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British Journal of Anaesthesia Jan 2017Human error poses significant risk for hospitalized patients causing an estimated 100,000 to 400,000 deaths in the USA annually. Medication errors contribute, with error... (Review)
Review
Human error poses significant risk for hospitalized patients causing an estimated 100,000 to 400,000 deaths in the USA annually. Medication errors contribute, with error occurring in 5.3% of medication administrations during surgery. In this study 70.3% of medication errors were deemed preventable. Given the paucity of randomized controlled studies, we undertook a rigorous review of the literature to identify recommendations supported by expert opinions. An extensive literature search pertaining to medication error, medication safety, operating room, and anaesthesia was performed. The National Guidelines Clearinghouse was searched for any anaesthesia or operating room medication safety guidelines.A total of 74 articles were included. Recommendations were tabulated and assigned points based on a scale revised from a prior study. A total of 138 unique recommendations were identified, with point tallies ranging from 4 to 190. An in-person focus meeting occurred, where the 138 recommendations were reviewed, combined and condensed. A modified Delphi process was used to eliminate items found to be unimportant or those unable to be quantified (e.g. "minimize fatigue"). A total of 35 specific recommendations remained. Adverse events as a result of medication errors occur frequently in the operative setting. There are few rigorous studies to direct medication safety strategies, but this should not lead us to do nothing. The overwhelming consensus regarding best practices should be accepted, and the recommendations implemented. Our list of recommended strategies can hopefully be used to assess local vulnerabilities and institute system solutions.
Topics: Humans; Medication Errors; Operating Rooms; Patient Safety
PubMed: 28039240
DOI: 10.1093/bja/aew379 -
BMC Anesthesiology Aug 2023Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely...
BACKGROUND
Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff.
DESIGN
A questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively.
RESULTS
Between June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training.
CONCLUSION
Overall, anesthesia providers' attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice.
Topics: Humans; Operating Rooms; Anesthesiology; Hypnosis; Hospitals; Anesthesia
PubMed: 37620788
DOI: 10.1186/s12871-023-02229-3 -
Turkish Neurosurgery 2022To develop a scale in Turkish language for evaluating the surgical specialty residents? perceptions of educational climate in the operating room, with an emphasis on...
AIM
To develop a scale in Turkish language for evaluating the surgical specialty residents? perceptions of educational climate in the operating room, with an emphasis on learning in the operating suite and planning the relevant change for improved and standardized training.
MATERIAL AND METHODS
Three surgeons from different disciplines provided expert opinions and a focus group meeting was held on the necessity, scope, and specificity of the items. The 5-point Likert type draft scale consisted of 28 items including ten negative statements scored reversely and having total scores ranging between 28-140 points. There were 5 subscales: educational process, teamwork, communication, operating room infrastructure, and surgical skills education. For assessing the validity and reliability, 172 surgical specialty residents from three hospitals in different locations were asked to answer the paper-based scale items anonymously. Confirmatory factor analysis (CFA) was used to test validity, whereas Cronbach?s alpha reliability coefficients were calculated for internal consistency.
RESULTS
CFA revealed a chi-square, standard deviation, chi-square/standard deviation, and a p-value of 783.73, 340, 2.27, and 0.001, respectively. Cronbach?s alpha coefficient for educational process, teamwork, communication, operating room infrastructure, and surgical skills education subscales were calculated to be 0.61, 0.61, 0.63, 0.70, and 0.72, respectively. Cronbach?s alpha coefficient for all items was 0.89. Results indicated acceptable construct validity and internal consistency of the scale.
CONCLUSION
The newly developed scale was proven as a reliable and valid measurement instrument that can be used within the Turkish health system setting for assessing and improving the educational climate in the operating room.
Topics: Clinical Competence; Operating Rooms; Psychometrics; Reproducibility of Results; Surveys and Questionnaires
PubMed: 33978212
DOI: 10.5137/1019-5149.JTN.30775-20.1 -
Health Care Management Science Jun 2023This study seeks to improve the safety of clinical care provided in operating rooms (OR) by examining how characteristics of both the physical environment and the...
