1. Safety is everybody’s business. According the Hippocratic oath from 5th century : “ Never do harm to anyone” Safer Surgery can be defined as a reduction in avoidable harm to a surgical patient 2. It is a part of medical specialty that uses operative manual and instrumental technique on a patient to investigate or treat a pathological condition. Surgical team: 1. Surgeon 2. Surgeon’s assistance 3. Anesthetist 4. Scrub nurse 5. Scouting nurse 6. Surgical technologist 3.  Time or duration when patient admitted and discharge after completion of surgery. So, surgical safety has broadly included in different phases: 1. Preoperative(Diagnosis, investigation) 2. Per operative 3. Postoperative(Up to discharge) 4.  1. Adverse events: An incident which result in harm to the patient.  2. Near Miss: An incident which could resulted in unwanted harm but did not.  3. No-harm events: An incident that occur and reach to the patient but result in no injury. 5. An article in the Gurdian newspaper UK in March 2013 claimed that “five worst medical” nightmares a Pt faces, three related to surgery: 1. Wrong site surgery 2. Wrong patient surgery 3. Retained instruments and swabs The rate of harm in surgical patient is unknown but probably occur in about 10% surgical patient, though much of this harm will be minor. 6. 1. Patients themselves. 2. Healthcare professional 3. System failure. 4. Medical complexity 7. Patients Themselves 1. A variety of presentation. 2. Differing co-morbidities 3. Differing response to treatment 4. Patients are reluctant to speak up. 5. Refuse to co-operate 6. Hide and seek 8. Healthcare professional 1. Inadequate Pt assessment(delay or error in Diagnosis) 2. Failure to use or interpret appropriate test 3. Error in performance of an operation and test. 4. Inadequate monitoring or follow-up. 5. Deficient training or experience 6. Fatigue, overwork or time pressure. 7. Personal or psychological factor i.e. drug abuse or depression. 8. Lack of recognition of the danger of medical errors. 9. System failure 1. Poor communication between healthcare provider. 2. Inadequate staffing level 3. Overreliance on investigation 4. Lack of coordination at handover 5. Drug similarities. 6. Equipment failure due to lack of skilled operators. 7. Inadequate system to report and review patient safety incident. 10. Medical complexity 1. Advance and new technologies(laparoscopic, robotic surgery) 2. Potent drug and their side effects and interaction. 3. Working environment- Surgical ICU, HDU and Operation theatre 11. Surgery is one of the most complex health intervention to deliver. More than 100 million people worldwide require surgical treatment every year for different reason. Great Professor of Surgery Sir Alfred Cuschieri and other describes surgical errors in different categories that committed by the surgeons during care of the Patients. 12. 1. Diagnosis and management erro

2. Safety is everybody’s business. According
the Hippocratic oath from 5th century :
“ Never do harm to anyone”
Safer Surgery can be defined as a
reduction in avoidable harm to a
surgical patient

3. It is a part of medical specialty that uses
operative manual and instrumental technique
on a patient to investigate or treat a
pathological condition.
Surgical team:
1. Surgeon
2. Surgeon’s assistance
3. Anesthetist
4. Scrub nurse
5. Scouting nurse
6. Surgical technologist

4.  Time or duration when patient admitted
and discharge after completion of
surgery.
So, surgical safety has broadly included in
different phases:
1. Preoperative(Diagnosis, investigation)
2. Per operative
3. Postoperative(Up to discharge)

5.  1. Adverse events: An incident which
result in harm to the patient.
 2. Near Miss: An incident which could
resulted in unwanted harm but did not.
 3. No-harm events: An incident that
occur and reach to the patient but result
in no injury.

6. An article in the Gurdian newspaper UK in
March 2013 claimed that “five worst
medical” nightmares a Pt faces, three
related to surgery:
1. Wrong site surgery
2. Wrong patient surgery
3. Retained instruments and swabs
The rate of harm in surgical patient is
unknown but probably occur in about
10% surgical patient, though much of
this harm will be minor.

7. 1. Patients themselves.
2. Healthcare professional
3. System failure.
4. Medical complexity

8. Patients Themselves
1. A variety of presentation.
2. Differing co-morbidities
3. Differing response to treatment
4. Patients are reluctant to speak up.
5. Refuse to co-operate
6. Hide and seek

9. Healthcare professional
1. Inadequate Pt assessment(delay or error in
Diagnosis)
2. Failure to use or interpret appropriate test
3. Error in performance of an operation and test.
4. Inadequate monitoring or follow-up.
5. Deficient training or experience
6. Fatigue, overwork or time pressure.
7. Personal or psychological factor i.e. drug abuse
or depression.
8. Lack of recognition of the danger of medical
errors.

10. System failure
1. Poor communication between
healthcare provider.
2. Inadequate staffing level
3. Overreliance on investigation
4. Lack of coordination at handover
5. Drug similarities.
6. Equipment failure due to lack of skilled
operators.
7. Inadequate system to report and
review patient safety incident.

11. Medical complexity
1. Advance and new
technologies(laparoscopic, robotic
surgery)
2. Potent drug and their side effects and
interaction.
3. Working environment- Surgical ICU, HDU
and Operation theatre

12. Surgery is one of the most complex health
intervention to deliver. More than 100
million people worldwide require surgical
treatment every year for different
reason.
Great Professor of Surgery Sir Alfred
Cuschieri and other describes surgical
errors in different categories that
committed by the surgeons during care
of the Patients.

