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‌..sharing*healthcare*best*practices*
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29th!March!2012!
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***Surgical*Safety** ‌..sharing*healthcare*best*practices* * * * * * *
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2012 SQHN Workshop Report !
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…..sharing*healthcare*best*practices* !
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* *Workshop*Report* ! The!Society!for!Quality!in!Healthcare!in!Nigeria!held!its!2012!1st!Workshop!at!the!Lagos!Resource!Centre,!Lagos! on!the!29th!of!March,!2012.!!The!workshop!revolved!around!the!theme!Surgical*Safety!and!is!a!subItheme!of! the!2012!SQHN!Theme!of!Patient*Safety.!!The!workshop!was!based!on!a!tripod!of!the!following!subIthemes:! • Surgical!Safety! • Infection!Control!! • Anaesthesia! ! As!has!become!our!custom,!the!Workshop!is!an!avenue!to!share!hands!on!experience!to!everyday!issues!faced! in!the!healthcare!industry,!as!well!as!a!means!to!enlighten!the!participants!on!the!importance!of!patient!safety! and!most!of!all,!to!impart!knowledge.!! ! The!Workshop!objectives!were:!
1. 2. 3. 4. 5.
To!introduce!the!Surgical!Safety!! To!define!Safety!Culture,!its!components!and!factors!that!create!a!safe!culture! To!ascertain!the!role!of!leadership!in!establishing!a!safe!culture.! To!identify!the!methods!for!measuring!safety!culture.! To!identify!the!resources!to!support!the!implementation!of!a!safety!culture.!
! Workshop*Agenda* TIME%
ACTIVITY%
CO+ORDINATOR%
10:00%+%10:30%AM%
Participant%Registration%%
Ms.%Ema%Oche%
10:30%–%11:00%AM%
Workshop%Theme%Introduction%%
Mrs.%Njide%Ndili%
11:00%–%11:30%AM%
Surgical%Safety%
Dr.%Jimi%Coker%(Chief%of%Surgery%and%Group% Clinical%Adviser+%Lagoon%Hospitals)%
11:30%–%12:00%PM% 12:00%–%12:30%PM%
Interactive%Session% Infection%Control%
12:30%–%1:00%PM%
Interactive%Session%
1:00%–%1:45%PM% 1:45%–%2:15%PM%
Dr.%A.%G%Salaudeen%(Senior%Lecturer%&% Consultant%Community%Physician+% University%of%Ilorin)%
Tea%Break% Anaesthesia%
Dr.%Folabi%Osunkoya%(Lagoon%Hospitals,% Lagos)%
2:15%–%2:45%PM%
Interactive%Session%
2:45%–%3:00%PM%
Wrap%Up%
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Session*One* ! Speaker*1*–*Dr.*Jimi*Coker,*FRCS,*FRCS*(Gen.*Surg),*FWACSK*Chief*of*Surgery*&*Group*Clinical*Adviser*Lagoon* Hospitals,*Lagos** Topic:!!Surgical!Safety! ! ! According! to! the! Harvard! Medical! Practice! Study! • Promotes! adherence! to! established! safety! (1991),! patients! are! unintentionally! harmed! by! practices! treatment!in!almost!4%!of!admissions!in!New!York.!! • Minimal!resources!required!to!implement!a! The! US! Institute! of! Medicine! report! “To! Err! is! farIreaching!safety!intervention.! Human”! in! 2000! states! that! between! 44,000! and! ! 98,000! people! die! in! US! Hospitals! annually! as! a! Checklist*Roadblocks* result!of!medical!errors.! • Trained! to! be! specialists! “that’s! not! my! ! area”! The! JCAHO! Website! in! 2005,! the! root! causes! were! • Culture:!The!OR!is!the!surgeons!stage! identified! asI! communication,! procedural! • Silent!disengagement! compliance,! leadership,! competency/credentialing,! • 25I40&! of! RNs! say! they! would! be! hesitant! availability! of! info,! organization! culture.! ! Also! in! to! speak! up! if! the! saw! a! surgeon! making! a! 2006,! the! dominant! root! causes! of! Wrong! Site! mistake.! surgery!asI!Procedural!compliance,!communication,! ! leadership,! availability! of! information,! Necessary* changes* to* the* processes* for* safer* competency/credentialing,!orientation!training.!! patient*care* ! 1. Simplify! Dr.!Coker!identified!the!central!problems!in!surgical! 2. Standardize! safety!as:! 3. Create! checklists! and! reduce! reliance! on! 1. Being!unrecognized!as!a!public!health!issueI! memory! even!though!over!234!million!operations!are! 4. Eliminate!look!alike!and!sound!alike! done!globally!each!year!! 5. Training! 2. Lack! of! data! on! surgery! and! outcomesI! 