This study seeks to improve the safety of clinical care provided in operating rooms (OR) by examining how characteristics of both the physical environment and the procedure affect surgical team movement and contacts. We video recorded staff movements during a set of surgical procedures. Then we divided the OR into multiple zones and analyzed the frequency and duration of movement from origin to destination through zones. This data was abstracted into a generalized, agent-based, discrete event simulation model to study how OR size and OR equipment layout affected surgical staff movement and total number of surgical team contacts during a procedure. A full factorial experiment with seven input factors - OR size, OR shape, operating table orientation, circulating nurse (CN) workstation location, team size, number of doors, and procedure type - was conducted. Results were analyzed using multiple linear regression with surgical team contacts as the dependent variable. The OR size, the CN workstation location, and team size significantly affected surgical team contacts. Also, two- and three-way interactions between staff, procedure type, table orientation, and CN workstation location significantly affected contacts. We discuss implications of these findings for OR managers and for future research about designing future ORs.
Topics: Humans; Operating Rooms; Computer Simulation; Multivariate Analysis; Patient Care Team
PubMed: 36529790
DOI: 10.1007/s10729-022-09622-3 -
The Journal of Surgical Research Mar 2020Recent literature showed that analysis of interruptions can contribute to evaluating the care process in the operating room, and thus, understanding potential errors... (Review)
Review
BACKGROUND
Recent literature showed that analysis of interruptions can contribute to evaluating the care process in the operating room, and thus, understanding potential errors that may occur during surgical procedures. The aim of this comprehensive review was to summarize current knowledge on the description and impact of interruptions in surgery.
MATERIAL AND METHODS
A literature search was conducted according to a set of criteria in the databases MEDLINE, BASE, Cochrane's Library, and PsycINFO.
RESULTS
41 articles were included. Two main methodological approaches were found, observational in the OR, or controlled in an experimental simulated environment. Interruptions in the OR were manifold, and several classifications were used. The severity of interruptions differed according to the category of the interruptions. Interruptions were influenced by team familiarity and the expertise of the surgical team; high team familiarity and a high level of expertise decreased the frequency of interruptions. However, our literature search lacked controlled studies carried out in the OR. Interruptions seemed to increase the workload and stress of the surgical team and impair nontechnical skills, but no clear evidence of this was advanced.
CONCLUSIONS
Interruptions are probably risk factors for errors in the operating room. However, there is as yet no clear evidence of the association of interruption frequency with errors in the operating room. There is a need to define and target interruptions, which should be reduced by putting safeguards in place, thereby allowing those which could be beneficial and neglecting those with no potential consequences.
Topics: Humans; Medical Errors; Operating Rooms; Patient Care Team; Patient Safety; Quality Improvement; Risk Factors; Workload
PubMed: 31706542
DOI: 10.1016/j.jss.2019.10.024 -
Journal of Robotic Surgery Aug 2023Operating room nurses, who have an important place in the professional healthcare team, should be able to use technology effectively and adapt to innovations. This study...
Operating room nurses, who have an important place in the professional healthcare team, should be able to use technology effectively and adapt to innovations. This study is expected to shed light on how effective the development of robotic technologies and artificial intelligence and their integration into operating room nursing will be in fulfilling the requirements of contemporary nursing philosophy. This study was designed as a single group pre- and post-test quasi-experimental study. The quasi-experimental (pretest-posttest) research design was utilized to conduct the study in a Training and Research Hospital in Western Turkey. The nurses (n = 35) working in the operating room of the aforementioned hospital were included in the study. In this study, we aimed to determine whether operating room nurses experienced anxiety due to the use of artificial intelligence and robotic nurses, and the effectiveness of the training given to them in order to raise their awareness. The following three tools were used for data collection: The Nurses' Descriptive Characteristics Form, Artificial Intelligence Knowledge Questionnaire, and Artificial Intelligence Anxiety Scale. Data extraction and analysis were performed in a narrative and tabular way. According to this study, the training given to the operating room nurses significantly increased their knowledge levels about artificial intelligence and robotic nurses, and increased their artificial intelligence- and robotic nurse-related anxiety significantly (p < 0.05). The participating operating room nurses experienced limitations regarding current information, training programs and learning opportunities on robotic surgery. We recommend that the operating room nurses should be provided with trainings on artificial intelligence technologies and robotic nurses, and that they should be enabled to use these information technologies regarding future technologies actively.
