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Sadea Cirugía Segura

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  • 1. CIRUGIA SEGURA Jorge Rubio Elorza Vocal académico SADEA
  • 2. INTRODUCCIÓN
    • 234 millones cirugías/año
    • Muertes : 0,4-0,8% 1 millón
    • Complicaciones: 3 – 16%
    • 7 millones dishabilidades
  • 3. INTRODUCCIÓN
    • Estrategía OMS : CIRUGÍA SEGURA SALVA VIDAS
    • Disminuir el número de MUERTES QUIRÚRGICAS en el mundo
    • Fortalecer las medidas de SEGURIDAD
    • Implementar TÉCNICAS ANESTÉSICAS SEGURAS
    • Evitar la INFECCIÓN QUIRÚRGICA
    • Optimizar la COMUNICACIÓN en el equipo quirúrgico
  • 4. OBJETIVOS ESENCIALES
    • Realizar el Paciente y la cirugía CORRECTOS
    • Prevenir los RIESGOS ANESTÉSICOS y evitar el DOLOR
    • Prevenir y manejar los RIESGOS DE VÍA AÉREA: Difícil – Aspiración
    • Reconocer y preparar el manejo de SANGRADO MAYOR
    • Evitar REACCIONES ALERGÍCAS y EFECTOS FARMACOLÓGICOS ADVERSOS
  • 5. OBJETIVOS ESENCIALES
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Prevenir la RETENCIÓN inadvertida de GASAS – INSTRUMENTOS
    • Identificar adecuadamente TODAS LAS MUESTRAS DE PATOLOGÍA
    • Comunicación adecuada para realizar una CIRUGÍA SEGURA
    • Establecer y difundir por las INSTITUCIONES y EL SISTEMA DE SALUD INDICADORES DE GESTIÓN
  • 6. LISTA DE CHEQUEO
  • 7. LISTA DE CHEQUEO
    • CIRUGÍA SEGURA Prioritaria
      • ESTRATEGIA – LIDERES y EQUIPO QUIRÚRGICO
    • ADAPTABLE – NO REGULATORIO
    • SIMPLE - BREVE
    • FLUJO LABORAL NORMAL
    • CREAR CULTURA PRACTICAS SEGURAS RUTINARIAS
    • SEGUIMIENTO – CUMPLIMIENTO – ADHERENCIA minimizan RIESGOS COMUNES Y EVITABLES.
  • 8.  
  • 9. FASE DE ENTRADA
    • PRE-INDUCCIÓN ANESTÉSICA – SEGURIDAD DEL PROCEDIMIENTO ANESTESIA - ENFERMERIA
    • PACIENTE
    • Identificación – Sitio – Procedimiento - Consentimiento
    • SITIO
    • Marcación – No aplicable
    • CHEQUEO DE ANESTESIA ABCDEes
    • Equipos – Medicaciones – Riesgos del paciente
  • 10. FASE DE ENTRADA
    • PULSO-OXÍMETRO
    • Disponibilidad – Visible – Alarmas audibles
    • ALERGIAS
    • Alergeno reconocido – Confirmar o informar
    • VÍA AÉREA
    • Difícil: Técnica – Equipo VAD disponible – 2º persona
    • Aspiración: RGE – estomago lleno
  • 11. FASE DE ENTRADA
    • SANGRADO
    • > 500 mls – Niños > 7 mls/kgr
    • Cirugía – Anestesiología
      • 2 venas periféricas grandes
    • Líquidos – Sangre DISPONIBLES
    • INDUCCIÓN ANESTÉSICA
  • 12.  
