Pittsburgh Veterinary Specialty & Emergency Center
INDUSTRY INSIGHT
VETERINARY SERVICES
SPONSORED CONTENT
SURGICAL SAFETY CHECKLISTS
A Simple Solution to a Complex Problem
Over the past several decades , the field of medicine has become incredibly complex . With improvements in knowledge and technology , we have managed to make commonplace the treatment of diseases and injuries that were once thought to be untreatable . However , this increase in complexity can also predispose us to errors in the fast-paced , highstress setting of a hospital , be it human or veterinary .
A Harvard medical records query revealed that in daily practice the average physician manages 250 primary diseases and conditions , must consider over 900 concurrent active medical problems , prescribes 300 different medications , orders 100 individual laboratory tests , and performs more than 40 unique procedures .
The statistics are probably similar in the veterinary world , though one must also consider that we treat several different species and a constantly growing number of breeds of animal . Physicians in today ’ s world are some of the best and brightest , and are also incredibly highly trained — consider that in the early 1900s , one needed just a high school diploma and a one-year medical degree to become a doctor ; today , doctors must have a college degree , a four-year medical school education , and three to seven years of post-doctoral training in a specific area of practice . Nonetheless , medicine has become so complex that it can be difficult for humans — mere mortals — to handle .
One way in which the human medical field has attempted to manage the problem of increasing complexity is through specialization , and even sub-specialization . For example , physicians may focus their practice on diseases of a single organ or body system , or potentially on a specific age group . Few disciplines are more subspecialized than surgery . Despite the attention to detail and the incredible skill of today ’ s surgeons , though , it is estimated that there are greater than 150,000 surgery-related deaths each year in the United States alone . Perhaps the most alarming statistic is that more than half of these deaths are considered preventable .
Preventable how , you ask ? By limiting or eliminating human error . And how is that accomplished ? To date , the best solution is one borrowed from the aviation industry – a simple checklist .
In 2007 , the World Health Organization convened a meeting of surgical professionals
Michael Kraun , DVM Diplomate , American College of Veterinary Surgeons – Small Animal Pittsburgh Veterinary Specialty and Emergency Center , a BluePearl Veterinary Partners Hospital
Surgical Safety Checklist
Has the patient confirmed his / her identity , site , procedure , and consent ?
Yes
Is the site marked ? Yes Not applicable
Is the anaesthesia machine and medication check complete ?
Yes
Is the pulse oximeter on the patient and functioning ?
Yes
Does the patient have a :
Known allergy ? No Yes
Difficult airway or aspiration risk ? No Yes , and equipment / assistance available
Risk of > 500ml blood loss ( 7ml / kg in children )? No Yes , and two IVs / central access and fluids planned from the around the globe . The goal of the meeting was to determine ways in which surgery could be made safer for patients . The end result of the meeting was a first draft of a surgical checklist . The checks were arranged at three critical time points : prior to anesthesia , prior to surgical incision , and prior to leaving the operating room after the procedure . Ultimately , the final draft of the checklist contained 19 specific checks ( see image below ).
From 2007 to 2008 , the surgical checklist was implemented in eight hospitals around the world . The results were breathtaking : major complications dropped by 36 %, deaths fell by 47 %, infections fell by almost 50 %, and the number of patients having to return to the operating room due to bleeding or technical problems dropped by 25 %. In all , the checklist was used in an estimated 4,000 cases ; it was estimated to have saved 150 people from harm and 27 from death .
A decade after the introduction of the surgical checklist , similar lists are used in human and veterinary hospitals throughout the country and the world . And PVSEC is no exception . It ’ s just one example of our dedication to keeping your pet safe during his or her hospital stay .
If you are interested in reading more about the evolution of the surgical safety checklist , I highly recommend Dr . Atul Gawande ’ s “ The Checklist Manifesto ” ( Metropolitan Books , 2009 ).
Before induction of anaesthesia Before skin incision Before patient leaves operating room ( with at least nurse and anaesthetist ) ( with nurse , anaesthetist and surgeon ) ( with nurse , anaesthetist and surgeon )
Confirm all team members have introduced themselves by name and role .
Confirm the patient ’ s name , procedure , and where the incision will be made .
Has antibiotic prophylaxis been given within the last 60 minutes ?
Yes Not applicable
Anticipated Critical Events
To Surgeon : What are the critical or non-routine steps ? How long will the case take ? What is the anticipated blood loss ?
To Anaesthetist : Are there any patient-specific concerns ?
To Nursing Team : Has sterility ( including indicator results ) been confirmed ?
Are there equipment issues or any concerns ?
Is essential imaging displayed ? Yes Not applicable
This checklist is not intended to be comprehensive . Additions and modifications to fit local practice are encouraged . Revised 1 / 2009
Nurse Verbally Confirms : The name of the procedure Completion of instrument , sponge and needle counts
Specimen labelling ( read specimen labels aloud , including patient name )
Whether there are any equipment problems to be addressed
To Surgeon , Anaesthetist and Nurse : What are the key concerns for recovery and management of this patient ?
© WHO , 2009
Pittsburgh Veterinary Specialty & Emergency Center
South Hills location : 1535 Washington Road , Washington , PA 15301 , 724.809.2000 North Hills location : 807 Camp Horne Road , Pittsburgh , PA 15237 , 412.536.5248 Web site : PVS-EC . com
PETERS TOWNSHIP ❘ APRIL / MAY 2018 73