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A standardized marking procedure for ENT operations to prevent wrong-site surgery: development, establishment and subsequent evaluation among patients and medical personnel.一种用于耳鼻喉科手术的标准化标记程序,以防止手术部位错误:在患者和医务人员中的开发、建立和后续评估。
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本文引用的文献

1
A survey of surgical team members' perceptions of near misses and attitudes towards Time Out protocols.一项关于手术团队成员对险些失误的认知以及对暂停程序态度的调查。
BMC Surg. 2013 Oct 9;13:46. doi: 10.1186/1471-2482-13-46.
2
Patient safety in the operating room at a governmental hospital.政府医院手术室中的患者安全。
J Egypt Public Health Assoc. 2013 Aug;88(2):85-9. doi: 10.1097/01.EPX.0000430955.28520.e5.
3
Surgical checklists: a systematic review of impacts and implementation.手术核对清单:对影响和实施情况的系统评价
BMJ Qual Saf. 2014 Apr;23(4):299-318. doi: 10.1136/bmjqs-2012-001797. Epub 2013 Aug 6.
4
Prevention of wrong-site and wrong-patient surgical errors.预防手术部位错误和患者错误相关的手术失误。
Prescrire Int. 2013 Jan;22(134):14-6.
5
Incidence of neurosurgical wrong-site surgery before and after implementation of the universal protocol.神经外科错误部位手术在实施通用协议前后的发生率。
Neurosurgery. 2013 Apr;72(4):590-5; discussion 595. doi: 10.1227/NEU.0b013e318283c9ea.
6
Patient safety in the operating room: I. Preoperative.手术室患者安全:I. 术前。
Plast Reconstr Surg. 2012 Nov;130(5):1038-1047. doi: 10.1097/PRS.0b013e31826945d6.
7
Avoiding wrong site surgery: a systematic review.避免错误部位手术:系统评价。
Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S28-36. doi: 10.1097/BRS.0b013e3181d833ac.
8
Preventing surgical confusions in ophthalmology (an American Ophthalmological Society thesis).预防眼科手术中的混淆(美国眼科学会论文)
Trans Am Ophthalmol Soc. 2007;105:513-29.
9
Site and side of surgery: getting it right.手术部位与手术侧别:确保正确无误
Can J Surg. 2003 Apr;46(2):85-9.
10
Incidence of wrong-site surgery among hand surgeons.手外科医生中手术部位错误的发生率。
J Bone Joint Surg Am. 2003 Feb;85(2):193-7. doi: 10.2106/00004623-200302000-00002.

“是左眼,对吧?”

"It is the left eye, right?".

机构信息

Risk Management and Patient Safety Unit, Assuta Hospital, Ramat Hachayal, Tel-Aviv, Israel.

Research Wing, Ziv Medical Center, Safed, Israel ; Tel-Hai Academic College, Upper Galilee, Israel.

出版信息

Risk Manag Healthc Policy. 2014 Apr 8;7:77-80. doi: 10.2147/RMHP.S60728. eCollection 2014.

DOI:10.2147/RMHP.S60728
PMID:24748828
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3986280/
Abstract

OBJECTIVE

Because wrong-site confusion is among the most common mistakes in the operations of paired organs, we have examined the frequency of wrong-sided confusions that could theoretically occur in cataract surgeries in the absence of preoperative verification.

METHODS

Ten cataract surgeons participated in the study. The surgeons were asked to complete a questionnaire that included their demographic data, occupational habits, and their approach to and the handling of patients preoperatively. On the day of operation, the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a 2-meter distance from the patient's face. The surgeons' answers were compared to the actual operation side. Patients then underwent a full time-out procedure, which included side marking before the operation.

RESULTS

Of the total 67 patients, the surgeons correctly identified the operated side of the eye in 49 (73%) by name and in 56 (83%) by looking at patients' faces. Wrong-side identification correlated with the time lapsed from the last preoperative examination (P=0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (P=0.000). Surgeon seniority or age did not correlate to the number of wrong identifications.

CONCLUSION

This study illustrates the high error rate that can result in the absence of side marking prior to cataract surgery, as well as in operations on other paired organs.

摘要

目的

由于错侧混淆是配对器官手术中最常见的错误之一,因此我们检查了在没有术前验证的情况下,白内障手术中可能理论上发生的错侧混淆的频率。

方法

十位白内障外科医生参与了这项研究。要求外科医生填写一份问卷,内容包括他们的人口统计学数据、职业习惯以及他们术前对患者的处理方式。在手术当天,外科医生仅根据患者的姓名来识别手术侧。在研究的第二阶段,外科医生被要求在距离患者面部两米的距离处识别手术侧。将外科医生的答案与实际手术侧进行比较。然后,患者接受了全面的暂停程序,包括手术前的侧标。

结果

在总共 67 名患者中,外科医生通过姓名正确识别了 49 名(73%)患者的手术眼,通过观察患者的面部正确识别了 56 名(83%)患者的手术眼。错误侧识别与上次术前检查的时间间隔有关(P=0.034)。同一外科医生(同一天)进行的白内障手术数量也与错误识别数量相关(P=0.000)。外科医生的资历或年龄与错误识别数量无关。

结论

这项研究说明了在白内障手术或其他配对器官手术前不进行侧标时可能导致的高错误率。