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

Raccomandazioni per la sicurezza in sala operatoria - Ottobre 2009A SU «.OIC Al SAEETY CHECK LISTact mechanism of ìmprovement ìs lese dear andmost lìkely raulti&ct&tìal. Use of thè checklistmvolved bota changes io eysteins and changesm thè behavior of individuai surgical teams. loimplpmfttt thè cheddìst, ali sfres aad to introducea. formai passe In care during surgery fot preoperativeteam ìntroductions and briefrags andpottoperatta debrrefings, team practices thatbare preikutiy beco shown to be assotiaredwìthJmprored iiftty processes and atthudes*4'*''31 andwith a rate of compUcatìons and death redttcedby as nuch as 60%.1J The phjlosophy of ensurìngthè correct ideotity of thè patìent and siteducagli preoperatiie alte marking, orai confizmaùoain che operathg toom, and ocber measuresprored robe new to most of thè sojdyhospitals.In adcUtìon, inatitutioti of thè checkiisi reqokeddtanges in systenos at three instìtutìons,in order to caange tbe location of admmìstrationofantìbiotics, dwddtst impIaDaitatìon enoonragedthè adminìsoation of antìbjotìcs fa thè operatingroom tather than ài tìi* pieoperathewarda, whete ddays are fiequent. The checklistptovided additional orai confinnatjon of appropriateantibìotic use, hicieaffiiig die adbetencetate from 56 to 83%; thh inteneatkn alone basbeen shown to reduce die rate of surgical-Dtekifectk» by 33 to 88%.»" Otiier p«aitìal!ylifesaving measures were also moie lìkdy to bejnatitoted, ìndudìng an objectrre airway evalaatìonand u« of pube oxìmetry, tìxxigh thè changein tfaeae meaanres wu leas dmnatìc." Althoogbdie onùstion of individuai siepe was stili freqoent,orerall adherence io thè ajbgroup of siitófety hidìcaeors increased by two thìrds, Tbemra of these individuai systemic and behavjoralchanges could accoont fbr die improremaitsobserved.Anotber mechanism, however, could be thèHawthorne efftct, an improvement in performancedue to sobjects* knowledge of bekig observed.1*The coumbution of me Hawmome effèct is djffìcult to dteentangle in diis study. TbechecJdtet 3s oralb/ perfbnned by peers and ìs ìntentjonattjrdesigned m create a collectire awarenessamong surgical teams about wboher saiètyproceasea are being oompleted. However, ouranajyàs does sbow that die presence of studypersonod in die operating roam was not responsjblefbr me ckange in thè rate of compiicatiatis.Thìs ttadjr has severa! lìmàattans. Tbe design,ìnvoMng a comparison of preiQtttventioa data~JIp"