Application of healthcare failure mode and effect analysis in preventing nursing interruption with negative outcome in operating room / 中国实用护理杂志

Objective:To explore the effect of healthcare failure mode and effect analysis (HFMEA) in reducing the incidence of nursing interruption with negative outcome in operating room, so as to maximize the smooth progress of the surgical process.Methods:This was a quasi experimental study. The gastrointestinal surgery room of Shandong Provincial Hospital Affiliated to Shandong First Medical University was selected for the study. According to the surgical sequence, 38 surgeries performed in the gastrointestinal surgery suite from August 15-30, 2021 were set as the control group, and the conventional healthcare cooperation model process was implemented; 42 surgeries performed from September 15-30, 2021 were set as the intervention group, and the operating room under the HFMEA model was implemented negative outcome care disruption event management process.A video tracking method combined with a surgical care disruption event register was used to investigate the occurrence of negative outcome care disruption events in the operating room, comparing the number, duration, source of disruption events and the incidence of near miss events in the operating room between the control group and the intervention group.Results:In the control group, there were 38 observed surgeries, 190 negative outcome care interruptions, negative outcome interruptions of (5.26 ± 1.02) min duration, and no near misses; in the intervention group, there were 42 observed surgeries, 84 negative outcome care interruptions, negative outcome interruptions of (2.06 ± 0.08) min duration, and no near misses. There were statistically significant differences in the number, duration of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 18.71, t = - 20.28; all P<0.01). There was statistically significant difference in the source of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 12.71, P<0.01). Conclusions:HFMEA model can effectively reduce the number of negative nursing interruptions in the operating room, shorten the duration of interruptions, and minimize potential safety hazards caused by nursing interruptions, which is conducive to ensuring the safety of patients.

Spinal anesthesia increases the frequency of extubation in the operating room and decreases the time of mechanical ventilation after cardiac surgery

Abstract Introduction: The delayed extubation of patients undergoing mechanical ventilation (MV) in the postoperative period of cardiac surgery (CS) is associated with mortality. The adoption of spinal anesthesia (SA) combined with general anesthesia in CS influences the orotracheal intubation time (OIT). This study aims to verify if the adoption of SA reduces the time of MV after CS, compared to general anesthesia (GA) alone. Methods: Two hundred and seventeen CS patients were divided into two groups. The GA group included 108 patients (age: 56±1 years, 66 males) and the SA group included 109 patients (age: 60±13 years, 55 males). Patients were weaned from MV and, after clinical evaluation, extubated. Results: In the SA group, considering a 13-month period, 24% of the patients were extubated in the operating room (OR), compared to 10% in the GA group (P=0.00). The OIT was lower in the SA group than in the GA group (SA: 4.4±5.9 hours vs. GA: 6.0±5.6 hours, P=0.04). In July/2017, where all surgeries were performed in the GA regimen, only 7.1% of the patients were extubated in the OR. In July/2018, 94% of the surgeries were performed under SA, and 64.7% of the patients were extubated in the OR (P=0.00). The OIT on arrival at the intensive care unit to extubation, comparing July/2017 to July/2018, was 5.3±5.3 hours in the GA group vs. 1.7±3.9 hours in the SA group (P=0.04). Conclusion: The adoption of SA in CS increased the frequency of extubations in the OR and decreased OIT and MV time.

Utilization effect evaluation for operation rooms based on time node / 中华医院管理杂志

Objective@#To analyze the effect of variables on both " effective operative time" and " operative turnaround rate" .@*Methods@#Based on the time node data of operation rooms (OR) of a hospital in 2017, SPSS 19.0 statistical software was used to analyze the " effective operative time" and " operative turnover rate" under different condition variables. The methods include mean value, standard deviation and independent sample t test.@*Results@#The mean values of " effective operative time" varied with months (with the highest month of 9.18±2.49 h/d, and the lowest month of 7.93±2.60 h/d), and with workdays as well (the highest on Monday: 8.72±2.57 h/d, and the lowest on Friday: 7.77±2.67 h/d). Meanwhile it also varied with ORs (the highest of 9.92±2.50, and the lowest of 4.84±1.98). In surgeries which started before 8: 30 am, the effective operative time of OR was significantly higher than others. On Mondays, the effective operative time of ORs was the highest, but the operative turnover rate was poor (as low as 13.20%). There was significant difference in the operative turnover rate between specialized ORs and those not for general purpose.@*Conclusions@#In order to optimize the comprehensive utilization of operation rooms, it is necessary to coordinate the operations, reduce the proportion of non-planned operations on " Mondays" , raise the turnover rate, and strengthen the coordination between working posts.

