手术安全核查的SWOT分析
|
摘要
目的采用SWOT分析方法,综合评价手术安全核查的优势、劣势、机会和威胁,为合理运用手术安全核查表、提高手术室安全护理提供参考。方法在观察2017年1月至2017年6月在华中科技大学同济医学院附属协和医院进行手术治疗的患者在手术安全核查中发生的护理中断事件,并分析其发生频率、来源、类型及与护士级别的关系,寻找劣势(weaknesses)的基础之上,通过文献检索,分别分析手术安全核查的优势、机遇和威胁。结果共检索有效文献15篇,通过文献阅读发现手术安全核查优势和劣势并存,机遇和威胁共存。其中,着重研究的劣势中共观察到2 483例患者,其中发生手术安全核查护理中断事件2 053起,平均0.83起/例,护理中断主要来源于器械设备的准备(57.77%);类型分析侵扰型占50.02%,是手术安全核查护理中断的主要类型;中断时护士的手头事务主要为病情观察,为24.26%;差异均有统计学意义(P<0.05);手术安全核查时发生护理中断事件与护士级别统计分析差异无统计学意义(P>0.05)。结论手术安全核查优势和劣势、机遇和威胁共存,在实际使用中应该选择在机遇中充分利用其优势,规避其劣势威胁,保证手术安全核查的积极意义,提升护理质量和保障患者安全。
Objective SWOT analysis was used to comprehensively evaluate the strengths, weaknesses, opportunities and threats of surgical safety verification, so as to provide references for the rational use of surgical safety checklist and the improvement of safe nursing in operating room. Methods The weaknesses of surgical safety checklist were analyzed on the basis of a direct observation study to document the frequency, sources and types of nursing interruption incidents and their as well as the relationship with different levels of the nurses in 3 critical stages of surgical safety verification in patients undergoing surgical treatment in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2017 to June 2017.Results A total of 15 effective literature articles were retrieved. Through literature review, it was found that the advantages and disadvantages, opportunities and threats of surgical safety verification coexist. In terms of disadvantages, 2483 patients were observed totally in this study, among whom 2053 cases of nursing interruption events occurred in surgical safety verification, with an average of 0.83 events per case. The nursing interruption resulted mainly from the equipment preparation(57.77%); the intrusion type accounted for 50.02%, which is the main type of interruption of surgical safety verification of nursing. The major affairs involved in nursing interruption were observation(24.26%). Multivariate analysis showed statistically significant difference in source, type and affairs(P<0.05). The statistical analysis between nursing interruption in surgical safety verification and different levels of the nurses showed no significant difference(P>0.05). Conclusion Surgical safety verification is a combination of strengths and weaknesses as well as opportunities and threats. In practical use, we should choose to make full use of its advantages and opportunities and avoid its weaknesses and threats, so as to ensure the positive effects of surgical safety verification, to improve the quality of nursing and to ensure patients' safety.
Objective SWOT analysis was used to comprehensively evaluate the strengths, weaknesses, opportunities and threats of surgical safety verification, so as to provide references for the rational use of surgical safety checklist and the improvement of safe nursing in operating room. Methods The weaknesses of surgical safety checklist were analyzed on the basis of a direct observation study to document the frequency, sources and types of nursing interruption incidents and their as well as the relationship with different levels of the nurses in 3 critical stages of surgical safety verification in patients undergoing surgical treatment in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2017 to June 2017.Results A total of 15 effective literature articles were retrieved. Through literature review, it was found that the advantages and disadvantages, opportunities and threats of surgical safety verification coexist. In terms of disadvantages, 2483 patients were observed totally in this study, among whom 2053 cases of nursing interruption events occurred in surgical safety verification, with an average of 0.83 events per case. The nursing interruption resulted mainly from the equipment preparation(57.77%); the intrusion type accounted for 50.02%, which is the main type of interruption of surgical safety verification of nursing. The major affairs involved in nursing interruption were observation(24.26%). Multivariate analysis showed statistically significant difference in source, type and affairs(P<0.05). The statistical analysis between nursing interruption in surgical safety verification and different levels of the nurses showed no significant difference(P>0.05). Conclusion Surgical safety verification is a combination of strengths and weaknesses as well as opportunities and threats. In practical use, we should choose to make full use of its advantages and opportunities and avoid its weaknesses and threats, so as to ensure the positive effects of surgical safety verification, to improve the quality of nursing and to ensure patients' safety.
引文
[1] Weiser T G,Regenbogen S E,Thompson K D,et al.An estimation of the global volume of surgery:a modelling strategy based on available data[J].Lancet,2008,372(9633):139-144.
[2] Gawande A A,Thomas E J,Zinner M J,et al.The incidence and nature of surgical adverse events in Colorado and Utah in 1992[J].Surgery,1999,126(1):66-75.
