Spec. 2011;4: Coheña M, García J, Córdoba A, Juárez J, Montaño P. Proposal of a Surgical Security Checklist in Podiatric Surgery. Clin Res Foot Ankle. 2014; Nilsson L, Lindberget O, Gupta A, Vegfors M. Implementing a pre operative checklist to increase patient safety: a 1 year follow up of personnel attitudes. Acta Anaesthesiol Scand. 2010;54: Martínez O, Gutiérrez S, Liévano SA. Propuesta para implantar una Lista de Verificación de Seguridad en procedimientos invasivos y quirófano. Rev CONAMED. 2011;16: Hawkins RB, Levy SM, Zhao JY, Doody KA, Lally KP, Kao LS, et al. Assesment of the implementation of a Surgical preoperative checklist. J Surg Res. 2012;172: Autar R. The management of deep vein thrombosis: the Autar DVT risk assessment scale re-visited. J Orth Nurs. 2003;7: Truran P, Critchley RJ, Gilliam A. Does using the WHO surgical checklist improve compliance to venous thromboembolism prophylaxis guidelines? Surgeon. 2011;9: Sewell M, Adebibe M, Jayakumar P, Jowett C, Kong K, Vemulapalli K, et al. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. Int Orthop. 2011;35: Vats A, Vincent CA, Nagpal KR, Davies W, Darzi A, Moorthy K. Practical challenges of introducing WHO surgical checklist: UK pilot experience. BMJ. 2010; 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. 2013;25: Winters BD, Gurses AP, Lehmann H, Sexton JB, Rampersad CJ, Pronovost PJ. Clinical review: checklists-translating evidence into practice. Crit Care. 2009;13: Lyons VE, Popejoy LL. Meta-Analysis of Surgical Safety Checklist Effects on Teamwork, Communication, Morbidity, Mortality, and Safety. West J Nurs Res. 2013;36: Wachter RM, Shojania KG, Duncan BW. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evid Rep Technol Assess De Vries EN, Eikens MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA. Prevention of Surgical Malpractice Claims by Use of a Surgical Safety Checklist. Ann Surg. 2011;253: Cavallini GM, Campi L, De Maria M, Forlini M. Clinical risk management in eyeout patient surgery: a new surgical safety checklist for cataract surgery and intravitreal anti-vegf injection. Graefes Arch Clin Exp Ophthalmol. 2013;251: De Vries EN, Prins HA, Crolla RMPH, Den Outer AJ, Van Andel G, Van Helden SH, et al. Effect of a Comprehensive Surgical Safety System on Patient Outcomes. N Engl J Med. 2010;363: Tillman M, Wehbe-Janek H, Hodges B, Smythe WR, Papaconstantinou HT. Surgical care improvement project and surgical site infections: can integration in the surgical safety checklist improve quality performance and clinical outcomes? J Surg Res. 2013;184: Butterworth P, Gilheany MFA, Tinley P. Postoperative infection rates in foot and ankle surgery: a clinical audit of Australian podiatric surgeons. Aust Health Rev. 2010;34: Zgonis T, Jolly GP, Garbalosa JC. The efficacy of prophylactic intravenous antibiotics in elective foot and ankle surgery. J Foot Ankle Surg. 2004;43: Bliss LA, Ross-Richardson CB, Sanzari LJ, Shapiro DS, Lukianoff AE, Bernstein BA, et al. Thirty-Day Outcomes Support Implementation of a Surgical Safety Checklist. J Am Coll Surg. 2012;215: Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AS, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360: Panesar SS, Noble DJ, Mirza SB, Patel B, Mann B, Emerton M, et al. Can the surgical checklist reduce the risk of wrong site surgery in orthopaedics?-can the checklist help? Supporting evidence from analysis of a national patient incident reporting system. J Orthop Surg Res. 2011;6: Soria-Aledo V, Andre Da Silva Z, Saturno PJ, Grau-Polan M, Carrillo-Alcaraz A. Dificultades en la implantación del checklist en los quirófanos de cirugía. Cir Esp. 2012;90: Van Klei W, Hoff R, Van Aarnhem E, Simmermacher R, Regli L, Kappen T, et al. Effects of the introduction of the WHO Surgical Safety Checklist on in-hospital mortality: a cohort study. Ann Surg. 2012;255:44 9.
