CEBU, Philippines - Cebuanos these days ought to be lobbying and holding mass actions for a critical issue – patient safety. Every patient has the right to be safe in the hands of the surgeon. But has that right been significantly accorded? Are hospitals as patient safety conscious and sensitive as the surgeons?
Forget the oil price hike or charter change. Patient safety rights is a serious issue worth fighting for – not just in operating rooms or hospitals but also on the streets. Surgeons in the region are now undertaking serious moves on patient safety. And while these moves are pretty much belated and nascent, it is better to have stepped on the water than not having done anything at all.
Surgeons in the region have long been aware of errors in operating rooms but while no in-depth study has been made as to how far and how many patients have been affected by surgical errors, at least something is being done right now. There are aggressive campaigns at promoting and implementing a Universal Protocol on Patient Safety checklist. Prepared by the World Health Organization, this checklist should have been implemented in Cebu and other hospitals in the region at least a decade ago. Apparently what stalled it were hospital budgets and logistics and there seemed no culture for patient safety until some patients started walking around with objects in their bodies that are not part of the appendage.
Protocol checklist.
Basically this protocol has a three-phased checklist that begins with a sign in or that stage before anesthesia is induced, time out before the skin incision and sign out before the patient leaves the operating room. At the sign in stage or before anesthesia is induced, surgeons are required to confirm the identity of the patient, site where surgery will be done, the procedure and yes, the consent of the patient was taken beforehand. Site of the surgery must be properly marked and the pulse oximeter on the patient is functioning. There are scary observations that not all hospitals in Cebu have pulse oximeters. Also at the sign in, there must at least be 500 ml of blood on standby. Other than that, patients must be checked for allergies and airway and aspiration risks.
Before the skin incision or time out, surgeons must confirm all team members are introduced by name and role and that means surgeons, anesthesiologist and nurse must verbally confirm patient, site and procedure. Also at this stage the surgeon must anticipate critical events, unexpected steps and anticipated blood loss. Then when the surgery is done and before the patient leaves the operating room, a sign out is done where the nurse verbally confirms the name of the procedure, instrument count including for count of syringe and sponge are correct, specimens are well labeled and key concerns for recovery and management.
In many ways the protocol checklist is very specific. That’s because the objectives of safe surgery is to make sure that patient is the correct patient and will be operated at the correct site, methods used are known to prevent harm from administration of anaesthetics while protecting the patient from pain. Surgery recognizes and effectively prepares for life-threatening loss of airway or respiratory function, risks of blood loss and avoids allergic or adverse drug reaction.
Safe surgery is equally important to minimize risks for surgical site infection, prevent inadvertent retention of instruments or sponges in surgical wounds and secure and accurately identify all surgical specimens. The other thing about safe surgery is that there must be effective communication and information exchange in the conduct of safe operation. Hospitals and public health systems must establish routine surveillance of surgical capacity, volume and results.
How about the hospitals?
Thing is, while surgeons want to make a clean go at patient safety and safe surgery, they are only surgeons. Hospitals too must be equally committed about making patient safety part of their mission, vision and protocol. It’s just that in Cebu, patient safety rights is not such a big issue. Those who may have been hapless victims of errors in the operating room are not one to file suits against their surgeons.
Patient safety and safe surgery are still issues that need to be imbibed in patients and for hospitals to be seriously committed in adopting. Until there is a sponge floating in your belly, not many people care much about patient safety. If we are not concerned about it now, we just won’t know how many more will have sponges inside their bellies or lose wrong breasts because the site of the procedure was not confirmed before anesthesia was induced. The price of complacency in patient safety is not just the loss of a limb, it’s a life.