O documento discute indicadores de qualidade e segurança para pacientes cirúrgicos. Ele descreve o checklist da OMS para cirurgias seguras, que aborda problemas como o paciente, cirurgia e local corretos, anestesia e ressuscitação seguras, e trabalho em equipe efetivo. O estudo piloto mostrou que o uso do checklist reduziu a taxa de mortalidade e complicações em mais de um terço.

1. CAROLINAS MEDICAL CENTER Relato de Experiência: Segurança dos Pacientes Cirúrgicos no Perioperatorio: Indicadores de Qualidade Fábia Tlusty, RN II, BSN, CNOR

2. CHARLOTTE CAROLINA DO NORTE

3. CAROLINAS MEDICAL CENTER

4. CAROLINAS MEDICAL CENTER

5. WHO SCIP IHI AHRQ CMS ????? JCAHO AORN

13. PROGRAMA PILOTO CHECKLIST - WHO

14. London, UK EURO EMRO WPRO I SEARO AFRO PAHO I Amman, Jordan Toronto, Canada New Delhi, India Manila, Philippines Ifakara, Tanzania WPRO II Auckland, NZ PAHO II Seattle, USA O CHECKLIST DA OMS FOI TESTADO EM OITO CIDADES NO MUNDO

40. Resultados -Todos os Locais Haynes et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine 360:491-9. (2009) Baseline Checklist P value Cirurgias 3733 3955 - Morte 1.5% 0.8% 0.003 Complicacoes 11.0% 7.0% <0.001 Infeccao Sitio Cirurgico 6.2% 3.4% <0.001 Reoperacao Nao Planejada 2.4% 1.8% 0.047

48. Consentimento Cirurgico

50. Verificacao de Procedimento Checklist

53. STEPPS

54. IntraOp Screens: 01 General Case Information

69. SCD'S FOTO

73. BEAR HUGGER FOTO

75. INICIATIVA SCIP

84. 2514 5097 892 1842 799 1658 823 1597 Number of Cases #DIV/0! 50,3% 47,0% 59,0% 45,0% Staff Attendance at Rotating Stations #DIV/0! 45,8% 52,0% 48,0% 37,5% Staff Attendance at Auditorium In-services Education Attendance 53,3% 31,0% 56,0% 31,0% 52,0% 31,0% 52,0% 31,0% Posting Accuracy +/- 15 minutes Posting Accuracy of Length of Case Time 59,0% 77,7% 53,0% 79,0% 48,0% 76,0% 76,0% 78,0% 100,0% Pt. family/friends update during surgery every hr. Patient Satisfaction #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Eye protection worn by OR staff #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Hand wash/Foam in/out #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Safe Zone Identified/ Utilized appropriately #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Bovie Holster in use #DIV/0! #DIV/0! 100,0% Horizontal surfaces dusted in room prior to first case of the day Back to Basics #DIV/0! #DIV/0! Cases Cancelled #DIV/0! #DIV/0! 100,0% Pain assessment completed Preop Holding #DIV/0! Cases Cancelled 22,7 19,00 18,00 31,00 20 minutes Anesthesia Clinic Wait Preop Screening 13,0% 32,3% 14,0% 32,0% 14,0% 33,0% 11,0% 32,0% # Flash Loads/Procedure 8,0 3,1 7,2 3,1 7,4 3,0 9,3 3,1 2,1 # Procedures/Flash load 291,0 369,4 123 585 108 551 88 515 # Flash Loads 1202,2 1343,4 891 1842 799 1658 821 1597 # Procedures Sterile Processing 92,7% 92,6% 92,0% 93,0% 95,0% 92,0% 91,0% 92,0% 100,0% Fire Safety Measures Implemented ODS MOR ODS MOR ODS MOR ODS MOR GOAL 1st Q 09 MAR FEB JAN II: MEDICAL MANAGEMENT/QUALITY #DIV/0! #DIV/0! 100,0% Critical test results reported to surgeon within 20 min (FS ) #DIV/0! 99,0% 100,0% 97,1% 100,0% 100,0% Critical test results reported to surgeon within 30 min. (PTHI) 99,0% 97,0% 99,0% 98,0% 99,0% 94,0% 99,0% 95,0% 100,0% Risks and Benefits noted prior to surgery 99,8% 98,4% 99,90% 99,50% 100,00% 93,00% 99,60% 99,80% 100,0% Patient Identification 100,0% 99,9% 100,0% 100,0% 100,0% 100,0% 100,0% 99,7% 100,0% Pt. Free of Retained Foreign Bodies N/A 97,7% N/A 100,0% N/A 98,0% N/A 95,0% 100,0% Intraoperative Transplant Data Form Completion all procedures Risk/Patient Safety 99,7% 99,6% 100,0% 99,8% 99,9% 99,9% 98,8% 99,5% 100,0% Time out Documented 95,7% 96,3% 94,0% 97,0% 94,0% 97,0% 96,4% 97,0% 100,0% Implants and instrumentation available per Picis #DIV/0! #DIV/0! 100,0% Implants and instrumentation available chart audit #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Time out Pause- All team members #DIV/0! #DIV/0! 100,0% Universal Protocol Documentation Complete UNIVERSAL PROTOCOL #DIV/0! #DIV/0! Mediastinal Procedures #DIV/0! #DIV/0! Back Procedures #DIV/0! #DIV/0! Total Joints Surgical Infection Rate 89,5% IP SCIP: Appropriate Care Score All Components 100,0% 100,0% Pt.is normothermic immediately post op for colorectal procedures 99,6% 100,0% Hair removal with clippers 80% * 99,3% 100,0% Prophylactic Antibiotic Selection 85% * 97,4% 100,0% Antibiotic given 1 hr prior to incision SCIP ODS MOR ODS MOR ODS MOR ODS MOR GOAL 1st Q 09 MAR FEB JAN II: MEDICAL MANAGEMENT/QUALITY