  • 13. FASE DE PAUSA
    • PRE-INCISIÓN QUIRÚRGICA – CONFIRMACIÓN TODO EL EQUIPO QUIRÚRGICO
    • INTEGRANTES
    • Identificación – Función – Capacidades
    • PACIENTE Verbal
    • Nombre – Procedimiento – Sitio - Posición
    • EVENTOS CRÍTICOS
    • Peligros críticos – Plan Quirúrgico
  • 14. FASE DE PAUSA
    • CIRUGIA
    • Pasos Modificados – Duración – Sangrado
      • Sangrado severo – Lesiones – Morbilidad mayor
    • ANESTESIA
    • Ptos sanguineos – Características - Comorbilidades
    • ENFERMERIA
    • Esterilización OK – Problemas de equipo
  • 15. FASE DE PAUSA
    • PROFILAXIS ANTIBIÓTICA
    • < 60 minutos – Aplicación vs Redosificar
      • Procedimientos NO aplicable
    • IMAGENES
    • Perioperatorias
    • Necesarias pero NO disponible
    • No aplicable
    • INCISIÓN QUIRÚRGICA
  • 16.  
  • 17. FASE DE SALIDA
    • PRE-SALIDA DEL QX – INFORMAR AL PERSONAL DE LA UCPA
    • PROCEDIMIENTO REALIZADO
    • CONTEO DE INSTRUMENTAL, GASAS Y AGUJAS
    • Curaciones – Basura – Herida - imagenes
    • MUESTRA DE PATOLOGÍA
    • Paciente – Nombre – Descripción - Marcas
  • 18. FASE DE SALIDA
    • INSTRUMENTOS - EQUIPOS
    • UCPA TODO EL EQUIPO QUIRÚRGICO
    • Plan de manejo – Eventos de riesgo específicos en recuperación
    • INFORMACIÓN APROPIADA A TODO EL EQUIPO
    • HISTORIA CLÍNICA
    • EVALUACIÓN DE CALIDAD DEL SERVICIO
  • 19. 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 The Checklist was piloted in 8 cities…
  • 20. VENTAJAS
    • Adaptable a las necesidades específicas
    • Implementación incremental?
    • Soportado por evidencia científica
    • Evaluado en diferentes condiciones
    • Asegura adherencia a prácticas seguras
    • Mínimo consumo de recursos
  • 21. POR QUE?
    • SALVAVIDAS
    • Previene COMPLICACIONES
    • Disminuye COSTOS médicos por el error
    • Participación institucional la red de SOPORTE internacional de LA LISTA DE CHEQUEO
    • Reconocimiento institucional como LIDER en SEGURIDAD DEL PACIENTE
  • 22.  
  • 23. BIBLIOGRAFIA
    • Realizar el Paciente y la cirugía CORRECTOS
    • American Academy of Orthopaedic Surgery. &quot;AAOS Advisory Statement on Wrong-Site Surgery.&quot; Retrieved 25 January, 2008, from http://www.aaos.org/about/papers/advistmt/1015.asp.
    • American College of Surgeons (2002). &quot;Statement on ensuring correct patient, correct site, and correct procedure surgery.&quot; Bulletin of the American College of Surgeons 87(12).
    • Australian Commission on Safety and Quality in Healthcare. &quot;Ensuring Correct Patient, Correct Site, Correct Procedure.&quot; Retrieved 23 August, 2007, from http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/content/former-pubs-archive-correct.
  • 24. BIBLIOGRAFIA
    • Realizar el Paciente y la cirugía CORRECTOS
    • Joint Commission. &quot;Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery.&quot; Retrieved 15 February, 2007, from http://www.jointcommission.org/PatientSafety/UniversalProtocol/.
    • Kwaan, M. R., D. M. Studdert, et al. (2006). &quot;Incidence, patterns, and prevention of wrong-site surgery.&quot; Arch Surg 141(4): 353-7; discussion 357-8.
    • Joint Commission. &quot;A follow-up review of wrong site surgery.&quot; Retrieved 3 May, 2007, from http://www.jointcommission.org/SentinelEvents/sentineleventalert/sea_24.htm
  • 25. BIBLIOGRAFIA
    • Prevenir los RIESGOS ANESTÉSICOS y evitar el DOLOR
    • Arbous, M. S., A. E. Meursing, et al. (2005). &quot;Impact of anesthesia management characteristics on severe morbidity and mortality.&quot; Anesthesiology 102: 257-68.