Translating Evidence to Safer Care Patient Safety Research Introductory Course Session 7 Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg
UNILATERAL VS. BILATERAL FIRST RAY SURGERY: A PROSPECTIVE STUDY OF 186 CONSECUTIVE CASES COMPLICATIONS, PATIENT SATISFACTION, AND COST TO SOCIETY Robert Fridman DPM, Jarrett Cain DPM, Lowell Weil Jr. DPM,
BIBLIOGRAPHICAL REVIEW ON COST OF PATIENT SAFETY FAILINGS IN ADMINISTRATION OF DRUGS. SUMMARY. Bibliographical review on cost of Patient Safety Failings in administration of drugs. Summary This has been
Last Updated: Version 4.3b NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Information Form CMS/The Joint Commission: Suspended (Effective immediately beginning with July 1, 2014 discharges)
Dr NG FU YUEN Associate Consultant Department of Orthopaedics and Traumatology Queen Mary Hospital Aging Population in Hong Kong Life Expectancy Female 86 Male 81 Figure from Census and Statistics Department,
BIBLIOGRAPHICAL REVIEW ON COST OF PATIENT SAFETY FAILINGS IN NOSOCOMIAL INFECTIONS. SUMMARY. Bibliographical review on cost of Patient Safety Failings in nosocomial s. Summary This study has been conducted
Orthopaedic Surgery Ankle Fractures The Department of Orthopaedics offers specialist medical and surgical treatments on musculoskeletal disorders, joint replacements, foot and ankle disorders, among other
FACTORS ASSOCIATED WITH ADVERSE EVENTS IN MAJOR ELECTIVE SPINE, KNEE, AND HIP INPATIENT ORTHOPAEDIC SURGERY Dov B. Millstone, Anthony V. Perruccio, Elizabeth M. Badley, Y. Raja Rampersaud Dalla Lana School
Risk Management and Patient Safety Evolution and Progress Madrid February 2005 Charles Vincent Professor of Clinical Safety Research Department of Surgical Oncology & Technology Imperial College London
Quality of care series Number 1: Medical error Extract from Addressing global patients safety issues. An advocacy toolkit for patient organisations. International Alliance of Patient Organizations. 2008.
Position Statement: The Use of VTED Prophylaxis in Foot and Ankle Surgery Position Statement There is currently insufficient data for the (AOFAS) to recommend for or against routine VTED prophylaxis for
Medication Reconciliation Transfer of medication information across settings keeping it free from error. By Jane H. Barnsteiner, PhD, RN, FAAN Medication error is the most common type of error affecting
C HAPTER 4 O RAL AND M AXILLOFACIAL S URGERY I. TREATMENT PLANNING GUIDELINES As part of informed consent, the clinician should carefully explain the risks and benefits of oral and maxillofacial surgery
Available online at www.jbr-pub.org Open Access at PubMed Central The Journal of Biomedical Research, 2014, 000(000):000-000 Research Paper Intraoperative patient information handover between anesthesia
Claim#:021914-174 Initials: J.T. Last4SSN: 6996 DOB: 5/3/1970 Crime Date: 4/30/2013 Status: Claim is currently under review. Decision expected within 7 days Claim#:041715-334 Initials: M.S. Last4SSN: 2957
AORN Position Statement on One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure POSITION STATEMENT The goal of perioperative nursing
Journal of Pharmacy and Pharmacology 3 (2015) 33-38 doi: 10.17265/2328-2150/2015.01.005 D DAVID PUBLISHING Evaluation of Glycemic Control with a Pharmacist-Managed Post-Cardiothoracic Surgery Insulin Protocol
DOI 10.1186/s40064-015-1505-6 RESEARCH Open Access Do general practitioners prescribe more antimicrobials when the weekend comes? Meera Tandan 1*, Sinead Duane 1 and Akke Vellinga 1,2 Abstract Inappropriate
MN Community Measurement Total Knee Replacement Impact and Recommendation Document June 2010 Degree of Impact Relevance to Consumers, Employers and Payers Annually there are over 500,000 total knee replacement
National Clinical Programme in Surgery (NCPS) Care Pathway for the Management of Day Case Consultant Surgeon DRAFT VERSION 0.5 090415 Table of Contents 1.0 Purpose... 3 2.0 Scope... 3 3.0 Responsibility...
