Improving Operating Room and Perioperative Safety: Background and Specific Recommendations
Stephen C. Schimpff, MD
University of Maryland School of Medicine, Baltimore, and the University of Maryland School of Public Policy, College Park, Maryland
The 1999 Institute of Medicine report To Err Is Human put a spotlight on death from preventable medical errors. Surgically related errors are second only to medication errors as the most frequent cause of error-related death.
Although many hospitals have ongoing programs to improve medication safety, most hospitals are not focused in a meaningful way on operating room (OR) safety despite the import of the OR to the hospital's finances and despite clearly efficacious available technologies.
The perioperative environment is a high-risk area with high velocity, high complexity, and high stakes. OR errors lead to disproportionately more harm than errors elsewhere in the hospital. Actual adverse events are relatively rare in any given OR suite, but near misses are rather common. It is possible to learn much from evaluating near misses (along with adverse events) with root-cause analyses and then instituting changes in processes and systems to assist humans from making their inevitable errors. This article outlines approaches that when combined can markedly improve safety in the OR.
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An operating room (OR), also called surgery center, is the unit of a hospital where surgical procedures are performed. An operating room may be designed and equipped to provide care to patients with a range of conditions, or it may be designed and equipped to provide specialized care to patients with specific conditions.
The instruments used during a surgical procedure are different for external and internal treatment; the same tools are not used on the outside and inside of the body. Once internal surgery is started, the surgeon uses smaller, more delicate devices.
A medical error, on the other hand, is an adverse event that could be prevented given the current state of medical knowledge. The QuIC task force expanded the IOM's working definition of a medical error to cover as many types of errors as possible. Their definition of a medical error is as follows: "The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.
Errors can include problems in practice, products, procedures, and systems." A useful, brief definition of a medical error is that it is a preventable adverse event.
The causes of medical errors are complex and not yet completely understood. Some causes that have been identified include the following: Communication errors.
One widely publicized case from 1994 involved the death of a Boston newspaper columnist from an overdose of chemotherapy for breast cancer due to misinterpretation of the doctor's prescription; the patient was given four times the correct daily dose, when the doctor intended the dosage to be administered instead over a four-day period. Other cases involve medication mix-ups due to drugs with very similar names. The Food and Drug Administration (FDA) has identified no fewer than 600 pairs of look-alike or sound-alike drug names since 1992.
Patients are an important resource in lowering the rate of medical errors. The QuIC task force has put together some fact sheets to help patients improve the safety of their health care.
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