Manuale per la sicurezza in sala operatoria - Azienda Sanitaria ...

Raccomandazioni per la sicurezza in sala operatoria - Ottobre 2009A SUWHCALaAPrrYCHECKLISTthese guidelines, we desàgoed a 19-item check-IJst ìotended to be globally applicable and toreduce thè rate of major surgkal compUcations(Table IX (Far thè fonnatted checklist, see thèSupplementaiy Appenda, arajlable with thè fillitest of this artide at N3M.org.) We hypothesizedthat ìmpleroeotatjon of this cbeddist and thèassodateti culture changes it sjgnified would teducethè rate* of death and major compUcatìonsafta sorger? la diverse setti ngs.METHODSS TU BY DESIGNWe coadncted a prospettive stndy of prejnterrcntionand postìatetTentkm petìods at thè ejghthospiols partjàpating as pìlot srtes in die SaieSurgery Swes JJws program (Table 2). The» institmionswere selected on thè baste of theìr geognphìcdistribution within WMO reg jons, withthè goal of reptesenting a diverse set of sodoecolaide3 lists «irgàcal safety policies in piace ateach insàtnticD befbre thè Rudy. We required thata ooinvestigatot at cadi ske lead thè pnject kxallyand titat thè hocpital adminìstratkM snpport thèmterrmtìou. A locai data cdfector was chos«a ateach site and naioed b? thè Ebur primarr mfeaigaflorahi die identification and reporting of processmeasures and compUcations. ThJs petsonwozked on thè study fiill-time and djd not bavedinical reaponsftìlhieB at thè study site. Eacb hosphaljdentified between eoe and fbur operatingroora* to aore as stuày tooms. Patìents who were16 years of age or oider and were unda^oing noncaidjacsaigeryinthoseroomswerecoo«cutLvdyenrolled in thè stud?. The human subjects committecsof thè Harvard Schod of PuhUc Health,thè WHO, and each participatiag hospitil approvedthè study and waiwd thè requirement fotwritten infbrmed consent fram patjents.IMTEIVEHTIOHThe interantion ìnrolved a two-step dxeddist-(mptemenution program. After cotlectìng base-Ime data, eacfa locai investìgatorwas ghen iofarmatìonaboot areas of rdentified deficiencìes andwas then asked to impiemem thè 19-jtem WHOsafè-suigery cheddist CTible 1] to improre practfceswithin thè instìtatk». The chedcùst coaàttsof an orai confirmation bysur£ìcaJ teams of thècompletioo of thè basic steps fbr oisuring safeddircry of anesthesia, prophjdaiìs against mfectìoo,eflèctjwe ceamworic, and other essentìal pcactàcesin sorgery.lt isusedatthree criticai junouresin caro: beiate anesthesh ffl adm'mistered, ìnunedjafiefybefbre tndsion, aad beforc thè patìent ìstaken out ofthe opemàng toom. The cheddist wastraoslated imo locai language «hen appropriateand was adjus&ed to fit into thè flow of caie ateach institutiofl. The locai studjr team intzodacedthè cheddist to operanng-room stafl; using lectuies,written matedals, or direa guidaace. Theing by dìstribatìng a recorded video to thè stud/sires, partkàpatiag ina tdecooference with cacilocai study team, and maidng a vishto eacfa site.The cfaeddistwai introduced to die stady roanaorar aperìod of 1 weekto 1 monm. Data ooUectianresumed dudng thè first week of cheddist use.StaLocatimiB«diTyp«PrinceHBmzih Ho^AtlUniveni^ of Washington McdalCenterSt Francis Designateti District HoifritalPtilippine Ornerai HospblTorofto CenemiNew Deftil, Indùifek>r*,T»nzwiiaMinih, Phlippine»Toronto, CwudcLoodon, Enfl»f>dAudcland, NewZnland5007])410371IMO7445417101524319le31Charitjr, urtaiPutte. u*«iDirtrkt, mral* & Mary't Hospitd hu sface been renamed St Miry'i HoapftaUImperìd Cotìeg* Nràorwl Heahh Service Trust.N ENGLJ UCDjfifl^ NQH.OIC JANUkRY 2g, 2OO9àcurezzadeipaàaitì52