Investigating the prevention of hospitalacquired infection through standardized teaching ward rounds in clinical nursing R. Zhang The Nursing Department, An tu Hospital, Shanghai, China Corresponding author:
Lives Lost, Lives Saved: A Comparative Analysis of Avoidable Deaths at Hospitals Graded by The Leapfrog Group April 2016 by Matt Austin, Ph.D. Jordan Derk, M.P.H. Armstrong Institute for Patient Safety
Errors in the Operating Room Patrick E. Voight RN BSN MSA CNOR President Association of perioperative Registered Nurses (AORN) What What We All We Strive All Strive For: For: Patient Patient Safety Safety
, pp.156-163 http://dx.doi.org/10.14257/astl.2015.104.34 Perception of Safety Attitude and Priority and Progress of Safe Practices of Nurses in Emergency Services Hospitals Sung Jung Hong 1 1 Department
Patient Safety Curriculum Florida State University College of Medicine Dennis Tsilimingras, M.D., M.P.H. Director, Center on Patient Safety Assistant Professor of Family Medicine and Rural Health Florida
September 12, 2011 Janet M. Corrigan, PhD, MBA President and Chief Executive Officer National Quality Forum 601 13th Street, NW Suite 500 North Washington, D.C. 20005 Re: Measure Applications Partnership
Mascherek et al. Patient Safety in Surgery 2013, 7:36 RESEARCH Open Access Frequency of use and knowledge of the WHO-surgical checklist in Swiss hospitals: a cross-sectional online survey Anna C Mascherek
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
Surgical Care Improvement Project: A Valuable Initiative in Surgery R. Taylor Ripley January 23, 2012 Learning by presenting errors at a morbidity and mortality conference is a part of which of the following
Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based
Patient outcomes following Akin osteotomy using staple fixation 2015 AOFAS Annual Meeting Long Beach, CA July 2015 Duke Orthopaedic Surgery Julie A Neumann, MD Kathleen D Reay, MD Kendall E Bradley, MS
Principles of Systematic Review: Focus on Alcoholism Treatment Manit Srisurapanont, M.D. Professor of Psychiatry Department of Psychiatry, Faculty of Medicine, Chiang Mai University For Symposium 1A: Systematic
EDUCATIONAL PLANNING TOOL: Designing a Continuing Medical Education (CME) Activity This planning tool has been designed to lead you through the educational planning process and facilitate the collection
A clinical guideline recommended for use In: By: For: Key words: Department of Orthopaedics, NNUHT Medical staff Trauma & Orthopaedic Inpatients Deep vein thrombosis, Thromboprophylaxis, Orthopaedic Surgery
Journal of Orthopaedic Surgery 2003: 11(2): 166 173 Clinical pathways in total knee arthroplasty: A New Zealand experience JM Pennington, DPG Jones, S McIntyre Department of Orthopaedic Surgery, Dunedin
Mitigating Surgical Medical Malpractice Exposure in Ambulatory Surgery Centers Making Your Ambulatory Surgery Center a Healthcare SafetyZone Even though Ambulatory Surgery Centers (ASCs) have been around
Strategies and Tools to Enhance Performance and Patient Safety Ice Breaker Mod 1 05.2 06.2 Page 2 2 Do No Harm Jess Story Do no Harm Jess' Story Mod 1 05.2 06.2 Page 3 3 Medical Error Have you been affected
1 FEMORAL NECK FRACTURE FOLLOWING TOTAL KNEE REPLACEMENT László Sólyom ( ), András Vajda & József Lakatos Orthopaedic Department, Semmelweis University, Medical Faculty, Budapest, Hungary Correspondence:
Knowledge of diabetes mellitus amongst nursing students Effect of an intervention Sukhpal Kaur, Indarjit Walia Abstract : Nurses are the key providers of diabetes care. However the information provided
: Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout Thomas K. Wuest Clinical Orthopaedics and Related Research ISSN 0009-921X Clin Orthop Relat Res DOI 10.1007/s11999-016-4899-8
PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)
Safety indicators for inpatient and outpatient oral anticoagulant care 1 Recommendations from the British Committee for Standards in Haematology (BCSH) & National Patient Safety Agency (NPSA) Address for
Nasal Antiseptic Swabs Decolonize the nose without the risk and complexity of antibiotics* Shown to safely and efficiently reduce S. aureus. Can be used as part of a bundled intervention for patient decolonization.