[3] Kable A K,Gibberd R W,Spigelman A D.Adverse events in surgical patients in Australia[J].International Journal for Quality in Health Care,2002,14(4):269-276.
[4] Hohenfellner R.Re:A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population[J].European Urology,2009,56(2):395-0.
[5] Patient Safety:Surgical Safety Web Map.Geneva:World Health Organization.http://maps.cga.harvard.edu/surgical_safety/.Accessed 8 March 2016.
[6] 陈虎,刘勇,王吉善,等.2011版三级综合医院评审标准设计思路与特点[J].中国卫生质量管理,2014,21(1):6-8.
[7] Gillespie B M,Chaboyer W,Thalib L,et al.Effect of using a safety checklist on patient complications after surgery:a systematic review and meta-analysis[J].Anesthesiology,2014,120(6):1380-9.
[8] Haugen A S,Softeland E,Almeland S K,et al.Effect of the World Health Organization checklist on patient outcomes:a stepped wedge cluster randomizedcontrolled trial[J]Ann Surg.2016 Feb;263(2):e24-5.
[9] Development and implementation results of an interactive computerized surgical checklist for robotic-assisted gynecologic surgery[J].Journal of Robotic Surgery,2015,9(1):11-18.
[10] Papaconstantinou H T,Smythe W R,Reznik S I,et al.Surgical safety checklist andoperating room efficiency:results from a large multispecialty tertiary carehospital [J].Am J Surg.2013;206:853e859.discussion 859-860.
[11] De Vries E N,Prins H A,Crolla R M P H,et al.Effect of a Comprehensive Surgical Safety System on Patient Outcomes[J].New England Journal of Medicine,2010,363(20):1928-1937.
[12] Haynes A B,Weiser T G,Berry W R,et al.Changes in safety attitude and relationship to decreased postoperative morbidity and mortality followingimplementation of a checklist-based surgical safety intervention[J].BMJ Qual Saf,2011,20(1):102-107.
[13] Cullati S,Licker M J,Francis P,et al.Implementation of the surgical safetychecklist in Switzerland and perceptions of its benefits:Cross sectional survey[J].PLoS One,2014,9(7):e101915,18.
[14] Molina G,Jiang W,Edmondson L,et al.Implementation of the Surgical Safety Checklist in South Carolina Hospitals Is Associated with Improvement in Perceived Perioperative Safety[J].Journal of the American College of Surgeons,2016:S1072751516000363.
[15] Bohmer A B,Kindermann P,Schwanke U,et al.Long-term effects of a perioperative safety checklist from the viewpoint of personnel[J].Acta AnaesthesiolScand,2013,57(2):150-157.
[16] Papaconstantinou H T,Jo C,Reznik S I,et al.Implementation of a surgical safetychecklist:impact on surgical team perspectives[J].Ochsner J,2013,13(3):299-309.
[17] Vats A,Vincent C A,Nagpal K,et al.Practical Challenges of Introducing WHO Surgical Checklist:UK Pilot Experience[J].Bmj,2010,340(340):b5433.
[18] Paul O’Connor,Catriona Reddin,Michael O’Sullivan,et al.Surgical checklists:the human factor[J].Patient Safety in Surgery,7,1(2013-05-14),2013,7(1):1-7.
[19] Conley D M,Singer S J,Edmondson L,et al.Effective surgical safety checklistimplementation[J].J Am Coll Surg,2011,212(5):873-879.
[20] Helmio P,Takala A,Aaltonen L M,et al.First year with WHO Surgical SafetyChecklist in 7148 otorhinolaryngological operations:use and user attitudes[J].Clin Otolaryngol,2012,37(4):305-308.
[21] Haugen A S,S■fteland E,Eide G E,et al.Impact of the World Health Organization’s Surgical Safety Checklist on safety culture in the operating theatre:acontrolled intervention study[J].Br J Anaesth,2013,110(5):807-815.
[22] Healy J M.How hospital leaders implemented a safe surgery protocol inAustralian hospitals[J].Int J Qual Health Care,2012,24(1):88-94.
[23] Russ S,Rout S,Sevdalis N,et al.Do safety checklists improve teamwork andcommunication in the operating room?A systematic review[J].Ann Surg,2013,258(6):856-871.
[24] Fourcade A,Blache J L,Grenier C,et al.Barriers to staff adoption of a surgicalsafety checklist[J].BMJ Qual Saf,2012,21(3):191-197.
[25] Bohmer A B,Wappler F,Tinschmann T,et al.The implementation of a perioperative checklist increases patients’ perioperative safety and staff satisfaction[J].Acta Anaesthesiol Scand,2012,56(3):332-338.
[26] Aveling E L,McCulloch P,Dixon-Woods M.A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low income countries[J].BMJ Open,2013(3):e003039.
