Vilz T O, Günther-Lübbers T-C, Stoffels B, Lorenzen H, Schäfer N, Kalff J C, Overhaus M
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland.
Institut für Medizinische Biometrie, Informatik und Epidemiologie, Universitätsklinikum Bonn, Deutschland.
Zentralbl Chir. 2016 Feb;141(1):37-44. doi: 10.1055/s-0034-1396146. Epub 2015 Feb 27.
In recent years there has been a significant increase of surgical procedures worldwide. Perioperative complication occurred in approximately 10 %, mortality was about 0.5 %. Half of these adverse events were considered to have been preventable. With the introduction of a perioperative checklist by the WHO in 2008, a significant reduction of morbidity and mortality could be achieved. The aim of this study was to investigate the success of the implementation process of the checklist at a maximum care hospital over a three-year period and to expose and analyse any occurring issues.
At various time points (introduction phase, five months, one year and three years after implementation) a total of 358 operations was investigated. First the presence and the handling of the checklist were investigated followed by an analysis of possible influencing factors on the processing. To examine a potential perioperative malpractice, three typical perioperative errors known from the literature on patient safety were analysed.
The presence of the checklist improved significantly during the study. With the exception of the first column (signed by ward nurse) the checklist was processed more often among the participants (anaesthesia nurse, anaesthesia physician, surgeon) over the time. However the "sign out" column edited by the surgeon at the end of the operation fell below expectations. In addition to the duration after implementation the level of experience of the surgeon was a relevant factor for a properly completed checklist. During the study a malpractice was found in two cases, a checklist could not be detected.
Within the study we could demonstrate the difficulties of introducing a surgical checklist at a maximum care hospital. Therefore involved nursing or medical staff must be aware of the usefulness of the checklist and should be motivated to use it. In addition, periodical lectures, training courses and role modelling of nursing and medical staff are required. The objective must be to establish the checklist into daily routine as it is a simple and efficient tool to reduce perioperative morbidity and mortality.
近年来，全球外科手术数量显著增加。围手术期并发症发生率约为10%，死亡率约为0.5%。其中一半的不良事件被认为是可以预防的。2008年世界卫生组织引入围手术期检查表后，发病率和死亡率显著降低。本研究的目的是调查一家特级护理医院在三年期间检查表实施过程的成效，并揭示和分析出现的任何问题。
在不同时间点（引入阶段、实施后五个月、一年和三年）共调查了358例手术。首先调查检查表的存在情况和处理方式，然后分析对流程可能产生影响的因素。为了检查潜在的围手术期医疗失误，分析了文献中关于患者安全的三种典型围手术期错误。
在研究期间，检查表的存在情况有显著改善。除第一栏（由病房护士签字）外，随着时间推移，检查表在参与者（麻醉护士、麻醉医生、外科医生）中被处理的频率更高。然而，外科医生在手术结束时编辑的“签字确认”栏未达预期。除了实施后的时长外，外科医生的经验水平也是检查表正确填写的一个相关因素。研究期间发现两例医疗失误，其中一例未发现检查表。
在本研究中，我们证明了在特级护理医院引入手术检查表存在困难。因此，相关护理或医务人员必须意识到检查表的有用性，并应积极使用它。此外，需要定期举办讲座、培训课程，并为护理和医务人员树立榜样。目标必须是将检查表融入日常工作，因为它是降低围手术期发病率和死亡率的简单有效工具。