Human Behavioural Guidance Version No: 0.1 Purpose of this document This document comprises the Human Behavioural Guidance for NHS Organisations in relation to the changes to the Main Specialty and Treatment
Activities for MANAGERS Australian Safety and Quality Framework for Health Care Putting the Framework into action: Getting started Contents Principle: Consumer centred Area for action: 1.1 Develop methods
www.bpac.org.nz keyword: warfarinaspirin FOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE Key Concepts In atrial fibrillation (AF) warfarin is more effective than aspirin for stroke prevention.
ORIGINAL ARTICLE Peripheral Intravenous Catheter Complication Rates between those Indwelling > 96 Hours to those Indwelling 72 96 Hours: A Retrospective Correlational Study Ascoli GB* a, DeGuzman PB b,
Inter-hospital patient transfer A thematic analysis of the literature This literature review was prepared as part of the Victorian Quality Council s project on improving state-wide inter-hospital transfer
Health Benchmarks Program Clinical Quality Indicator Specification 2013 Measure Title USE OF IMAGING STUDIES FOR LOW BACK PAIN Disease State Musculoskeletal Indicator Classification Utilization Strength
Detecting Adverse Events in Thai Hospitals Using Medical Record Reviews: Agreement among Reviewers Pattapong Kessomboon, MD*, Supasit Panarunothai, MD**, Pradit Wongkanaratanakul, MD*** * Department of
Blue Distinction Centers for Spine Surgery Program Program Selection Criteria for 200 Mid-Point Designations Evaluation is based primarily on the facility s responses to the Blue Distinction Centers for
Cost of medical injury in New Zealand: a retrospective cohort study Paul Brown, Colin McArthur 1, Lynette Newby 1, Roy Lay-Yee, Peter Davis 2, Robin Briant Department of Community Health, University of
Acta Orthop. Belg., 2005, 71, 439-444 ORIGINAL STUDY Development of a clinical pathway for total knee arthroplasty and the effect on length of stay and in-hospital functional outcome Kris VANHAECHT, Walter
Improvement from Front Office to Front Line January 2014 Volume 40 Number 1 Using a Medication Event Huddle to Reduce Adverse Drug Events A core interdisciplinary medication event huddle team is particularly
Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Judith Long, MD,RWJCS Perelman School of Medicine Philadelphia Veteran Affairs Medical Center Background Objective Overview Methods
Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize
Prevention of healthcare associated (nosocomial) infection : Safer surgery overview of strategies Assoc. Professor John Ferguson May 2011 firstname.lastname@example.org www.tinyurl.com\nepal68 Also see
DISCLAIMER ARTHROPLASTY SOCIETY VTE INFORMATION Venous thromboembolism is the most common complication after total hip and total knee arthroplasty. In recent times members of the Australian Orthopaedic
Standards of proficiency Operating department practitioners Contents Foreword 1 Introduction 3 Standards of proficiency 7 Foreword We are pleased to present the Health and Care Professions Council s standards
An Enterprise Risk Management Approach to Consent to Treatment Fay A. Rozovsky, JD, MPH The Rozovsky Group, Inc., Bloomfield, CT Timothy Kelly, MS, MBA Dialog Medical, Atlanta, GA AGENDA Discuss the historic
Accepted Article Case report: Amyand s hernia, diagnosis to consider in a routine procedure Diana Fernanda Benavides de la Rosa, Íñigo López de Cenarruzabeitia, Francisca Moreno Racionero, Luis María Merino
Crisis Resource Management (CRM) Goals Develop an understanding of the cognitive and technical actions involved in managing a critical event (thinking and doing) Advance the ability to generate a differential
Joint Commission Center for Transforming Healthcare Reducing the Risk of Wrong Site Surgery Wrong Site Surgery Project Participants The Joint Commission s Center for Transforming Healthcare aims to solve
Bahrain Medical Bulletin, Vol. 32, No. 1, March 2010 Health-Care Associated Infection Rates among Adult Patients in Bahrain Military Hospital: A Cross Sectional Survey Kelechi Austin Ofurum, M.Sc, B.Sc*,
AAFP Reprint No. 281 Recommended Curriculum Guidelines for Family Medicine Residents Risk Management and Medical Liability This document was endorsed by the American Academy of Family Physicians (AAFP).