[27] Takala R S,Pauniaho S L,Kotkansalo A,et al.A pilot study of the implementationof WHO surgical checklist in Finland:improvements in activities andcommunication[J].Acta Anaesthesiol Scand,2011(55):1206-1214.
[28] Fudickar A1,Horle K,Wiltfang J,Bein B.The effect of the WHO Surgical SafetyChecklist on complication rate and communication[J].Dtsch Arztebl Int,2012,109(42):695-701.
[29] Jett Q R,George J M.Work interrupted:a closer look at the role of interruptions in organizational life[J].Acad Manage Jour,2003,28(3):494-505.
[30] Haynes A B,Weiser T G,Berry W R,et al.A surgical safety checklist to reducemorbidity and mortality in a global population[J].N Engl J Med,2009 Jan 29,360(5):491-9.
[31] WHO Safe Surgery Saves Lives 2009.Available at:http://www.who.int/patientsafety/safesurgery/en/.Accessed May 22,2017.
[32] Perides M.An Introduction to Quality Assurance in Health Care[J].Journal of Epidemiology & Community Health,2003,58(7):627.
[33] Donabedian A.The quality of care.How can it be assessed?[J].JAMA,1988,260(8):1743-1748.
[34] 王文静.手术室护理纠纷的原因及防范对策[J].中国现代药物应用,2014(9):237-238.
[35] Freeman R,Mckee S,Lee-Lehner B,et al.Reducing Interruptions to Improve Medication Safety[J].J Nurs Care Qual,2012,28(2):176-185.
[36] 程丽,曲东明,陶永红.腹腔镜手术护理中断事件的现状调查[J].中国实用护理杂志,2017,33(25):1984.
[37] Linda M H,Cheryl P,Pam H,et al.Interruptions and pediatric patient safety[J].J Ped Nurs,2010,25(3):167-175.
[38] Zingiryan A,Paruch J L,Osler T M,et al.Implementation of the surgical safety checklist at a tertiary academic center:Impact on safety culture and patient outcomes[J].American Journal of Surgery,2016,214(2):193-197.
[39] Devcich D A,Weller J,Mitchell S J,et al.A behaviourally anchored rating scale for evaluating the use of the WHO surgical safety checklist:development and initial evaluation of the WHOBARS[J].Bmj Quality & Safety,2015,25(10):778.
[2] Gawande A A,Thomas E J,Zinner M J,et al.The incidence and nature of surgical adverse events in Colorado and Utah in 1992[J].Surgery,1999,126(1):66-75.
[3] Kable A K,Gibberd R W,Spigelman A D.Adverse events in surgical patients in Australia[J].International Journal for Quality in Health Care,2002,14(4):269-276.
[4] Hohenfellner R.Re:A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population[J].European Urology,2009,56(2):395-0.
[5] Patient Safety:Surgical Safety Web Map.Geneva:World Health Organization.http://maps.cga.harvard.edu/surgical_safety/.Accessed 8 March 2016.
[6] 陈虎,刘勇,王吉善,等.2011版三级综合医院评审标准设计思路与特点[J].中国卫生质量管理,2014,21(1):6-8.
[7] Gillespie B M,Chaboyer W,Thalib L,et al.Effect of using a safety checklist on patient complications after surgery:a systematic review and meta-analysis[J].Anesthesiology,2014,120(6):1380-9.
[8] Haugen A S,Softeland E,Almeland S K,et al.Effect of the World Health Organization checklist on patient outcomes:a stepped wedge cluster randomizedcontrolled trial[J]Ann Surg.2016 Feb;263(2):e24-5.
[9] Development and implementation results of an interactive computerized surgical checklist for robotic-assisted gynecologic surgery[J].Journal of Robotic Surgery,2015,9(1):11-18.
[10] Papaconstantinou H T,Smythe W R,Reznik S I,et al.Surgical safety checklist andoperating room efficiency:results from a large multispecialty tertiary carehospital [J].Am J Surg.2013;206:853e859.discussion 859-860.
[11] De Vries E N,Prins H A,Crolla R M P H,et al.Effect of a Comprehensive Surgical Safety System on Patient Outcomes[J].New England Journal of Medicine,2010,363(20):1928-1937.
[12] Haynes A B,Weiser T G,Berry W R,et al.Changes in safety attitude and relationship to decreased postoperative morbidity and mortality followingimplementation of a checklist-based surgical safety intervention[J].BMJ Qual Saf,2011,20(1):102-107.
[13] Cullati S,Licker M J,Francis P,et al.Implementation of the surgical safetychecklist in Switzerland and perceptions of its benefits:Cross sectional survey[J].PLoS One,2014,9(7):e101915,18.
[14] Molina G,Jiang W,Edmondson L,et al.Implementation of the Surgical Safety Checklist in South Carolina Hospitals Is Associated with Improvement in Perceived Perioperative Safety[J].Journal of the American College of Surgeons,2016:S1072751516000363.