13. 1. Diagnosis and management errors.
2. Resuscitation errors.
3. Prophylaxis errors.
4. Prescription and parenteral
administration errors.
5. Situation awareness, identification and
teamwork errors.
6. Technical and operative errors.

14. 1. Wrong patient in the operation theatre.
2. Surgery performed in the wrong side or
site
3. Wrong procedure
4. Failure to communicate changes in the
patient condition.
5. Disagreement about proceeding.
6. Retained instruments or swabs.

15. 1. Cognitive error of judgment.
2. Procedural(Steps of surgery not
followed)
3. Executional (damage)
4. Misinterpretation.
5. Missed iatrogenics injury.
Several studies have shown that majority
of surgical errors(53-70 per cent) occur
outside the operating theatre, before or
after the surgery.

22. 1. Right surgeon, Right place, Right time:
Right surgeon- a surgeon of adequate
training and experience.
Trained surgeons require updating in current
techniques and training in new one.
For trainee: described later…..
Right time is applicable for emergency
surgery…

23. 2. Standardisation of process: It based on
research evidence or best practice i.e.
 Pre-op investigation
 Optimization of co morbidity
 Optimization of malnutrition
 DVT prophylaxis
 Antibiotic prophylaxis
 Management of pt require emergency
surgery

24. 3. Communicating openly with patients and
their carers and obtaining consent:
 Details and uncertainties of the diagnosis
 The purpose and details of the proposed surgery
 Known possible side effects and potential complications
 The likely prognosis
 Other options for treatment, including the option not to
treat
 Explanation of the likely benefits and probabilities of
success for each option
 The name of the doctor who will have overall responsibility
 A reminder that the patient can change his or her mind at
any time

25. 3 Surgical safety checklist : In 2008, the World
Health Organization (WHO) published
guidelines of recommended practices to
reduce the rate of preventable surgical
complications and death worldwide)
 WHO Surgical Safety Checklist: UK process
Step 1: Prelist briefing
Step 2: Sign in(Before induction of anaesthesia)
Step 3: Time out(Before skin incision)
Step 4: Sign out(Before patient leaves operating room)
Step 5: Postlist debriefing

27.  The WHO checklist should be completed for
every patient coming to theatre
 Appropriate antibiotic and venous
thromboembolism (VTE) prophylaxis,
monitoring, careful positioning,
temperature, glycaemic and infection
control
 The operating theatre environment should
be optimised with regard to lighting,
ventilation, humidity and temperature


28.  Additional equipment, such as diathermy and
tourniquets, should be used while recognising their
potential complications
 Theatre etiquette including scrubbing, prepping
and draping and personnel movement is designed
to minimise crossinfection

29. 4. Learning from incidents: by reporting, analysis to
reduce further mistakes but……
Unfortunately this is not very effective because of
• Many incidents are not reported
• Number are more so difficult to give priorities
• Not always correct analysis
• Difficulty in implementing action
• Complaints from Pt also another source of
learning but it may be often for harassment.

30. 5. Prescribing safely: Unfortunately, edication
errors are common and their many causes
include:
• poor assessment or inadequate knowledge
of patients and their clinical conditions;
• inadequate knowledge of the medications;
• dosage calculation errors;
• illegible hand writing;
• confusion regarding the name or the mixing
up of medications.

31.  Regulating and licensing of physicians and
healthcare institutions;
 developing and adopting policies for
patient safety and quality improvement;
 providing patient safety education
rogrammes;
 instituting national clinical audits;
 reporting (and learning from) adverse
events;
 setting up agencies to resolve concerns
about the practice of doctors by providing
case and incident management services

32.  The probability of a patient being harmed
in hospital is higher with, for example, the
risk of healthcare-associated infection
being as much as 20 times higher than in
developed countries.
 At least 50 per cent of medical equipment
in developing countries is unusable or only
partly usable and often the equipment is
not used due to lack of parts or necessary
skills.
 Lack of monitoring in training programme
 Lack of accountability, corruption,
malpractice

33.  Surgical assistants are frequently surgeons in
training.
 They are therefore in theatre to help the
senior surgeon and to learn as much as
possible.
 Role:
1. Preparation. review the anatomy and
the operation before surgery to anticipate
and understand the actions of the senior
surgeon. They should start scrubbing first,
having checked that the patient is ready
for theatre.

34. 2. Training: Trainees should write important steps of
proposed operation in brief on a board in the
operating theatre.
3. At surgery: should try to provide the surgeon with
the best access possible by placing and holding
retractors and showing the surgeon the field
where they are working. Instruments and
retractors should always be asked for by name.
4. After surgery: The assistant should help transfer
the patient safely off the table and may write the
operative note. They should keep a log of all
operations attended and what they have learnt
from each case.

35.  All bleeding eventually stops.
 A very bold surgeon is one who realise that his pt takes all
the risk.
 It takes 5 years to know when to operate, 20 years to learn
when not to.
 There are only 3 rules to a surgeons life : eat when u can;
sleep when u can; don’t screw with pancrease.
 Don’t look for for things you don’t want to find
 The lesser the indication the greater will be the
complication
 Surgery like making love , should be done gently with
adequate exposure.
 Pyar aur surgeon kabhi jukhta nahi.
 Never rely on investigation it is always better to open and
see if confused.