CLINICAL AVOIDING INJURY TO THE INFERIOR ALVEOLAR NERVE BY ROUTINE USE OF INTRAOPERATIVE RADIOGRAPHS DURING IMPLANT PLACEMENT Jeffrey Burstein, DDS, MD; Chris Mastin, DMD; Bach Le, DDS, MD Injury to the
A patient's guide Your clinic's contact details are: Name: Contact number: Contents 2 Why have I been prescribed Xarelto? 2 What is Xarelto? 3 How do I take Xarelto? 3 What should I do if I miss a dose
SECTION 5 HOSPITAL SERVICES Table of Contents 1 GENERAL POLICY... 2 1-1 Clients Enrolled in a Managed Care Plan... 3 1-2 Clients NOT Enrolled in a Managed Care Plan (Fee-for-Service Clients)..................
Surgical specimen identification errors: A new measure of quality in surgical care Martin A. Makary, MD, MPH, a,d,e Jonathan Epstein, MD, b Peter J. Pronovost, MD, PhD, a,c,d,e E. Anne Millman, MS, a,d,e
Article ID: WMC004535 ISSN 2046-1690 An Oncology Nursing Intervention to Reduce Adverse Drug Events in Ambulatory Cancer Patients Peer review status: No Corresponding Author: Dr. Esther Una Cidon, Doctor
ANESTHESIA & YOU Anesthesia for Ambulatory Surgery T oday the majority of patients who undergo surgery or diagnostic tests do not need to stay overnight in the hospital. In most cases, you will be well
Perioperative Medicine Past, Present and Future BSOA Spring Scientific Meeting, Birmingham 4 th June 2015 Mike Swart Torbay Hospital Torquay Devon A simple definition of perioperative medicine Anaesthesia
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Medical technology guidance SCOPE MAGEC system for spinal lengthening in children with early onset scoliosis 1 Technology 1.1 Description of the technology
INFORMED CONSENT FOR SLEEVE GASTRECTOMY This informed-consent document has been prepared to help inform you about your Sleeve Gastrectomy including the risks and benefits, as well as alternative treatments.
Patient Education Full Project Description The World Health Organization defines patient education as any combination of learning experiences designed to help individuals improve their health, by increasing
The Expanding Role of the Nurse Practitioner and Physician Assistant Across the Continuum of Care for the CTS Patient: Preoperative, Postoperative, and After Discharge Jane MacIver RN NP PhD Peter Munk
ECRI Institute Perspectives Rise in office-based surgery and anesthesia demands vigilance over safety Advances in technology and anesthesia allow invasive procedures once done only in hospitals or ambulatory
ANNIE NEDROW, MD, MBA ASSOCIATE DIRECTOR DUKE INTEGRATIVE MEDICINE MICHELLE BAILEY, MD, FAAP DIRECTOR, MEDICAL EDUCATION DUKE INTEGRATIVE MEDICINE EMILY RATNER, MD, FAAMA CLINICAL PROFESSOR STANFORD UNIVERSITY
Original Article http://dx.doi.org/10.3349/ymj.2014.55.2.523 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 55(2):523-529, 2014 Assessing Safety Attitudes among Healthcare Providers after a Hospital-Wide
The Informed Consent Process and the Electronic Medical Record Mercer Medical Center Macon, Georgia July 14, 2005 Aaron S. Fink, MD Professor of Surgery Emory University Manager, Surgical and Perioperative
Journal section: Oral Surgery Publication Types: Research doi:10.4317/medoral.17085 http://dx.doi.org/doi:10.4317/medoral.17085 : Dental care risk management plan Bernardo Perea-Pérez 1 Andrés Santiago-Sáez