[15] Bohmer A B,Kindermann P,Schwanke U,et al.Long-term effects of a perioperative safety checklist from the viewpoint of personnel[J].Acta AnaesthesiolScand,2013,57(2):150-157.
[16] Papaconstantinou H T,Jo C,Reznik S I,et al.Implementation of a surgical safetychecklist:impact on surgical team perspectives[J].Ochsner J,2013,13(3):299-309.
[17] Vats A,Vincent C A,Nagpal K,et al.Practical Challenges of Introducing WHO Surgical Checklist:UK Pilot Experience[J].Bmj,2010,340(340):b5433.
[18] Paul O’Connor,Catriona Reddin,Michael O’Sullivan,et al.Surgical checklists:the human factor[J].Patient Safety in Surgery,7,1(2013-05-14),2013,7(1):1-7.
[19] Conley D M,Singer S J,Edmondson L,et al.Effective surgical safety checklistimplementation[J].J Am Coll Surg,2011,212(5):873-879.
[20] Helmio P,Takala A,Aaltonen L M,et al.First year with WHO Surgical SafetyChecklist in 7148 otorhinolaryngological operations:use and user attitudes[J].Clin Otolaryngol,2012,37(4):305-308.
[21] Haugen A S,S■fteland E,Eide G E,et al.Impact of the World Health Organization’s Surgical Safety Checklist on safety culture in the operating theatre:acontrolled intervention study[J].Br J Anaesth,2013,110(5):807-815.
[22] Healy J M.How hospital leaders implemented a safe surgery protocol inAustralian hospitals[J].Int J Qual Health Care,2012,24(1):88-94.
[23] Russ S,Rout S,Sevdalis N,et al.Do safety checklists improve teamwork andcommunication in the operating room?A systematic review[J].Ann Surg,2013,258(6):856-871.
[24] Fourcade A,Blache J L,Grenier C,et al.Barriers to staff adoption of a surgicalsafety checklist[J].BMJ Qual Saf,2012,21(3):191-197.
[25] Bohmer A B,Wappler F,Tinschmann T,et al.The implementation of a perioperative checklist increases patients’ perioperative safety and staff satisfaction[J].Acta Anaesthesiol Scand,2012,56(3):332-338.
[26] Aveling E L,McCulloch P,Dixon-Woods M.A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low income countries[J].BMJ Open,2013(3):e003039.
[27] Takala R S,Pauniaho S L,Kotkansalo A,et al.A pilot study of the implementationof WHO surgical checklist in Finland:improvements in activities andcommunication[J].Acta Anaesthesiol Scand,2011(55):1206-1214.
[28] Fudickar A1,Horle K,Wiltfang J,Bein B.The effect of the WHO Surgical SafetyChecklist on complication rate and communication[J].Dtsch Arztebl Int,2012,109(42):695-701.
[29] Jett Q R,George J M.Work interrupted:a closer look at the role of interruptions in organizational life[J].Acad Manage Jour,2003,28(3):494-505.
[30] Haynes A B,Weiser T G,Berry W R,et al.A surgical safety checklist to reducemorbidity and mortality in a global population[J].N Engl J Med,2009 Jan 29,360(5):491-9.
[31] WHO Safe Surgery Saves Lives 2009.Available at:http://www.who.int/patientsafety/safesurgery/en/.Accessed May 22,2017.
[32] Perides M.An Introduction to Quality Assurance in Health Care[J].Journal of Epidemiology & Community Health,2003,58(7):627.
[33] Donabedian A.The quality of care.How can it be assessed?[J].JAMA,1988,260(8):1743-1748.
[34] 王文静.手术室护理纠纷的原因及防范对策[J].中国现代药物应用,2014(9):237-238.
[35] Freeman R,Mckee S,Lee-Lehner B,et al.Reducing Interruptions to Improve Medication Safety[J].J Nurs Care Qual,2012,28(2):176-185.
[36] 程丽,曲东明,陶永红.腹腔镜手术护理中断事件的现状调查[J].中国实用护理杂志,2017,33(25):1984.
[37] Linda M H,Cheryl P,Pam H,et al.Interruptions and pediatric patient safety[J].J Ped Nurs,2010,25(3):167-175.
[38] Zingiryan A,Paruch J L,Osler T M,et al.Implementation of the surgical safety checklist at a tertiary academic center:Impact on safety culture and patient outcomes[J].American Journal of Surgery,2016,214(2):193-197.
[39] Devcich D A,Weller J,Mitchell S J,et al.A behaviourally anchored rating scale for evaluating the use of the WHO surgical safety checklist:development and initial evaluation of the WHOBARS[J].Bmj Quality & Safety,2015,25(10):778.