IN Upper St. Clair Summer 2018

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

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