The document discusses death on the operation table (DOT) from the perspective of gynecologists and surgeons. It notes that DOT is always a possibility in any surgery and shares results from a survey that found 80% of DOT cases are non-preventable and often occur during emergency surgeries. The document provides strategies for handling DOT, including proper documentation, informed consent, communication with relatives and police, and the importance of support systems. It emphasizes honesty, integrity, and a sympathetic approach in these difficult situations.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focussed on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focussed on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care.
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
Basic Intravenous Therapy 3: Fluids And Electrolytes, Balance and Imbalance, ...Ronald Magbitang
Lecture Presentation in Basic Intravenous Therapy Seminar, discussion on Body Fluids and Electrolytes, Normal Values and the Imbalances, the symptomatology and treatment and precautions, and, finally the different types of commonly available, utilized IVF in clinics
an insight on medical negligence and certain techniques that can be adopted to ensure that such errors or mistakes can be avoided. Deliberately or not we must always ensure that proper healthcare is provided and received.
Litigations in our practice and modern assisted reproductive technologies - e...Anu Test Tube Baby Centre
Presentation given in 2015 : How much does litigation affect our practice of using assisted reproductive technologies for the management of infertility? What do we know and what are the issues surrounding this technology?
A doctor first takes down a patient’s history. This is important as history-taking alone, at times, helps reach a diagnosis. Be accurate & precise in giving information.
Archer USMLE step 3 Ethics lecture notes. These lecture notes are samples and are intended for use with Archer video lectures. For video lectures, please log in at http://www.ccsworkshop.com/Pay_Per_View.html
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
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts for Reduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts for Reduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
12. D.O.T. : Survey of 100
Gynaecologists / Surgeons ..
done by our Team
80/20
IT CANNOT ALWAYS BE ELIMINATED ALL TOGETHER !
13. I become a Gynae surgeon I, realized that
despite a bad prognosis some patients
survive and despite good chances some
payients die.
I have never found out why this is so.
I have now stopped taking CREDIT for a
successful surgery. Before every surgery
I pray to god to help me do my best.
Dr. Sharda Jain
14. Do Not be aggressive to pick up knife
… “A living soul on chair is far better than dead”
In complicated surgeries I often regret
operating on patients who don’t survive.
The thought that perhaps an alternative
palliative therapy would have suited them
keeps nagging me.
Regret
Prof. PK Devi
15. Risk of Death
Caesarean Section 1 in 12,000
Hysterectomy 1 in 4000
Laparoscopy 1 in 8000
Minor Procedure 1 in 15000
Gross Underestimation !!
17. INFORMED CONSENT
Is to be taken Seriously
o Is vital for gynaecologists & Anesthetists to fully
understand the importance of counseling & take
STD / High Risk Consents
21. Few Facts
D.O.T.
It is like death in police custody where
there is no help for patient & nobody knows
the facts except doctors & their team.
Litigation Arrest
23. Handling a Death on OT Table
(Support System)
Challenging & Difficult Task
24. What are we worried
ABOUT – Breaking Bad News
• Damage to reputation
• Facing questions of relatives
• Fear of mob violence
• Handling police enquiry
• Medico-legal issues – arrest,
courts, case, judgment…
• Compensation amount
• Loss of confidence
• Stress in future cases
25. Loss of Reputation
What we fear most is the loss of our
reputation, which we build on hundreds of
good surgeries. If one case goes against us
in the court, and it gets publicized, we may
lose our hard – earned reputation.
Dr. Yogesh Agarwala
26. How to Break Bad News !
Is the MOST DIFFICULT TASK !!
27. Support Systems is Vital
(Surgeons & Anesthetists)
•OT Staff,
•Administration of Hospital
•Sr. Colleagues Have to extend helping hand
28. Before Declaring to Relatives
& Informing Police….
• During intra-operative procedure keep relatives
informed if patient is serious and collapsing.
• Complete all relevant documents such as case paper
with detailed anesthesia and surgeon notes,
resuscitation notes, any visiting consultant notes.
• Notes should tally among consultants and there should
not be any contradictions.
• Preserve all the broken ampoules of injections, no
expired drugs should ever be found in OT.
• Leave things as they are, do not clear up the OT.
• Take back all prescriptions if any, from relatives
especially for emergency drugs.
