Pt safty

1. PATIENT SAFETY IN
SURGERY
PROF. PANKAJ G. JANI
ASSOCIATE PROFESSOR
DEPARTMENT OF SURGERY
UNIVERSITY OF NAIROBI

2. SAFETY IS PARAMOUNT
 PRIMAM NON NOCERE
 FIRST DO NO HARM
 PATIENT SAFETY IS COMPROMISED
BY ERRORS

3. ERRORS
ERRORS IN HEALTH CARE
ARE THE EIGHTH LEADING
CAUSE OF DEATH IN THE U.S.
AND ACCOUNTS FOR 120,000
DEATHS ANNUALLY

4. CRISIS IN HEALTH CARE
National Safety Council, 1998

5. ERROR
 OF EXECUTION  FAILURE OF
PLANNED ACTION TO BE COMPLETED
AS INTENDED
 OF PLANNING  USE OF WRONG PLAN
TO ACHIEVE AN AIM

6. ADVERSE EVENT
(COMPLICATION)
INJURY CAUSED BY MEDICAL
MANAGEMENT OTHER
THAN THE UNDERLYING
CONDITION OF THE PATIENT

7. ADVERSE EVENT
 IF CAUSED BY ERROR(S) – IT IS
PREVENTABLE
 66% OF ALL ADVERSE EVENTS
ARE SURGICAL
 50% OF ALL ADVERSE EVENTS ARE
PREVENTABLE

8. PATIENT SAFETY IS THE PRIME DUTY OF THOSE:-
 ORGANISING }
 MANAGING } MEDICAL PRACTICE
 CONTROLLING }
THEY MUST PROVIDE
 THE RIGHT ENVIRONMENT } FOR DOCTORS
 MOTIVATED STAFF } TO TREAT
 CORRECT EQUIPMENT } PATIENTS
 ADEQUATE SUPPORT } SAFELY

9.  IN THE DEVELOPED WORLD THE
FOREGOING ITEMS ARE AVAILABLE SO TO
IMPROVE PATIENT SAFETY, IMPROVEMENT OF
“SAFETY CULTURE” IS CONCERNTRATED
UPON.
 IN DEVELOPING COUNTRIES FAR FROM
ABOVE AND A DIFFERENT FORUM NEEDED TO
ADDRESS ISSUES OF PROVISION OF SOUND
MEDICAL ENVIRONMENT AND THEREFORE I
WILL CONCERNTRATE ON LOCAL PROBLEMS
TO IMPROVE PATIENT SAFETY

10. RECRUITMENT FOR
SURGICAL TRAINING
SPECIAL SKILLS REQUIRED
 COMMUNICATION
 CLINICAL APTITUDE
 ATTITUDE
 MANUAL DEXTERITY
 PHYSICAL SKILLS } TO SELECT
 PSYCHOMETRIC } SURGEONS
TESTING } FOR TRAINING

11. TO IMPROVE PATIENT SAFETY
IN SURGERY IN DEVELOPING
COUNTRIES
 A GOOD SURGEON KNOWS WHEN NOT
TO OPERATE
 BIG SURGEONS MAKE BIG INCISIONS
 USE OF DRAINS
 USE OF NASOGASTRIC TUBES
 COLON PREPARATION
 ANTIBIOTICS

12. A GOOD SURGEON
KNOWS WHEN NOT TO
OPERATE
 INVESTGATIVE FACILITIES LIMITED
(C.T., U/S)
 GOOD CLINICAL SKILLS ESSENTIAL
 DEDICATION AND WORK DISCIPLINE
REQUIRED (REPEATED FREQUENT
EXAMINATIONS)
 BASIC LABORATORY FACILITIES TO BE
AVAILABLE

13. A GOOD SURGEON KNOWS
WHEN NOT TO OPERATE
 CANCER OF THE OESOPHAGUS (95% ADV)
 CANCER OF THE STOMACH (>90%)
 CANCER OF THE PANCREAS (>95% ADV)
 MANY OPERATED FOR PALLIATIVE CARE
AND WITH VERY LITTLE BENEFIT
 NEGATIVE APPENDECTOMY RATES(25%)
 NEGATIVE LAPAROTOMY RATES(PASW)
App. (20%)

14. BIG SURGEONS MAKE
BIG INCISIONS
 TREND FROM LOGITUDINAL INCISIONS TO
TRANSVERSE INCISIONS
 CAN OPERATE CONFIDENTLY WHEN YOU CAN
SEE CLEARLY
 DELAYED PRESENTATION
 ADVANCED PATHOLOGY
 ANTOMY DISTORTED

15. DRAINS
 ADVANCED PATHOLOGY
 DELAYED TREATMENT 
- DISTORTED ANTOMY

- DIFFICULT DISSECTION

MORE POST-OP COLLECTIONS
 POOR POST-OP INVESTIGATIVE FACILITIES

16. NESOGASTRIC TUBES
 YOUNG PATIENTS
 BENEFIT OUTWEIGHS HARM

17. COLON PREPARATION
LOCAL SERIES REQUIRED
BEFORE IT IS GIVEN UP

18. ANTIBIOTICS
SURGERY OF CONTAMINATED
AREAS SHOULD BE
DISCOURAGED IF
APPROPRIATE ANTIBIOTICS
NOT AVAILABLE

19. SURGERY WITHOUT
PROPER RESOURCES IS
BAD PRACTICE,
POTENTIALLY
DANGEROUS AND
UNACCEPTABLE