85. 2514 5097 892 1842 799 1658 823 1597 Number of Cases #DIV/0! 50,3% 47,0% 59,0% 45,0% Staff Attendance at Rotating Stations #DIV/0! 45,8% 52,0% 48,0% 37,5% Staff Attendance at Auditorium In-services Education Attendance 53,3% 31,0% 56,0% 31,0% 52,0% 31,0% 52,0% 31,0% Posting Accuracy +/- 15 minutes Posting Accuracy of Length of Case Time 59,0% 77,7% 53,0% 79,0% 48,0% 76,0% 76,0% 78,0% 100,0% Pt. family/friends update during surgery every hr. Patient Satisfaction #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Eye protection worn by OR staff #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Hand wash/Foam in/out #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Safe Zone Identified/ Utilized appropriately #DIV/0! 100,0% 100,0% 100,0% 100,0% 100,0% Bovie Holster in use #DIV/0! #DIV/0! 100,0% Horizontal surfaces dusted in room prior to first case of the day Back to Basics #DIV/0! #DIV/0! Cases Cancelled #DIV/0! #DIV/0! 100,0% Pain assessment completed Preop Holding #DIV/0! Cases Cancelled 22,7 19,00 18,00 31,00 20 minutes Anesthesia Clinic Wait Preop Screening 13,0% 32,3% 14,0% 32,0% 14,0% 33,0% 11,0% 32,0% # Flash Loads/Procedure 8,0 3,1 7,2 3,1 7,4 3,0 9,3 3,1 2,1 # Procedures/Flash load 291,0 369,4 123 585 108 551 88 515 # Flash Loads 1202,2 1343,4 891 1842 799 1658 821 1597 # Procedures Sterile Processing 92,7% 92,6% 92,0% 93,0% 95,0% 92,0% 91,0% 92,0% 100,0% Fire Safety Measures Implemented ODS MOR ODS MOR ODS MOR ODS MOR GOAL 1st Q 09 MAR FEB JAN II: MEDICAL MANAGEMENT/QUALITY