Title : Analysis of safe surgical practice in a uk based hospital: adherence to WHO guidelines during orthopaedic procedures Abdus Samee Wasim, Birmingham
Introduction: The number of surgical procedures being performed annually has consistently increased over the past years worldwide. With the increased demand this puts on surgical services, the surgical profession must ensure that standards are maintained and guidelines followed in order to mitigate risks and prevent adverse harm to patients. Wrong site surgery still remains an occurrence in the surgical profession. 38 Surgical ‘Never Events’ of which 20 were due to wrong site surgery were identified between April 2016- March 2017 following NHS improvement review. The WHO safety checklist aimed to address and standardise the process of safe surgery. Its currently the Gold standard across the globe, however cases of surgical never events persist. WHO advocates preoperative marking checks be performed at multiple stages prior to surgery: When procedure is scheduled, admission to operation theatre, before patient leaves pre-operative/ anaesthetic area and anytime responsibility of care changes
Methods: We investigated local adherence of preoperative guidelines with respect to emergency orthopaedic procedures and perioperative 4-Point patient marking verification checks. Prospective analysis of 24 cases over a 3 week period in a Trauma theatre. Patients undergoing orthopaedic surgery had their records analysed for presence and accurate completion of 4 part surgical safety preoperative marking checklists. The 4 Checks were as follows: 1) When patient marked with indelible pen, 2) When leaving ward area, 3) Prior to induction of anaesthesia and 4) During theatre team Time Out procedure
Results: 62% of patients had a surgical preoperative marking checklist filed in their notes with only 54% of cases having the procedure and site written on the checklist. 58% of surgical sites were checked at the first stage with this dropping to 37% at the second stage. Only 8% of cases had preoperative checks carried out at the 3rd stage with 25% of cases being checked during surgical time out
Conclusions: Results show poor compliance with recommended protocols to prevent wrong site surgery and surgical never events. This places patients at high risk unnecessarily and could have significant litigation costs and issues associated with it. Auditing such processes regularly and providing teaching for relevant healthcare staff remains the cornerstone of optimising safe surgical practice.