6. Increase!communication!and!feedback! improvement! in! maternal! mortality! is! 7. Teamwork! dependent!on!routine!surveillance,!which!is! 8. Adjust!environment! actually!lacking!for!surgical!care.!! 9. Adjust!work!schedules! 3. Failure!to!use!existing!safety!knowIhow:!the! ! high! rates! of! preventable! surgical! site! ! infection!results!from!inconsistent!timing!of! In!Summary,!Dr.!Coker!stated!that!surgical!safety!is! antibiotic!prophylaxis.!Despite!high!publicity! a! major! health! concern! and! availability! of! data! in! cases! of! wrongIpatient,! wrongIsite! Nigeria! will! define! the! problem! of! safety! and! its! operations!still!persist.!! outcomes.! He! also! stressed! that! the! need! for! ! checklist!should!never!be!underemphasized,!as!they! Advantages*of*using*the*WHO*Checklist* are!simple,!cheap!and!reliable,!as!well!as!help!save! • Customizable!to!local!setting!and!needs! lives! by! reducing! complications! and! death! by! 50%. • Supported!by!evidence! • Evaluated! in! diverse! settings! around! the! world!
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! Speaker*2*–*Dr.*A.*G.*SalaudeenK*MPH,*FWACP,*FMCPH,*FRSPHK*Department*of*Epidemiology*and*Community* Health,*University*of*Ilorin*Teaching*Hospital** Topic:*Infection*Control!! ! Dr.!Salaudeen!began!by!defining!Infection!and!explaining!that!at!times,!infections!are!not!present!at!the!time!of! admission,!but!appear!after!discharge!usually!as!a!direct!effect!of!Infectious!agents!or!indirect!toxin!production,! and!in!many!hospitals!in!subISaharan!Africa,!this!is!the!leading!cause!of!illness!an!even!death.!They!are!usually! referred!to!as!Health!Care!Associated!Infections!(HCAI).!In!UCH!Ibadan,!surgical!site!infection!was!the!2nd!most! prevalent!HCAI!and!accounted!for!27.9%!of!HCAI.! ! The*impact*of*HCAI* promoted!at!the!community!level!to! strengthen!selfIprotection!and!protection!of! • Prolonged!hospital!stay! others.! • Long!term!disability! 2. Hospital!administrators:!Healthcare!workers! • Increased!resistance!of!microorganisms!to! should!be!provided!with!access!to!safe!water! antimicrobials! supply!and!logistics!to!perform!hand!washing,! • Additional!financial!burden! as!well!as!alcoholIbased!hand!rub!at!the!point! • Unnecessary!deaths! of!patient!care.! ! 3. Health!workers:!Health!workers!should! The*vehicle*through*which*the*HCAI*is*passed* adhere!to!universal!norms!and!standards!in! • The!hospital!environment! healthcare.! • Common!Hospital!surfaces!! ! • Hospital!garments! The*challenges*faced* • Doctor’s!white!coats!and!ties/nurses!uniforms! • NonIadherence!to!standard!precautionary! • Hospital!equipmentsI!Stethoscopes,! measures! thermometer,!patient!care!devices,!trolleys,! • Limited!knowledge!on!infection!control!by! tables,!Bed!rails! healthcare!workers!and!patients! ! • Attitudinal!problem! Who*is*at*risk?* • Lack!of!effective!surveillance!systems! • Patients,!visitors!and!relatives!of!patients! • Infrequent!medical!audit.! • Hospital!staffI!clinical!and!administrative! • Ineffective!hospital!waste!management!! ! • Lack!of!basic!equipment!and!infrastructures! Quality*infection*control* • Poor!laboratory!backup! 1. Appropriate!environmentI!standard!theatre,! • Poor!funding! aseptic!environment! • Emerging!resistant!microbes.! 2. Appropriate!equipment!and!facilitiesI!avoid! ! reuse!of!equipments!where!possible.! Recommendations* 3. Sticking!to!standards! • Reactivation!of!infection!control!committee! 4. Education!and!training!of!health!care!workers! at!all!levels!to!monitor!health!facilities! 5. Protection!of!healthcare!workersI! immunization! • Hospital!workers!should!be!properly!trained! 6. Identification!of!hazards!and!risk!minimization! • Community!education!on!HCAI! 7. Incidence!monitoring!and!risk!assessment! • Periodic!Medical!audits! 8. Infection!control! • Provision!of!adequate!and!upItoIdate! * infrastructure!and!support!services!(water,! The*Role*of*Stakeholders* electricity)! 1. The!Government:!Hand!hygiene!should!be! made!national!priority!and!should!be! ! Page!4!of!5! !