Topics: Humans; Artificial Intelligence; Robotic Surgical Procedures; Operating Rooms; Nurses
PubMed: 37002463
DOI: 10.1007/s11701-023-01592-0 -
Journal of Graduate Medical Education Aug 2022
Topics: Humans; Internship and Residency; Operating Rooms
PubMed: 35991100
DOI: 10.4300/JGME-D-22-00003.1 -
Journal of Biomedical Informatics Dec 2022Surgical context-aware systems can adapt to the current situation in the operating room and thus provide computer-aided assistance functionalities and intraoperative...
BACKGROUND
Surgical context-aware systems can adapt to the current situation in the operating room and thus provide computer-aided assistance functionalities and intraoperative decision-support. To interact with the surgical team perceptively and assist the surgical process, the system needs to monitor the intraoperative activities, understand the current situation in the operating room at any time, and anticipate the following possible situations.
METHODS
A structured representation of surgical process knowledge is a prerequisite for any applications in the intelligent operating room. For this purpose, a surgical process ontology, which is formally based on standard medical terminology (SNOMED CT) and an upper-level ontology (GFO), was developed and instantiated for a neurosurgical use case. A new ontology-based surgical workflow recognition and a novel prediction method are presented utilizing ontological reasoning, abstraction, and explication. This way, a surgical situation representation with combined phase, high-level task, and low-level task recognition and prediction was realized based on the currently used instrument as the only input information.
RESULTS
The ontology-based approach performed efficiently, and decent accuracy was achieved for situation recognition and prediction. Especially during situation recognition, the missing sensor information were reasoned based on the situation representation provided by the process ontology, which resulted in improved recognition results compared to the state-of-the-art.
CONCLUSIONS
In this work, a reference ontology was developed, which provides workflow support and a knowledge base for further applications in the intelligent operating room, for instance, context-aware medical device orchestration, (semi-) automatic documentation, and surgical simulation, education, and training.
Topics: Workflow; Operating Rooms; Computer Simulation; Knowledge Bases
PubMed: 36368631
DOI: 10.1016/j.jbi.2022.104240 -
JACC. Clinical Electrophysiology Feb 2019
Topics: Defibrillators, Implantable; Operating Rooms; Pacemaker, Artificial; Risk Assessment
PubMed: 30784688
DOI: 10.1016/j.jacep.2019.01.008 -
Nigerian Journal of Clinical Practice Aug 2023Among various vascular access devices, midline catheters (MCs) are commonly used in emergency departments, but rarely in operating rooms.
BACKGROUNDS
Among various vascular access devices, midline catheters (MCs) are commonly used in emergency departments, but rarely in operating rooms.
AIMS
To evaluate the feasibility and safety of MCs in the operating room.
MATERIALS AND METHODS
This was a retrospective study. The medical records of patients who underwent MC placement in the operating room from October 2020 to July 2022 were reviewed. The rates of successful catheter insertion as well as major and minor complications were assessed.
RESULTS
Successful catheter insertions were achieved in 149 of 161 patients (92.5%). The median dwell time of midlines was eight days (IQR: 6-10 days). A major or minor complication occurred in 6.7% of the midlines. The rates of major complications of occlusion, upper extremity deep vein thrombosis (DVT), and catheter-related bloodstream infection were 1.3%, 0.7%, and 0%, respectively.
CONCLUSIONS
Placement of MCs in the operating room was feasible and safe. Also, the procedure provides an acceptable alternative for replacing central line catheters and peripherally inserted central catheters.
Topics: Humans; Operating Rooms; Retrospective Studies; Catheters; Emergency Service, Hospital; Medical Records
PubMed: 37635602
DOI: 10.4103/njcp.njcp_843_22