    • Cooper, J. B., R. S. Newbower, et al. (1978). &quot;Preventable anesthesia mishaps: a study of human factors.&quot; Anesthesiology 49(6): 399-406.
    • Eichhorn, J. H., J. B. Cooper, et al. (1986). &quot;Standards for patient monitoring during anesthesia at Harvard Medical School.&quot; Jama 256(8): 1017-20.
    • Gaba, D. M., K. J. Fish, et al. (1994). Crisis Management in Anesthesiology. New York, Churchill Livingston.
    • Hodges, S. C., C. Mijumbi, et al. (2007). &quot;Anaesthesia services in developing countries: defining the problems.&quot; Anaesthesia 62(1): 4-11.
  • 26. BIBLIOGRAFIA
    • Prevenir los RIESGOS ANESTÉSICOS y evitar el DOLOR
    • International Task Force on Anaesthesia Safety (1993). &quot;International standards for a safe practice of anaesthesia.&quot; European Journal of Anaesthesiology 10 (Suppl. 7): 12-15.
    • Runciman, W. B. (1993). &quot;Risk assessment in the formulation of anaesthesia safety standards.&quot; European Journal of Anaesthesiology - Supplement 7: 26-32.
    • Runciman, W. B. (2005). &quot;Iatrogenic harm and anaesthesia in Australia.&quot; Anaesthesia & Intensive Care 33(3): 297-300.
    • World Federation of Societies of Anaesthesiologists (WFSA). (Endorsed by the General Assembly of the WFSA at the 14th World Congress of Anaesthesiologists on 7 March 2008). &quot;2008 International Standards for Safe Practice of Anaesthesia.&quot; Retrieved 26 May 2008, from http://www.anaesthesiologists.org
  • 27. BIBLIOGRAFIA
    • Prevenir y manejar los RIESGOS DE VÍA AÉREA: Difícil– Aspiración
    • (1993). &quot;Practice Guidelines for Management of the Difficult Airway. A Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.&quot; Anesthesiology 78: 597-602.
    • Cormack, R. S. and J. Lehane (1984). &quot;Difficult tracheal intubation in obstetrics.&quot; Anaesthesia 39(11): 1105-11.
    • Crosby, E. T., R. M. Cooper, et al. (1998). &quot;The unanticipated difficult airway with recommendations for management.&quot; Can J Anaesth 45(8): 757-76.
    • Mallampati, S., S. Gatt, et al. (1985). &quot;A clinical sign to predict difficult tracheal intubation: a prospective study.&quot; Can Anaesth Soc J 32: 429-434.
  • 28. BIBLIOGRAFIA
    • Prevenir y manejar los RIESGOS DE VÍA AÉREA: Difícil– Aspiración
    • Murphy, M. and D. J. Doyle (2008). Airway evaluation. Management of the Difficult and Failed Airway. O. Hung and M. Murphy. New York, McGraw Hill: 3-15.
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    • Shiga, T., Z. Wajima, et al. (2005). &quot;Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance.&quot; Anesthesiology 103(2): 429-37.
  • 29. BIBLIOGRAFIA
    • Reconocer y preparar el manejo de SANGRADO MAYOR
    • American College of Surgeons: Committee on Trauma (1997). Advanced Trauma Life Support for Doctors. Chicago, ACS.
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    • Shires, T., D. Coln, et al. (1964). &quot;Fluid Therapy in Hemorrhagic Shock.&quot; Arch Surg 88: 688-93.
  • 30. BIBLIOGRAFIA
    • Evitar REACCIONES ALERGÍCAS y EFECTOS FARMACOLÓGICOS ADVERSOS
    • Baker, G. R., P. G. Norton, et al. (2004). &quot;The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.&quot; CMAJ Canadian Medical Association Journal 170(11): 1678-86.
    • Bowdle, T. A. (2003). &quot;Drug administration errors from the ASA Closed Claims Project.&quot; ASA Newsletter 67: 11-3.
