2 vietduc patient safety dec invasive procedures mw v. 1 mw checked 17 4 11
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Transcript of 2 vietduc patient safety dec invasive procedures mw v. 1 mw checked 17 4 11
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Merrilyn WaltonProfessor of Medical Education(Patient Safety)Faculty of MedicineUniversity of SydneyAustralia
Patient safety and invasive procedures
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Adverse event
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Learning objective for this session
To understand
- the main causes of adverse events in surgical and invasive procedural care
-How the use of guidelines, verification processes, and teamwork can facilitate the correct patient receiving the correct treatment at the appropriate time and place.
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Knowledge requirements for nurses/doctors
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Multiple Factors associated with adverse events
› Skills and experience of surgical team only 1 factor in Adverse Events
Design of the workplace
Poor teamwork
Poor safety culture
Poor hand over
Poor history taking
Poor continuity of care
Poor infection control
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What are the main types of adverse events experienced in relation to surgery
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The main types of adverse events aspoor infection control methods inadequate patient management failure by health-care providers to communicate effectively before, during and after operative procedures with invasive procedural and surgical care
Poor infection control methods
Infections, post operative sepsis
Inadequate patient management
Cardiovascular complications
Respiratory complications
Thromboembolic complications
Failure by doctors and nurses to communicate effectively before, during and after operative procedures with each other (the team) and the patient
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The main types of adverse events associated with invasive procedural and surgical care
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Poor infection control
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Inadequate patient management
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The verification processes for improving care in invasive procedures
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WHO Surgical Safety Checklist
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Practise operating room techniques that reduce risks and errors
Participating in team briefings and debriefings
Appropriately sharing information Asking questions Asserting oneself appropriatelyStating or sharing intentionsTeaching Managing workload
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Surgical mortality and morbidity meetings
o Is the meeting structured?
o Is there an emphasis on education and understanding?
o Is prevention the goal of the discussion?
o Are these meetings considered a core activity
o Is everyone involved?
o Are nurses, including junior nurses and students, encouraged to attend?
o How are deaths handled?
o Is a written summary of the discussions kept?
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Techniques for safe care
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Performance requirements for nurses/doctors
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Summary
The value of guidelines
Nurses and doctors need to understand the reasons for the guidelines
Verification steps can minimize mistakes in patient identity
The use if everyday techniques can improve communication and minimize errors
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