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! ! ! ! ! ! ! ! !!!!!!!!!!! ! ! Speaker*3*–*Dr.!Afolabi!OsunkoyaI!Dept.!of!Anaesthesia,!Lagoon!Hospitals,!Lagos!! Topic:!!The!Role!of!Anaesthesia!in!Surgical!Safety! ! Dr.!Osunkoya!noted!that!the!use!of!anaesthesia,! c. Aseptic!technique!during!invasive! sedation!and!surgical!intervention!is!common!in! procedures! healthcare!organizations.!Over!230!million!patients! d. Perioperative!thermoregulation! undergo!anaesthesia!for!major!surgery!in!the!world! ! each!year,!and!7!million!people!develop!severe! 2. Less!certain!interventions! complications!from!which!1!million!people!die.!He! a. Face!masks!and!theatre!traffic! further!gave!a!timeline!of!anaesthesiaIrelated! b. Regional!anaesthetic!techniques! complications!and!improvements!from!1950I1980,! c. Inspired!oxygene!composition! where!major!complications!occurred!in!older! d. Glycaemic!control! patients,!emergency!operations!and!extensive!co! ! morbidities.!! 3. Speculative!interventions! ! a. GoalIdirected!fluid!management! The*JCI*Standards*for*Hospitals* b. Minimizing!blood!transfusions! 1. Anaesthesia!and!Surgical!care!(ASC)! c. Enhances!recovery!after!surgery! Standards! (EARS)! 2. 50!measurable!elements!(36!anaesthetic)! d. Opioid!induced!immunosuppression! 3. Anaesthesia!services!are!available!to!meet! ! patient!needs,!and!all!such!services!meet! Dr.!Osunkoya!concluded!by!noting!that!anaesthesia! local!and!national!standards.! had!shared!characteristics!with!other!complex!work! 4. A!qualified!individual!is!responsible!for! or!human!environments,!such!as:! managing!the!anaesthesia!services.!! • Uncertain!dynamic!environments! 5. Policies!and!procedures!guide!the!care!of! • Multiple!sources!of!concurrent!information! patients!undergoing!moderate!and!deep! • Shifting!or!competing!goals! sedation.! • Reliance!upon!indirect!or!inferred! 6. A!qualified!individual!conducts!a!preI indications! anaesthesia!and!preIinduction!assessment! • IllIstructured!problems! 7. Each!patient’s!anaesthesia!care!is!planned! • Actions!having!immediate!and!multiple! and!documented!in!the!patients!record! consequences! 8. Each!patient’s!postIanaesthesia!status!is! • Moments!of!intense!stress!interleaved!with! monitored!and!documented,!and!the! long!periods!of!routine!activity! patient!is!discharged!from!the!recovery!area! • Sophisticated!technologies!with!many! by!a!qualified!individual!or!by!using! redundancies! established!criteria.! • High!stakes! ! • Multiple!players!with!differing!priorities! Modifiable*factors*for*development* • An!environment!highly!influenced!by!group! 1. Well!established!interventions! norms!and!organizational!culture.! a. Antibiotic!prophylaxis! b. Hand!hygiene! ! ! !