Pittsburgh Veterinary Specialty & Emergency Center
INDUSTRY INSIGHT
VETERINARY SERVICES
SPONSORED CONTENT
SURGICAL SAFETY CHECKLISTS
A Simple Solution to a Complex Problem
Over the past several decades, the field of medicine has become incredibly complex. With improvements in knowledge and technology, we have managed to make commonplace the treatment of diseases and injuries that were once thought to be untreatable. However, this increase in complexity can also predispose us to errors in the fast-paced, highstress setting of a hospital, be it human or veterinary.
A Harvard medical records query revealed that in daily practice the average physician manages 250 primary diseases and conditions, must consider over 900 concurrent active medical problems, prescribes 300 different medications, orders 100 individual laboratory tests, and performs more than 40 unique procedures.
The statistics are probably similar in the veterinary world, though one must also consider that we treat several different species and a constantly growing number of breeds of animal. Physicians in today’ s world are some of the best and brightest, and are also incredibly highly trained— consider that in the early 1900s, one needed just a high school diploma and a one-year medical degree to become a doctor; today, doctors must have a college degree, a four-year medical school education, and three to seven years of post-doctoral training in a specific area of practice. Nonetheless, medicine has become so complex that it can be difficult for humans— mere mortals— to handle.
One way in which the human medical field has attempted to manage the problem of increasing complexity is through specialization, and even sub-specialization. For example, physicians may focus their practice on diseases of a single organ or body system, or potentially on a specific age group. Few disciplines are more subspecialized than surgery. Despite the attention to detail and the incredible skill of today’ s surgeons, though, it is estimated that there are greater than 150,000 surgery-related deaths each year in the United States alone. Perhaps the most alarming statistic is that more than half of these deaths are considered preventable.
Preventable how, you ask? By limiting or eliminating human error. And how is that accomplished? To date, the best solution is one borrowed from the aviation industry – a simple checklist.
In 2007, the World Health Organization convened a meeting of surgical professionals
Michael Kraun, DVM Diplomate, American College of Veterinary Surgeons – Small Animal Pittsburgh Veterinary Specialty and Emergency Center, a BluePearl Veterinary Partners Hospital
Surgical Safety Checklist
Has the patient confirmed his / her identity, site, procedure, and consent?
Yes
Is the site marked? Yes Not applicable
Is the anaesthesia machine and medication check complete?
Yes
Is the pulse oximeter on the patient and functioning?
Yes
Does the patient have a:
Known allergy? No Yes
Difficult airway or aspiration risk? No Yes, and equipment / assistance available
Risk of > 500ml blood loss( 7ml / kg in children)? No Yes, and two IVs / central access and fluids planned from the around the globe. The goal of the meeting was to determine ways in which surgery could be made safer for patients. The end result of the meeting was a first draft of a surgical checklist. The checks were arranged at three critical time points: prior to anesthesia, prior to surgical incision, and prior to leaving the operating room after the procedure. Ultimately, the final draft of the checklist contained 19 specific checks( see image below).
From 2007 to 2008, the surgical checklist was implemented in eight hospitals around the world. The results were breathtaking: major complications dropped by 36 %, deaths fell by 47 %, infections fell by almost 50 %, and the number of patients having to return to the operating room due to bleeding or technical problems dropped by 25 %. In all, the checklist was used in an estimated 4,000 cases; it was estimated to have saved 150 people from harm and 27 from death.
A decade after the introduction of the surgical checklist, similar lists are used in human and veterinary hospitals throughout the country and the world. And PVSEC is no exception. It’ s just one example of our dedication to keeping your pet safe during his or her hospital stay.
If you are interested in reading more about the evolution of the surgical safety checklist, I highly recommend Dr. Atul Gawande’ s“ The Checklist Manifesto”( Metropolitan Books, 2009).
Before induction of anaesthesia Before skin incision Before patient leaves operating room( with at least nurse and anaesthetist)( with nurse, anaesthetist and surgeon)( with nurse, anaesthetist and surgeon)
Confirm all team members have introduced themselves by name and role.
Confirm the patient’ s name, procedure, and where the incision will be made.
Has antibiotic prophylaxis been given within the last 60 minutes?
Yes Not applicable
Anticipated Critical Events
To Surgeon: What are the critical or non-routine steps? How long will the case take? What is the anticipated blood loss?
To Anaesthetist: Are there any patient-specific concerns?
To Nursing Team: Has sterility( including indicator results) been confirmed?
Are there equipment issues or any concerns?
Is essential imaging displayed? Yes Not applicable
This checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged. Revised 1 / 2009
Nurse Verbally Confirms: The name of the procedure Completion of instrument, sponge and needle counts
Specimen labelling( read specimen labels aloud, including patient name)
Whether there are any equipment problems to be addressed
To Surgeon, Anaesthetist and Nurse: What are the key concerns for recovery and management of this patient?
© WHO, 2009
Pittsburgh Veterinary Specialty & Emergency Center
South Hills location: 1535 Washington Road, Washington, PA 15301, 724.809.2000 North Hills location: 807 Camp Horne Road, Pittsburgh, PA 15237, 412.536.5248 Web site: PVS-EC. com
CHARTIERS VALLEY ❘ SUMMER 2018 9