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PATIENT SAFETY IN SURGERY.ppt

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					PATIENT SAFETY IN
SURGERY

  PROF. PANKAJ G. JANI
 ASSOCIATE PROFESSOR
DEPARTMENT OF SURGERY
 UNIVERSITY OF NAIROBI
SAFETY IS PARAMOUNT

n   PRIMAM NON NOCERE

n   FIRST DO NO HARM

n   PATIENT SAFETY IS COMPROMISED
    BY ERRORS
ERRORS
ERRORS IN HEALTH CARE
ARE THE EIGHTH LEADING
CAUSE OF DEATH IN THE U.S.
AND ACCOUNTS FOR 120,000
DEATHS ANNUALLY
CRISIS IN HEALTH CARE




    National Safety Council, 1998
    ERROR
n   OF EXECUTION ® FAILURE OF
    PLANNED ACTION TO BE COMPLETED
    AS INTENDED



n   OF PLANNING ® USE OF WRONG PLAN
    TO ACHIEVE AN AIM
ADVERSE EVENT
(COMPLICATION)

INJURY CAUSED BY MEDICAL
 MANAGEMENT OTHER
THAN THE UNDERLYING
CONDITION OF THE PATIENT
ADVERSE EVENT
n     IF CAUSED BY ERROR(S) – IT IS
    PREVENTABLE

n     66% OF ALL ADVERSE EVENTS
    ARE SURGICAL

n     50% OF ALL ADVERSE EVENTS ARE
    PREVENTABLE
PATIENT SAFETY IS THE PRIME DUTY OF THOSE:-

n   ORGANISING      }
n   MANAGING        }   MEDICAL PRACTICE
n   CONTROLLING     }


THEY MUST PROVIDE

n   THE RIGHT ENVIRONMENT   }    FOR DOCTORS
n   MOTIVATED STAFF         }    TO TREAT
n   CORRECT EQUIPMENT       }    PATIENTS
n   ADEQUATE SUPPORT        }    SAFELY
n   IN THE DEVELOPED WORLD THE
    FOREGOING ITEMS ARE AVAILABLE SO TO
    IMPROVE PATIENT SAFETY, IMPROVEMENT OF
    “SAFETY CULTURE” IS CONCERNTRATED
    UPON.

n   IN DEVELOPING COUNTRIES FAR FROM
    ABOVE AND A DIFFERENT FORUM NEEDED TO
    ADDRESS ISSUES OF PROVISION OF SOUND
    MEDICAL ENVIRONMENT AND THEREFORE I
    WILL CONCERNTRATE ON LOCAL PROBLEMS
    TO IMPROVE PATIENT SAFETY
RECRUITMENT FOR
SURGICAL TRAINING
SPECIAL SKILLS REQUIRED
n COMMUNICATION
n CLINICAL APTITUDE
n ATTITUDE
n MANUAL DEXTERITY


n   PHYSICAL SKILLS   } TO SELECT
n   PSYCHOMETRIC      } SURGEONS
    TESTING           } FOR TRAINING
    TO IMPROVE PATIENT SAFETY
    IN SURGERY IN DEVELOPING
    COUNTRIES
n   A GOOD SURGEON KNOWS WHEN NOT
    TO OPERATE
n   BIG SURGEONS MAKE BIG INCISIONS
n   USE OF DRAINS
n   USE OF NASOGASTRIC TUBES
n   COLON PREPARATION
n   ANTIBIOTICS
    A GOOD SURGEON
    KNOWS WHEN NOT TO
    OPERATE
n   INVESTGATIVE FACILITIES LIMITED
    (C.T., U/S)
n   GOOD CLINICAL SKILLS ESSENTIAL
n   DEDICATION AND WORK DISCIPLINE
    REQUIRED (REPEATED FREQUENT
    EXAMINATIONS)
n   BASIC LABORATORY FACILITIES TO BE
    AVAILABLE
    A GOOD SURGEON KNOWS
    WHEN NOT TO OPERATE
n CANCER OF THE OESOPHAGUS (95% ADV)
n CANCER OF THE STOMACH (>90%)

n CANCER OF THE PANCREAS (>95% ADV)

n MANY OPERATED FOR PALLIATIVE CARE
  AND WITH VERY LITTLE BENEFIT
n NEGATIVE APPENDECTOMY RATES(25%)

n NEGATIVE LAPAROTOMY RATES(PASW)

 App. (20%)
BIG SURGEONS MAKE
BIG INCISIONS
n   TREND FROM LOGITUDINAL INCISIONS TO
    TRANSVERSE INCISIONS

n   CAN OPERATE CONFIDENTLY WHEN YOU CAN
    SEE CLEARLY

n   DELAYED PRESENTATION

n   ADVANCED PATHOLOGY

n   ANTOMY DISTORTED
DRAINS

n   ADVANCED PATHOLOGY
n   DELAYED TREATMENT ¯
           - DISTORTED ANTOMY
                    ¯
           - DIFFICULT DISSECTION
                    ¯
          MORE POST-OP COLLECTIONS
n   POOR POST-OP INVESTIGATIVE FACILITIES
NESOGASTRIC TUBES

n YOUNG   PATIENTS



n BENEFIT   OUTWEIGHS HARM
COLON PREPARATION

LOCAL SERIES REQUIRED

BEFORE IT IS GIVEN UP
ANTIBIOTICS

SURGERY OF CONTAMINATED
AREAS SHOULD BE
DISCOURAGED IF
APPROPRIATE ANTIBIOTICS
NOT AVAILABLE
SURGERY WITHOUT
PROPER RESOURCES IS
BAD PRACTICE,
POTENTIALLY
DANGEROUS AND
UNACCEPTABLE

				
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