Robert Marie-Claude, Choi Catherine J, Shapiro Fred E, Urman Richard D, Melki Samir
From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA.
From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA.
J Cataract Refract Surg. 2015 Oct;41(10):2171-8. doi: 10.1016/j.jcrs.2015.10.060.
To implement and measure the effect of a surgical safety checklist on the prevention of serious medical errors (never-events).
Boston Eye Group, Boston, Massachusetts, USA.
Retrospective cohort study.
A safety checklist incorporating 28 sources of error was designed and implemented in December 2011 at the Boston Eye Group's refractive surgical center. Consecutive patients who had primary or enhancement laser vision correction (LVC) between July 2009 and February 2014 were included in this study. Before that date, a general checklist fashioned around the World Health Organization time-out procedure was used. The latter subjects were recruited as controls. The perioperative characteristics of both groups were retrospectively compared.
The study comprised 2951 consecutive patients who had primary or enhancement LVC between July 2009 and February 2014; of these, 1417 patients (2744 eyes) had LVC after the implementation of a presurgical safety checklist. The general checklist fashioned around the World Health Organization time-out procedure was used for 1534 patients (2969 eyes). Both groups were comparable in patient age. The most common surgical procedures were laser in situ keratomileusis (78%) and laser-assisted subepithelial keratectomy with mitomycin-C (16%). Although there were 2 (0.07%) serious errors in the prechecklist cohort, none occurred following implementation of the safety checklist protocol (P = .23). The medical errors involved wrong refractive aim in 1 patient and wrong person-wrong procedure-wrong aim in another.
Multiple potential sources of error exist in refractive surgery. The broad-scale implementation of a detailed presurgical safety checklist was helpful in minimizing and preventing serious errors (never-events) during LVC.
Drs. Shapiro and Urman are members of the Institute for Safety in Office-Based Surgery, a nonprofit organization whose aims are to implement safety checklists for office-based surgery. No author has a financial or proprietary interest in any material or method mentioned.
实施并评估手术安全检查表对预防严重医疗差错（重大不良事件）的效果。
美国马萨诸塞州波士顿的波士顿眼科集团。
回顾性队列研究。
2011年12月，在波士顿眼科集团的屈光手术中心设计并实施了一份包含28个差错来源的安全检查表。纳入2009年7月至2014年2月期间接受初次或增效激光视力矫正（LVC）的连续患者。在此日期之前，使用的是围绕世界卫生组织暂停程序制定的通用检查表。将后者的患者招募为对照。对两组的围手术期特征进行回顾性比较。
该研究包括2009年7月至2014年2月期间连续接受初次或增效LVC的2951例患者；其中，1417例患者（2744只眼）在实施术前安全检查表后接受了LVC。1534例患者（2969只眼）使用了围绕世界卫生组织暂停程序制定的通用检查表。两组患者年龄相当。最常见的手术方式是准分子原位角膜磨镶术（78%）和丝裂霉素C辅助的准分子上皮下角膜磨镶术（16%）。虽然检查表实施前的队列中有2例（0.07%）严重差错，但在实施安全检查表方案后未发生严重差错（P = 0.23）。医疗差错包括1例患者的屈光目标错误和另1例患者的错人 - 错程序 - 错目标。
屈光手术中存在多种潜在的差错来源。详细的术前安全检查表的广泛实施有助于在LVC期间减少和预防严重差错（重大不良事件）。
夏皮罗博士和厄曼博士是门诊手术安全研究所的成员，该非营利组织的目标是为门诊手术实施安全检查表。没有作者对文中提及的任何材料或方法拥有财务或所有权权益。