The design of a kind of multifunctional wire arranging plate and the relative analysis for its effect and satisfaction in the application of operation room / 中国医学装备

Objective: To analyze the clinical application effect and satisfaction of a self designed multifunctional wire arranging plate in the nursing care of operation rooms. Methods: 108 patients who had received abdominal operation were divided into observation group (54 cases) and control group (54 cases) according to random method. And risk nursing was applied in both of two groups, while a multifunctional wire arranging plate was given additionally to the observation group. The psychological comfort level, quality of care and satisfaction between the two groups were compared. Results: The postoperative SAS and SDS scores of both groups were better than that of preoperative scores, and the postoperative SAS and SDS of observation group were significantly higher than that of control group (t=9.2126, t=13.3934, P<0.01). And the scores of basic nursing, aseptic condition, nursing record, goods management and safety management of the observation group were (96.23±3.24), (95.56±7.23), (93.36±6.32), (93.65±6.45) and (95.69±2.65), respectively. And all of them were significantly better than that of the control group (t=12.1185, t=13.8281, t=8.7427, t=11.0142, t=10.0133, P<0.01). The difference of total satisfaction rate of nursing between the observation group (94.44%) and control group (79.63%) was significant (x2=5.2523, P<0.05). Conclusion: The application of a multifunctional wire arranging plate for nursing care in operation rooms can effectively enhance the psychological comfort level of patients, and promote the quality improvement of nursing, and enhance nursing satisfaction of patients.

El ambiente quirúrgico seguro: paradigma emergente en la práctica profesional de la cirugía / The safe surgical environment: emergent paradigm in the surgical professional practice

Desde que las Guerras Mundiales que se escenificaron en el siglo XX, en los teatros operacionales del conflicto en Europa, Norte de Africa, medio oriente, Asia, I y II Guerras Mundiales, Corea, Viet Nam, Afganistán Guerra Arabe- Israelí obligó a los países involucrados a atender a los millones de víctimas resultantes, planificando, organizando y rediseñando a pasos acelerados las estructuras de asistencia médica, capaces de suministrar recursos de atención masivo del trauma y estrategias para tratar a sus soldados y a la población civil. La consecuencia positiva para el avance de la medicina y especialmente de la cirugía de estos tragicos sucesos, fue la aparición y el desarrollo de la "cirugía compleja" y la conquista del abordaje quirúrgico de regiones del cuerpo humano, hasta ese momento vedados a la actividad del tratamiento quirúrgico: cavidad craneal, cirugía torácica, trauma cardiovascular, cirugía intestinal de urgencia, anestesia y manejo respiratorio, antibióticos, derivados sanguíneos, resucitación cardio-respiratoria y evacuación y trasporte de heridos. Varias décadas después el desarrollo de esta cirugía compleja, produjo un aumento desmesurado de la morbi-mortalidad ocasionado principalmente por los efectos de la anestesia inadecuada, hemorragias masivas, infección-sepsis y factores de error humano. Surgen entonces nuevas líneas de investigación clínica para identificar y disminuir estos factores. Esos esfuerzos logran al final del siglo XX y comienzos del XXI, resultados tangibles y eficaces mejorando los resultados finales de la cirugía. Por estos logros surge un nuevo paradigma en el mundo de la cirugía, conocido como "el ambiente quirúrgico seguro"; que comprende estrategias operativas y organizacionales, tales como: reingeniería de quirófanos, innovaciones tecnológicas, digitalización de aparatos de registro y la protección integral de los equipos humanos interactuantes en los servicios quirúrgicos. En este ensayo se describen...

Since the occurrence of the World Wars in the 20th. Century, at the military operational theatres in Europe, North Africa, Meddle East, Korea, Viet nam, Afghanistan and Israel the countries involved in these conflicts were forced to render medical care to the million of casualities in thousands of battlefields, specially organizing massive trauma care to military personnel also to civilian populations. The positive result of this tragic scenarios was that medicine as a whole and surgery, was the development of the so called "complex surgical care", and the conquest of the surgical approach of different regions of the human body, until then impossible to reach with therapeutic efficacy: intracranial structures, thoracic surgery, cardio-vascular injuries, acute intestinal trauma anesthesia and respiratory ventilation, antibiotics, blood replacement, cardio pulmonary resuscitation; and triage and the planning of transport of wounded soldiers. Some decades later, the development of the complex surgery reachers alarming levels of morbidity and mortality, mainly due to inadequate delivered anasthesia, massive hemorrhage, uncontrolled bacterial infections-sepsis and lethal consequences of human errors. New lines of clinical investigations and research conducted in the late XX century and early XXI century gave the answers to obtain strategies to diminish and fight this adverse factors; improving better outcomes for surgical therapies. This achievement gave birth to a new paradigm into the surgical world which is identified nowadays as the "safe surgical environment", compromising new strategies to redesing surgical operating rooms, application of technological discoveries, digitalization of patient's surveillance and bio protection of the surgical personnel avoiding events as accidents, thermal injuries, and infections with transmissible diseases in this scenario. In this paper will be described fundamental definitions of novel paradigm, reviewing concepts...