Mason Matthew Charles, Griggs Rebecca Katie, Withecombe Rachel, Xing Eunice Yun, Sandberg Charlotte, Molyneux Matthew Keith
Department of General Surgery, Weston General Hospital, Weston-super-Mare, UK.
Department of General Surgery, Royal United Hospitals, Bath, UK.
BMJ Open Qual. 2018 Aug 21;7(3):e000294. doi: 10.1136/bmjoq-2017-000294. eCollection 2018.
National Health Service England published the National Safety Standards for Invasive Procedures (NatSSIP) in 2015. They mandated that individual trusts produce Local Safety Standards for Invasive Procedures (LocSSIPs), a set of safety standards drawn from the NatSSIP that apply to a particular clinical situation in a given department, for all invasive procedures. The project goal was to design and implement the LocSSIP within the endoscopy department. A draft LocSSIP was produced, and a pilot study conducted to gain initial feedback on its use. Version 1 of the checklist was produced and after approval, rolled out for use within the endoscopy department at 'time out' and 'sign out'. A scoring system was developed that allowed the quality of the performance of LocSSIPs to be assessed and recorded as a 'compliance score'. After 2 months, an independent observer spent a week assessing use of the checklist, recording completion and a compliance score. Analysis of this data led to a number of changes in performing the checklist, wider multidisciplinary team education and integration of the checklist into existing documentation, before reassessing at 12 months. In 2016, 'time out' checks were completed in 100% of cases, but full completion was only observed in 68%. 'Sign out' checks were completed in 91% of cases, with full completion in 71%. In 2017, 'time out' checks were completed in 100% of cases, with full completion in 85%. 'Sign out' checks were completed in 100% of cases, with full completion in 91%. The composite score for compliance in 2016 was 57% increasing to 90% in 2017. In conclusion, stronger departmental leadership, broadening education and integration of the checklist into routine documentation to reduce duplication led to significant improvements in compliance with use of the checklist. Ongoing education and assessment is imperative to ensure that compliance is maintained to ensure patient safety.
英国国家医疗服务体系于2015年发布了《侵入性操作国家安全标准》（NatSSIP）。该标准要求各信托机构制定《侵入性操作地方安全标准》（LocSSIPs），这是一套从NatSSIP中提取的安全标准，适用于特定部门特定临床情况下的所有侵入性操作。该项目的目标是在内镜科室设计并实施LocSSIP。制定了LocSSIP草案，并进行了一项试点研究以获取关于其使用的初步反馈。生成了清单的第1版，经批准后，在内镜科室的“暂停”和“签字确认”环节推出使用。开发了一个评分系统，用于评估和记录LocSSIP的执行质量，作为“合规分数”。2个月后，一名独立观察员花了一周时间评估清单的使用情况，记录完成情况和合规分数。对这些数据的分析导致在重新评估12个月之前，在执行清单、更广泛的多学科团队教育以及将清单纳入现有文档方面进行了一些更改。2016年，100%的病例完成了“暂停”检查，但只有68%观察到完全完成。91%的病例完成了“签字确认”检查，完全完成的比例为71%。2017年，100%的病例完成了“暂停”检查，完全完成的比例为85%。100%的病例完成了“签字确认”检查，完全完成的比例为91%。2016年的综合合规分数为57%，2017年增至90%。总之，更强有力的部门领导、扩大教育范围以及将清单纳入常规文档以减少重复工作，导致清单使用的合规性有了显著提高。持续的教育和评估对于确保维持合规性以保障患者安全至关重要。
