Safety hazards | Recommendations |
---|---|
Unreliable documentation of pre-operative health status | • National uniform health declaration • Standardized surgery notification form (Mandatory registration of the most important data, consistent registration of contagious conditions, and preset limitations of care) • Standardized routines for pre-operative assessment • Routine use of ASA classification • Selective pre-operative anaesthesiologist assessment based on ASA classification (Patients with ASA I-II are assessed on request; those with ASA IV are assessed invariably.) |
Divergent systems of documentation between different units | • Consistent admission notes (structured with standard headings, preferably partly delegated to a specialist nurse) • Systems for documenting important medical information accessible to everyone • Systems for patient records with a structure suitable for surgery as well as anaesthesia Harmonization of management programmes of clinics involved in the same course of care • Coordinated and uniform systems for drug prescriptions for anaesthesia and surgery |
Insufficient planning of high-risk procedures | • Multidisciplinary forum for evaluation of high-risk patients • Weekly scheduling of surgical programmes operations in the entire unit • Daily scheduling of programmes in each theatre |
Inconsistent use of checklists | • Routine use of the WHO checklist |
Lack of standardized communication | • Open dialogue during surgery • Team training with anaesthesia and surgery crew • Reporting based on SBAR |
No routines for feedback on adverse events | • Mortality and morbidity conferences common to surgery and anaesthesia personnel |