    • Jensen, L. S., A. F. Merry, et al. (2004). &quot;Evidence-based strategies for preventing drug administration errors during anaesthesia.&quot; Anaesthesia 59(5): 493-504.
    • Webster, C. S., A. F. Merry, et al. (2001). &quot;The frequency and nature of drug administration error during anaesthesia.&quot; Anaesth Intensive Care 29(5): 494-500.
  • 31. BIBLIOGRAFIA
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Astagneau, P., C. Rioux, et al. (2001). &quot;Morbidity and mortality associated with surgical site infections: results from the 1997-1999 INCISO surveillance.&quot; J Hosp Infect 48(4): 267-74.
    • Bratzler, D. W. and P. M. Houck (2004). &quot;Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project.&quot; Clin Infect Dis 38(12): 1706
    • Bratzler, D. W., P. M. Houck, et al. (2005). &quot;Use of antimicrobial prophylaxis for major surgery: baseline results from the national surgical infection prevention project.&quot; Arch Surg 140(2): 174-82.-15.
  • 32. BIBLIOGRAFIA
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Classen, D. C., R. S. Evans, et al. (1992). &quot;The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.&quot; N Engl J Med 326(5): 281-6.
    • Dellinger, E. (1997). Surgical infections and choice of antibiotics. Textbook of surgery: the biological basis of modern surgical practice. D. Sabiston. Philadelphia, W.B. Saunders: 264-280.
    • Dellinger, E. (1999). Nosocomial infection. American College of Surgeons. Care of the surgical patient. D. Wilmore, M. Brennan, A. Harken, J. Holcroft and J. Meakins. New York, Scientific American.
    • Dellinger, E. P. (2007). &quot;Prophylactic antibiotics: administration and timing before operation are more important than administration after operation.&quot; Clin Infect Dis 44(7): 928-30.
  • 33. BIBLIOGRAFIA
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Dellinger, E. P., P. A. Gross, et al. (1994). &quot;Quality standard for antimicrobial prophylaxis in surgical procedures. The Infectious Diseases Society of America.&quot; Infect Control Hosp Epidemiol 15(3): 182-8.
    • Dellinger, E. P., S. M. Hausmann, et al. (2005). &quot;Hospitals collaborate to decrease surgical site infections.&quot; Am J Surg 190(1): 9-15.
    • Fry, D. (2003) Surgical site infection: Pathogenesis and prevention. Medscape Volume, DOI:
    • Fry, D. E. (1995). Surgical Infections. Boston, Little, Brown and Company.
  • 34. BIBLIOGRAFIA
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Garibaldi, R. A., D. Skolnick, et al. (1988). &quot;The impact of preoperative skin disinfection on preventing intraoperative wound contamination.&quot; Infect Control Hosp Epidemiol 9(3): 109-13.
    • Gaynes, R. P. (1998). Surveillance of nosocomial infections. Hospital Infections. J. V. Bennett and P. S. Brachman. Philadelphia, Lippincott-Raven Publishers: 65-84.
    • Horan, T. C., D. H. Culver, et al. (1993). &quot;Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System.&quot; Infection Control and Hospital Epidemiology 14(2): 73-80.
  • 35. BIBLIOGRAFIA
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Horan, T. C., R. P. Gaynes, et al. (1992). &quot;CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.&quot; Am J Infect Control 20: 271-274.
    • Kurz, A., D. I. Sessler, et al. (1996). &quot;Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group [see comments].&quot; N Engl J Med 334(19): P 1209-15.
    • Moro, M. L., F. Morsillo, et al. (2005). &quot;Rates of surgical-site infection: an international comparison.&quot; Infect Control Hosp Epidemiol 26(5): 442-8.
  • 36. BIBLIOGRAFIA
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Rioux, C., B. Grandbastien, et al. (2007). &quot;Impact of a six-year control programme on surgical site infections in France: results of the INCISO surveillance.&quot; J Hosp Infect 66(3): 217-23.
