Trimmel H, Fitzka R, Kreutziger J, von Goedecke A
Abteilung für Anästhesie, Notfall- und Allgemeine Intensivmedizin, Karl Landsteiner Institut für Medizinische Simulation und Patientensicherheit, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Österreich.
Anaesthesist. 2013 Jan;62(1):53-60. doi: 10.1007/s00101-012-2117-y.
Adverse events are not unusual in a more and more complex anesthesiological environment. The main reasons for this are an increasing workload, economic pressure, growing expectations of patients and deficits in planning and communication. However, these incidents mostly do not refer to medical deficits but to flaws in non-technical skills (team organisation, task orientation, decision making and communication). The introduction of the WHO Safe Surgery Checklist depicted that a structural approach can improve the situation. However, it is still questionable if this measure is strong enough and recent publications revealed initial criticisms. Furthermore, remaining security gaps could be found even though the checklist was implemented in the anesthesiological practice of a big teaching hospital. Therefore, an additional checklist was developed to implement an anesthesia briefing in the daily routine. The main objective was to establish a security check before induction similar to the aeronautical pre-flight check. Additionally, this measure should improve coordination of the anesthesiology team. Working through the checklist, doctors and nurses are guided to focus on conjoint patient care prior to induction of anesthesia. In a web-based survey the general attitude of coworkers towards patient safety, as well as the acceptability of the new briefing check was scrutinised at two times: directly before implementation of the checklist and 1 year after. The results (84 % of medical and 97 % of healthcare staff answered the questionnaires) showed improvements with high relevance to parameters associated with awareness concerning safety issues and team coordination. In conclusion, it appears that patient safety can be significantly improved with little time effort of 3-5 min per patient. A prospective trial will be conducted to confirm the impact of this measure on improvements in patient safety.
在日益复杂的麻醉环境中,不良事件并不罕见。造成这种情况的主要原因是工作量增加、经济压力、患者期望不断提高以及规划和沟通方面的不足。然而,这些事件大多并非源于医疗缺陷,而是非技术技能方面的缺陷(团队组织、任务导向、决策和沟通)。世界卫生组织手术安全核对表的引入表明,一种结构化方法可以改善这种状况。然而,这项措施是否足够有力仍值得怀疑,最近的出版物也揭示了一些初步的批评意见。此外,尽管该核对表已在一家大型教学医院的麻醉实践中实施,但仍发现存在安全漏洞。因此,又制定了一份额外的核对表,以便在日常工作中进行麻醉术前简报。主要目的是在诱导麻醉前建立类似航空飞行前检查的安全检查。此外,这项措施应改善麻醉团队的协调。通过核对表的执行,医生和护士在麻醉诱导前被引导专注于联合的患者护理。在一项基于网络的调查中,两次审视了同事们对患者安全的总体态度以及新的术前简报核对表的可接受性:在核对表实施前和实施后1年。结果(84%的医务人员和97%的医护人员回答了问卷)显示,与安全问题意识和团队协调相关的参数有了显著改善。总之,似乎每位患者只需花费3至5分钟的少量时间就能显著提高患者安全。将进行一项前瞻性试验,以确认这项措施对改善患者安全的影响。