PATIENT SAFETY IN SURGERY

1. PATIENT SAFETY IN SURGERY PROF. PANKAJ G. JANI ASSOCIATE PROFESSOR DEPARTMENT OF SURGERY UNIVERSITY OF NAIROBI

2. SAFETY IS PARAMOUNT • PRIMAM NON NOCERE • FIRST DO NO HARM • PATIENT SAFETY IS COMPROMISED BY ERRORS

3. ERRORS ERRORS IN HEALTH CARE ARE THE EIGHTH LEADING CAUSE OF DEATH IN THE U.S. AND ACCOUNTS FOR 120,000 DEATHS ANNUALLY

4. CRISIS IN HEALTH CARE National Safety Council, 1998

5. ERROR • OF EXECUTION  FAILURE OF PLANNED ACTION TO BE COMPLETED AS INTENDED • OF PLANNING  USE OF WRONG PLAN TO ACHIEVE AN AIM

6. ADVERSE EVENT (COMPLICATION) INJURY CAUSED BY MEDICAL MANAGEMENT OTHER THAN THE UNDERLYING CONDITION OF THE PATIENT

7. ADVERSE EVENT • IF CAUSED BY ERROR(S) – IT IS PREVENTABLE • 66% OF ALL ADVERSE EVENTS ARE SURGICAL • 50% OF ALL ADVERSE EVENTS ARE PREVENTABLE

8. PATIENT SAFETY IS THE PRIME DUTY OF THOSE:- • ORGANISING } • MANAGING } MEDICAL PRACTICE • CONTROLLING } THEY MUST PROVIDE • THE RIGHT ENVIRONMENT } FOR DOCTORS • MOTIVATED STAFF } TO TREAT • CORRECT EQUIPMENT } PATIENTS • ADEQUATE SUPPORT } SAFELY

9. IN THE DEVELOPED WORLD THE FOREGOING ITEMS ARE AVAILABLE SO TO IMPROVE PATIENT SAFETY, IMPROVEMENT OF “SAFETY CULTURE” IS CONCERNTRATED UPON. • IN DEVELOPING COUNTRIES FARFROM 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

10. RECRUITMENT FOR SURGICAL TRAINING SPECIAL SKILLS REQUIRED • COMMUNICATION • CLINICAL APTITUDE • ATTITUDE • MANUAL DEXTERITY • PHYSICAL SKILLS } TO SELECT • PSYCHOMETRIC } SURGEONS TESTING } FOR TRAINING

11. TO IMPROVE PATIENT SAFETY IN SURGERY IN DEVELOPING COUNTRIES • A GOOD SURGEON KNOWS WHEN NOT TO OPERATE • BIG SURGEONS MAKE BIG INCISIONS • USE OF DRAINS • USE OF NASOGASTRIC TUBES • COLON PREPARATION • ANTIBIOTICS

12. A GOOD SURGEON KNOWS WHEN NOT TO OPERATE • INVESTGATIVE FACILITIES LIMITED (C.T., U/S) • GOOD CLINICAL SKILLS ESSENTIAL • DEDICATION AND WORK DISCIPLINE REQUIRED (REPEATED FREQUENT EXAMINATIONS) • BASIC LABORATORY FACILITIES TO BE AVAILABLE

13. A GOOD SURGEON KNOWS WHEN NOT TO OPERATE • CANCER OF THE OESOPHAGUS (95% ADV) • CANCER OF THE STOMACH (>90%) • CANCER OF THE PANCREAS (>95% ADV) • MANY OPERATED FOR PALLIATIVE CARE AND WITH VERY LITTLE BENEFIT • NEGATIVE APPENDECTOMY RATES(25%) • NEGATIVE LAPAROTOMY RATES(PASW) App. (20%)

14. BIG SURGEONS MAKE BIG INCISIONS • TREND FROM LOGITUDINAL INCISIONS TO TRANSVERSE INCISIONS • CAN OPERATE CONFIDENTLY WHEN YOU CAN SEE CLEARLY • DELAYED PRESENTATION • ADVANCED PATHOLOGY • ANTOMY DISTORTED

15. DRAINS • ADVANCED PATHOLOGY • DELAYED TREATMENT  - DISTORTED ANTOMY  - DIFFICULT DISSECTION  MORE POST-OP COLLECTIONS • POOR POST-OP INVESTIGATIVE FACILITIES

16. NESOGASTRIC TUBES • YOUNG PATIENTS • BENEFIT OUTWEIGHS HARM

17. COLON PREPARATION LOCAL SERIES REQUIRED BEFORE IT IS GIVEN UP

18. ANTIBIOTICS SURGERY OF CONTAMINATED AREAS SHOULD BE DISCOURAGED IF APPROPRIATE ANTIBIOTICS NOT AVAILABLE

19. SURGERY WITHOUT PROPER RESOURCES IS BAD PRACTICE, POTENTIALLY DANGEROUS AND UNACCEPTABLE