How to avoid unintentional harm

HARMONY Making sure Hawkes Bay Hospital surgical teams are on the same page are infection control adviser Margaret Drury (left), surgeon Alister Dray, clinical director surgical services Dr John Rose, visiting health quality and visiting Health Quality and Safety Commission perioperative harm advisor Dr Ian Civil and chief medical officer Dr John Gommans. PHOTO/WARREN BUCKLAND HBT14252602

Surgical teams at Hawke's Bay Hospital are learning new ways to avoid unintended harm from surgery.

Yesterday more than 100 clinicians were shown strategies to ensure safe surgical teamwork by Health Quality and Safety Commission perioperative harm adviser Ian Civil.

The lunchtime presentation was part of a national campaign to reduce perioperative harm - unintended harm to a patient before, during or after an operation.

"It can include foreign bodies left in during an operation such as a swab or instrument, accidental injury during an operation and complications such as blood clots or infection," Dr Civil said.

Two years ago the Hawke's Bay District Health Board (DHB) adopted the World Health Organisation's Checklist for ensuring safer surgery.

DHB chief medical officer Dr John Gommans said it was proven internationally that by following the checklist properly, through good team engagement and communication, unintended consequences were reduced.

"The checklist has three stages: sign in, time out before starting surgery and a sign-out debrief - making sure at each stage we are ready to proceed and do the job properly," he said.

Surgery was not hierarchical and each team member had an important role in the DHB's seven theatres, he said.

"It is not the ticking of boxes that is important but the communication and engagement of the team around the process."

Dr Civil said surgery team members changed daily and pre-operative briefings helped build rapport and ensured everyone understood their roles.

"Ensuring that everyone in the room has spoken at least once before the operation begins is important. Research has shown they are more likely to speak up if they have concerns about patient safety.

"The team should also discuss anticipated problems with staffing or equipment, talk about expectations for the day and deal with any questions or concerns. This means everyone knows exactly what is, or should be happening."

There would always be a small risk of unintended consequences "but we can certainly make sure that we do everything we intend to do".