[The use of RCGO triggers in the obstetric - gynecological procedures: the impact on the reduction of adeverse events. The experience of the Lombardia Region]. / L'utilizzo dei RCOG trigger in area ostetrica - ginecologica e la riduzione degli eventi avversi. L'esperienza della regione Lombardia.

The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until the end of pregnancy. The adverse events during labor and childbirth can have very serious physical, psychological and financial consequences for the child, the family, health professionals and the whole community. These events can be reduced through interventions aimed at improving the safety and quality of care, based on evidence-based knowledge, guidelines and practices that must be widely and effectively applied. This work reports the experience of the Lombardy Region on improvement actions in the obstetric and gynecological procedures for the reduction of adverse events and sentinel events through the monitoring and management of the RCGS trigger tool.

[The full risk based thinking management approach in Italian Healthcare Organizations 20 years after the publication of the book "To err is human"]. / L'approccio alla gestione full risk based thinking delle aziende sanitarie a 20 anni da To erri is human.

The COVID-19 pandemic event as an unexpected, non-preventable, unpredictable event in its many peculiarities requires a new reflection on the coordination of health risk management activities in Italian Healthcare Organizzations and the search for new skills that must be possessed by professionals who they cover the function of risk manager, documenting that the current approach to the safety of care requires an up date. In fact, it is necessary to rediscover a new paradigm in the area of health risk monitoring, prevention and management and the development of treatment safety strategies.

[Observational Team work Assessment for Surgery as Quality and Safety improvement tool]. / Il metodo osservazionale della capacità di lavorare in gruppo dell'equipe chirurgica: le OTAS (Observational team work Assessment for Surgery) quale strumento di migliormento della qualità e della sicurezza delle cure.

As in high reliability systems , also in surgery the causes of adverse events are primarily correlated to deficiencies in Non Technical Skills (individual and social skills), that contribute with Technical Skills to a safe surgical procedure. Non Technical Skills are cognitive behavioural and interpersonal abilities, that are not specific to the expertise of one profession, but very important to guarantee the patient safety and to reduce risk of errors and adverse events. The Observational Teamwork Assessment for Surgery (OTAS) is an useful tool to assess teamwork of the whole surgical team (surgeons, anaesthetists, nurses) in real time and through the surgical procedure (pre-intra-postoperative phases). OTAS consists of the two following parts: a) teamwork-related task checklist to fill by a surgeon, b) teamwork-related behaviours rated by a psychologist/human factors expert. Back translation in Italian language of the eight task checklists and of the rating scales of the five behavioural areas was performed by two Italian surgeons with certified English language knowledge. The OTAS model in Italian language was applied in four surgical procedures : the test-retest reliability was found to be acceptable with K- Pearson index. The internal consistency of behavioural scales appeared sound using Cronbach ?. OTAS is an useful tool to assess the risk factors correlated to patient and team and to detect the vulnerability areas where changes to reduce errors and improve surgical outcomes might be introduced.

[Infection risk and personal protective devices]. / Rischio infettivo e dispositivi di protezione individuale.

The Aa discuss the evidence and recommendations for the use of personal protective equipment by health care practitioners in general care settings; the use of aprons, gowns, gloves, eye protections, face masks is valutated on the basis of an assessment of the risk of transmission of microrganisms to the patient or from the patient to health care practitioners. The primary uses of personal protective equipment are to protect staff and reduce opportunities for transmission of microrganisms in hospitals. A trend to eliminate the unnecessary wearing of aprons, gowns and masks in general care settings has evolved over the past twenty years due to the absence of evidence that they are effective.