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September 2009
 
Three surgical safety steps
to protect patients
 
The HA's mission has always been to provide our patients with safe, high-quality services. In June this year, three surgical safety steps were introduced to enhance our safety culture and risk management in our operating theatres.

You can download a circular about these via the following path: ha.home > Thematic View > Quality and Safety > Patient Safety & Risk Management > Patient Safety Enhancement > Policy & Guidelines. In addition, Dr Libby Lee, our Chief Manager (Patient Safety and Risk Management), told HASLink more about them during a recent interview.

Dr Lee says she and her colleagues in the HAHO Patient Safety and Risk Management Team began drafting this surgical safety steps circular at the end of 2008. They were supported in their task by representatives from all the clusters and specialties, who actively contributed ideas and opinions about the guiding principles and details of surgical safety.

"Operating theatres in different hospitals have always had their own safety procedures, including checking procedures," she notes. "However, their details were very inconsistent. Our role has therefore been to unify them by developing one series of clear procedures that all our colleagues who work in operating theatres can follow effectively."

Team checking by surgeons, anaesthetists and nurses
The World Health Organization (WHO) also regards surgical safety as the second challenge, and it has addressed this by formulating relevant guidelines and a checklist for the reference of healthcare organisations around the world.
 
Dr Lee's team took note of the WHO guidelines while it was consolidating the many views and ideas it had received from its colleagues in cluster hospitals. They also gained the support from
representatives of various specialties. One subject it particularly considered was what information should be checked, and when. After in-depth discussion, it developed guidelines that it felt best suited the needs of Hong Kong and the HA. These are based on a concept of teamwork involving the three categories of healthcare professionals who work in operating theatres, namely surgeons, anaesthetists and nurses.
 
   
However, guidelines are still only guidelines. To be useful and effective, they must be implemented by people. "Our approach is for the three categories of healthcare professionals – each of whom plays a different role before, during and after surgery – to work together in following the three steps of surgical safety," explains Dr Lee.

"That means each category is responsible for checking the items related to their own role, while one colleague is responsible for co-ordinating the entire process and leading the team in checking key information, such as the patient's name and identity card number."

To illustrate this principle more clearly, Dr Lee's team has prepared a clever poster (right) that lists the most important points that need to be checked, as well as depicting a member of each professional category. This serves to remind all our colleagues in every category about the importance of teamwork in surgical safety.

Quoting from WHO data, Dr Lee highlights the fact that half of all the medical blunders that occur in developed countries and which result in permanent disability and death are related to surgical safety. Furthermore, medical statistics reveal that implementing a three-step surgical safety procedure can help to avoid a number of different types of medical blunders, such as the wrong surgical site being marked and medical consumables being left in the patient's body.

The Patient Safety and Risk Management Team plans to invite colleagues from hospitals to express their views about ways to improve the surgical safety policy further by attending a training and sharing workshop it is organising on 5 and 6 November.

The way forward
As for the next steps, the Patient Safety and Risk Management Team aims to introduce relevant checking guidelines for individual specialties. "For example, our colleagues should check different kinds of crucial information to safeguard patients who receive endoscopy, cardiography and radiotherapy treatment." Last, but not least, Dr Lee hopes to formulate similar mechanisms for use when patients undergo intrusive procedures in hospital wards.

Although the three-step policy is only being used in operating theatres at present, colleagues who work in other hospital environments should also remember one of its key messages, which is "time out". When undertaking each step of a complicated medical task under considerable pressure, all of us should pause for just a moment to check that we have done it in a satisfactory way before we proceed to the next step. Let's strive together to build up the safety culture and strengthen our risk-management mechanisms!