Anesthesiology, UTHSCSA, San Antonio, Texas, USA
Anesthesiology, UTHSCSA, San Antonio, Texas, USA.
BMJ Open Qual. 2022 Jan;11(1). doi: 10.1136/bmjoq-2021-001370.
Procedural time-outs and checklists are proven to be an effective means of improving teamwork and preventing wrong-sided procedures. The main objective of this study was to ensure that all regional nerve blocks being performed in the preoperative area at our hospital were executed with a proper time-out. The goal of this project was to increase integration of a safe preoperative block process including a time-out checklist to ensure; complete consents, correct patient and laterality were marked prior to each procedure. We focused on recognising events that took place before, during and after the nerve block including non-compliance with the checklist and deviations from protocol.
A safe preoperative block process current and future state flowchart, revised time-out checklist and action/implementation plan as part of our Plan-Do-Study-Act model was constructed using a multidisciplinary approach. Pre-implementation and post- implementation data were collected by medical students acting anonymously via direct observation noting the presence of an anaesthesiologist, resident, nurse, time-out for procedure, checklist completed and procedure start and sedation time representing a complete time-out.
The direct observations in the pre-implementation group showed a 20% (3/15) compliance with a correct time-out. The direct observations in the post implementation group showed 85% (12/14) compliance. This revealed a 65% increase in all portions of the time-out checklist completed. Comparative analysis confirmed decrease in non-compliance and deviations from protocol as displayed by 65% increase in all portions of time-out checklist completed.
We aimed to improve safety, communication and compliance for preoperative nerve blocks through development and implementation of a safe preoperative block process using a multidisciplinary model. We conclude that creation of a safe nerve block was achieved by integration of a preoperative nerve block process which included increased compliance to the time-out checklist, verifying patients and laterality with marking of patient prior to each procedure, identifying proper consents were completed and ensuring each regional nerve block was executed with a proper time-out.
程序暂停和清单已被证明是提高团队合作和防止手术失误的有效手段。本研究的主要目的是确保在我院术前区域进行的所有区域神经阻滞都经过适当的暂停。该项目的目标是整合安全的术前阻滞流程，包括暂停清单，以确保在每次操作前完成完整的同意书、正确标记患者和侧别。我们专注于识别在神经阻滞前后发生的事件，包括不遵守清单和违反方案的情况。
使用多学科方法构建安全术前阻滞流程当前和未来状态流程图、修订后的暂停清单以及行动计划，作为我们计划-执行-研究-行动模型的一部分。通过医学生匿名直接观察收集实施前和实施后的数据，记录麻醉师、住院医师、护士、手术暂停、清单完成以及手术开始和镇静时间的存在，代表完整的暂停。
实施前的直接观察显示，正确暂停的依从性为 20%（3/15）。实施后的直接观察显示，依从性为 85%（12/14）。这表明，完成暂停清单所有部分的依从性增加了 65%。比较分析证实，完成暂停清单所有部分的依从性增加了 65%，从而减少了不遵守和偏离方案的情况。
我们旨在通过使用多学科模型开发和实施安全的术前阻滞流程来提高术前神经阻滞的安全性、沟通和依从性。我们得出结论，通过整合术前神经阻滞流程，包括增加对暂停清单的依从性、在每次操作前标记患者以验证患者和侧别、识别完成适当的同意书并确保每次区域神经阻滞都经过适当的暂停，实现了安全的神经阻滞。