29. Help Yourself Not to be Beaten Up
INFORM
Superintendent of hospital
Police Station
Security Guards
Keep Emergency Exit available
30. Interaction with the POLICE
• Informing the police
• Police perform “Panchnama”
• Handing over the papers after numbering
• Information to police shall preferably be in
writing and the written acknowledgement should
be obtained.
• If the information is telephonic
one must note down name,
buckle number and
designation of the police.
32. Keep a Bold Face !!
Never worry, “Be concerned”
33. How to Handle The Situation…
Gather
Ask for help in OT
Relax
Review sequence of events
Do not adopt a “Blame Culture”
Proper documentation
No discrepancies in records
No comments by junior staff
Never worry, “Be concerned”
34. RELATIVES WANT to know TRUTH
Be honest
Integrity pays
Sympathetic approach
36. Tips to Communication Skills
• Avoid AGGRESSION or putting BLAME
on relatives
• Staff SHOULD NOT CONTRADICT
statements made by consultants to
avoid misinterpretation by relatives.
• DO NOT REFUSE TO
GIVE RECORDS
or refuse postmortem,
rather suggest it from your side.
37. Being Sensitive to Verbal & Nonverbal
Language of the patients & Relatives
Give time & space:
EMOTIONAL DISCHARGE
Give opportunity to ask questions
38. Arrest of a Doctor
• Postmortem report
• Opinion of police surgeon
• Discretion of the Investigating Officer
after taking opinion of expert panel
Arrest of a Doctor
Should not happen / But does happen inspite
of Supreme court Ruling
39. • A survey in the British Medical Journal reported
the attitudes of doctors towards the intra-operative
death of a patient………
• 84% response rate
• 92% of respondents had experienced a DOT
• Majority of deaths being expected by 60%
• 77% say these DOT are non-preventable
• 80% says occurring during emergency surgery
• In 41% of cases involving vascular surgery
• 87% had given repeat anesthesia in next 24
hours.
40. • The KARNATAKA HIGH COURT, while
proceeding a case of DOT held that in the
absence of postmortem, histopathology,
etc, the possibility of other causes of death
can’t be ruled out. The death on the
operation table by itself is not sufficient to
prove rashness or negligence against the
accused.
41. Supreme Court 2014
11 – points code on med Negligence
1. Negligence is a breach of duty or an act which Prudent and reasonable
man will not do
2. Negligence to be established by the prosecution must be culpable or
gross and not the negligence merely based upon an error of
judgment
3. Medical professional is expected to bring a reasonable degree
of skill and knowledge along with a reasonable degree of
care but neither the highest nor the lowest degree of care and
competence
4. A doctor would be able only where his conduct fell below that of
the standard of a reasonable competent practitioner in
the field.
5. Difference of opinion cannot be cited as negligence.
42. Supreme Court 2014
11 – points code on med Negligence
6. Just Because a professional looking at the gravity of illness had
taken a Higher Element Of Risk to redeem the patient out
of his suffering which did not yield the desired result, it may not
amount to negligence
7. Merely because a doctor chooses one course of action in
preference to the other one available, he would not be liable if
the action chosen by him was acceptable to the medical profession
It would not be conducive to the efficiency of the medical
profession if no doctor could administer medicine without a hinter
round his neck.
8. It would not be conducive to the efficiency of the medical without a
halter round his neck.
43. Supreme Court 2014
11 – points code on med Negligence
9. It is our duty not to harass or humiliate medical
professionals unnecessarily so as to allow them to
perform their duties without fear and apprehension
10. Doctors at times have to be saved from such
complaints that use criminal process as a tool for
presuming them or hospital and clinics for
extracting uncalled for compensation
11. Doctors are entitled to get protection so long as
they perform their duties with reasonable skill and
competence and in the interest of patients.
44. Last, But Not The Least…..
Every new day brings CHALLENGES AND OBSTACLES
Stop thinking about it constantly at HOME
Keep your morale & self confidence intact
Learn the lesson it teaches
Take a small break
45. We all make mistakes
?
How many of you have ever felt that
“I” should NOT be practicing medicine
because
I am too dangerous and not good for society
46. ADDRESS
11 Gagan Vihar , Near Karkari Morh
Flyover Delhi -51
CONTACT US
9650511339
011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com
