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Overview of Guideline and Walk Through SSSL ver 2.0


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A brief review on the principles and rationale behind the latest version of Safe Surgery Saves Lives initiative to enhance patient safety peri-operatively. Delivered in conjunction with a SSSL training workshop, it includes a walk through of the SSSL program.

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Overview of Guideline and Walk Through SSSL ver 2.0

  1. 1. Overview of Guideline and Walk Through SSSL ver 2.0 SSSL Workshop Bil. 01/2019 20th April 2019 Chea Chan Hooi Surgeon Sibu Hospital
  2. 2. Content • Surgical errors • Introduction to SSSL • Organisational structure • Objectives • OT etiquette • Using the checklist
  3. 3. Examples of surgical errors
  4. 4. Yes, he had hemorrhoids :]
  5. 5. Introduction • Adverse event in surgery is an important issue in which many are preventable • Surgical Safety Checklist introduced by the WHO in 2008 • In Malaysia, SSSL steering committee in 2008 and lauched Nov 2019 (Safer Surgery through Better Communication) • Implemented in all MOH hospitals from 01/01/2010 • July 2018, 2nd edition of SSSL guidelines lauched
  6. 6. Organisational structure • National level - Safe Surgery Steering Committee • State level - Safe Surgery State Committee • Hospital level • To identify suitable Safe Surgery champions or potential champions in the hospital to be members of the Safe Surgery Hospital Committee • To lead and to drive the SSSL programme • To plan the way forward of SSSL programme • To promote and disseminate information on safe surgery and SSSL programme • To monitor, evaluate the implementation and effectiveness of SSSL programme • To further strengthen and enhance implementation of SSSL in the state • To give feedback to the state and national committees regarding issues and challenges faced in order to improve the SSSL programme • To share and learn from patient safety incidents related to surgery • To encourage innovative improvement of surgical safety
  7. 7. Objectives • Improve surgical safety • Prevent surgical adverse events
  8. 8. Strategies • Improving communication and team work to ensure safer surgery • OT etiquette • Surgeons leadership in SSSL programme • The use of “Surgical Safety Checklist” to improve the standards of surgical safety • Pre-operative checklist • Operating team checklist • Swab and instrument count form • Pre-discharge check
  9. 9. OT etiquette • Personal Protective Equipment (PPE) • PPE is essential during surgery to protect the staff as well as the patient • Wear clean PPE in operating theatre (OT) • Surgical mask must be worn once the set of surgical instruments are opened. • If the surgery might predispose the staff to ‘splashing hazard’ such as blood and body fluid, eye protection is crucial • Once scrubbed, maintain sterility • If you are standing away from the operating field, clasp your hands together at the level of your chest • If you are standing at the OT table place your hands flat in the sterile area
  10. 10. • General matters: • Avoid wearing watch, bracelet, ring or fake nails • Avoid unnecessary traffic when surgery is ongoing • Surgeons/assistants should never take instruments from the instrument trolley/tray. • Ask for the instrument and wait for it to be passed to you • Blades and sharps are passed via a tray • Return all instruments once you have used them • Avoid unnecessary talk. Respond clearly with “yes” or “no” • Answering phone calls should be kept to a minimum and not at all if possible • Thank the team members before exiting a surgery
  11. 11. • For new healthcare personnel • Introduce yourself to operation theatre manager/nursing sister, the surgeons, the anaesthetist and clearly display your identification badge • Obtain surgeon permission before scrubbing or observing the surgery • If you are scrubbing for the case, know your patient well and the procedure
  12. 12. Surgeons leadership • Team work involving multidisciplinary staff • Demonstrate leadership skills and create safety culture • Based on feedbacks, surgeons leadership still needs to be further improved • Check procedures are done before ticked • Strive to involve all team members • Lead and drive the SSSL programme • Educate and motivate others outside OT
  13. 13. • Criteria of a good surgical leader • Act with integrity • Are honest, open and consistent • Are accessible • Are open to challenge and feedback • Are decisive • Are self aware and mindful of their impact on others • Recognise their own responses to stress
  14. 14. Check list Credit : Dato Dr Jamil
  15. 15. Pg 1
  16. 16. Pg 2
  17. 17. Pg 3
  18. 18. Pg 4
  19. 19. Patients with multiple surgeries performed by multiple teams • Patients with e.g. polytrauma, complex ENT or pelvic tumours • Problems • Prioritisation of procedures • Underestimated EBL • Prolonged GA • Risk of SSI • Retained FB • Add in the Multidisciplinary Checklist (2 pages) for each additional team • Primary team uses the usual 4 page checklist
  20. 20. Pg 1 Allergies
  21. 21. Pg 2
  22. 22. Conclusion • The majority of surgical adverse events are preventable • SSSL is not new to us • The goal is to cultivate a safety culture amongst OT members to minimise surgical & anaesthetic adverse events to ensure patient safety • Improve communications, work as a team and adopt SSSL check list will • Monitoring and feedback mechanisms for quality assurance
  23. 23. Know your role and do it well
  24. 24. Thank you! Questions?
  25. 25. SUSE 2.019