    • Smaill, F. and G. J. Hofmeyr (2002). &quot;Antibiotic prophylaxis for cesarean section.&quot; Cochrane Database Syst Rev(3): CD000933. Stone, H. H., B. B. Haney, et al. (1979). &quot;Prophylactic and preventive antibiotic therapy: timing, duration and economics.&quot; Ann Surg 189: 691-699.
    • Sullivan, S. A., T. Smith, et al. (2007). &quot;Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial.&quot; Am J Obstet Gynecol 196(5): 455 e1-5.
  • 37. BIBLIOGRAFIA
    • Minimizar riesgo de INFECCIÓN DE HERIDA QUIRÚRGICA
    • Van den Berghe, G., P. Wouters, et al. (2001). &quot;Intensive insulin therapy in the critically ill patients.[see comment].&quot; New England Journal of Medicine 345(19): 1359-67.
    • Washington, J. A., 2nd, W. H. Dearing, et al. (1974). &quot;Effect of preoperative antibiotic regimen on development of infection after intestinal surgery: Prospective, randomized, double-blind study.&quot; Ann Surg 180(4): 567-72.
    • Wilson, A. P., T. Treasure, et al. (1986). &quot;A scoring method (ASEPSIS) for postoperative wound infections for use in clinical trials of antibiotic prophylaxis.&quot; Lancet 1(8476): 311-3.
  • 38. BIBLIOGRAFIA
    • Prevenir la RETENCIÓN inadvertida de GASAS – INSTRUMENTOS
    • American College of Surgeons. &quot;American College of Surgeons: Statement on the Prevention of Retained Foreign Bodies after Surgery.&quot; Retrieved 5 February, 2008, from http://www.facs.org/fellows_info/statements/st-51.html.
    • Australian College of Operating Room Nurses and Association of peri-Operative Registered Nurses (2006). Counting of Accountable Items used during Surgery. Standards for Perioperative Nurses. ACORN: 1-12.
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  • 39. BIBLIOGRAFIA
    • Identificar adecuadamente TODAS LAS MUESTRAS DE PATOLOGÍA
    • Howanitz, P. J. (2005). &quot;Errors in laboratory medicine: practical lessons to improve patient safety.&quot; Arch.Pathol.Lab Med. 129(10): 1252-1261.
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  • 40. BIBLIOGRAFIA
    • Comunicación adecuada para realizar una CIRUGÍA SEGURA
    • Greenberg, C. C., S. E. Regenbogen, et al. (2007). &quot;Patterns of communication breakdowns resulting in injury to surgical patients.&quot; J Am Coll Surg 204(4): 533-40.
    • Lingard, L., S. Espin, et al. (2005). &quot;Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR.&quot; Qual.Saf Health Care 14(5): 340-346.
    • Lingard, L., S. Espin, et al. (2004). &quot;Communication failures in the operating room: an observational classification of recurrent types and effects.&quot; Qual.Saf Health Care 13(5): 330-334.
  • 41. BIBLIOGRAFIA
    • Comunicación adecuada para realizar una CIRUGÍA SEGURA
    • Makary, M. A., C. G. Holzmueller, et al. (2006). &quot;Operating room debriefings.&quot; Jt.Comm J.Qual.Patient.Saf 32(7): 407-10, 357.
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    • Makary, M. A., J. B. Sexton, et al. (2006). &quot;Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.&quot; J.Am.Coll.Surg. 202(5): 746-752.
  • 42. BIBLIOGRAFIA
    • Comunicación adecuada para realizar una CIRUGÍA SEGURA
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    • Comunicación adecuada para realizar una CIRUGÍA SEGURA
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    • Comunicación adecuada para realizar una CIRUGÍA SEGURA
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    • Establecer y difundir por las INSTITUCIONES y EL SISTEMA DE SALUD INDICADORES DE GESTIÓN
    • Berwick, D. M. (1989). &quot;Continuous improvement as an ideal in health care.&quot; N Engl J Med 320(1): 53-6.
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    • Establecer y difundir por las INSTITUCIONES y EL SISTEMA DE SALUD INDICADORES DE GESTIÓN
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