The core and purpose of medical safety is first and foremost patient safety [1]. Currently, tens of millions of people around the world undergo surgical treatment for various reasons every year, and 1 in 10 of them have experienced Medical errors[2]. Among the 5,632 dangerous events reviewed by the Joint Commission on Medical Institutions in the United States from 1995 to 2008, "wrong site surgery" accounted for 13.2%, ranking first [3]. Therefore, effectively carrying out surgical safety verification and preventing the occurrence of incorrect surgeries is an issue that needs to be discussed together around the world. To this end, the Chinese Hospital Association (CAN) revised and improved the "2009 Patient Safety Goals", and the Central Quality Committee of the National Ministry of Health also promulgated the implementation details of the "Surgical Safety Verification System" to ensure surgical safety. Since 2010, our hospital Starting from January 2020, on the basis of learning the above goals and systems, we will further refine the implementation safety verification process and content, and analyze the specific implementation effects. The report is as follows. one. Implementation of the Surgical Safety Verification System 1. Establishing a Surgical Safety Verification System 1.1 Publicity and training: Organize surgery-related personnel to study the "2009 Patient Safety Goals" carefully, understand its importance, explain the use of the surgical checklist, actively cooperate in the operating room, and anesthesia Doctors, surgeons, and operating room nurses actively participate, and there are many people. They must coordinate and cooperate with each other to successfully complete this work. 1.2 Verify the responsible persons and responsibilities. The safety verification of surgical patients is a complex process involving multiple departments, multiple personnel, and multiple links. It involves surgical patients, ward nurses, operating room nurses, anesthetists, and operating doctors. Each department interacts with each other. Only through coordination and mutual cooperation can verification in different periods be completed [4]. Verification must be carried out from the time the patient enters the operating room before any medical procedure is performed on the patient [5]. 1.3 Contents of surgical safety verification 1.3.1 Patient verification Verify the patient’s name, gender, department, hospitalization number, bed number, age, name of surgery, surgical method, surgical site, surgical site markings, drug allergy history, and skin condition , examination report, informed consent form, and identification band worn on the wrist or ankle. 1.3.2 Inspections during the operation are completed jointly by the surgeon, circulating nurse, and handwashing nurse: (1) Count all items together before the start of the operation, the second count before closing the body cavity, and the third count after closing the body cavity. Count again after the operation is completed and the skin is sutured; (2) Check the surgical specimens, fill in the labels accurately, and check the application form for pathology inspection. The hand-washing nurse completes specimen fixation and fills in and signs the registration book. The roving nurse again Confirm and sign; (3) Check the implant certificate and barcode during the operation. 1.3.3 Inspection of instruments and equipment. Establish a usage registration book for various instruments and equipment required for surgery. After using them, the circulating nurse should fill in the operating status in a timely manner. In addition to normal operation, they should also foresee whether the equipment needs repair and maintenance. 2. Surgical safety verification process 2.1 Nurse self-verification process and content Foreign data show that nurses began to perform double checks through handheld PC/scanner...Specifically code scanning and visual confirmation [6]. 2.1.1 Preoperative visit: First verification: The circulating nurse visits on the afternoon of the 1st day before the operation to learn about the patient’s identity (department, bed number, medical record number, name, age, gender), preoperative diagnosis, and name of the operation. Surgical site and identification, necessary examination results, cross-matching status, presence of special infections, allergic and surgical history, etc. 2.1.2 The second verification is carried out when the ward is handed over to the operating room. On the morning of the operation day, the handover and verification will be carried out according to the operation notice and the surgical patient handover record sheet with the ward nurse. If the patient is conscious and able to answer, the patient will have to explain his/her identity and meaning. Those who are unclear or unable to answer, as well as infants and young children, are identified through wristbands and confirmed by their legal relatives. After everything is correct, the operating room nurse and ward nurse will sign the handover record sheet. 2.1.3 For the third inspection of the operating room, an elective surgery prompt board [7] is hung in a prominent place at the door of the operating room, indicating the operating room, name, diagnosis, operation name, instruments, and circulating nurse for each operation on that day; Surgical prompt boards are also placed in eye-catching places in the room. The nurse who picks up the patient checks the corresponding content with the circulating nurse. Those who are unclear or the identity of infants and young children can be identified by wristbands. 2.2 The "three-party and five-party" verification process and content of the surgical team 2.2.1 Before anesthesia is performed, the anesthesiologist presides over and is responsible for verifying the patient's identity (the same as the preoperative nurse visit and verification content) and the name of the surgery according to the contents of the surgical safety checklist , informed consent, surgical site and identification, anesthesia safety inspection, skin, intravenous access, preoperative blood preparation, patient allergy history, antimicrobial skin test results, infectious disease screening results, body values, and imaging data wait. It will be checked and signed by three parties: the surgeon, the anesthesiologist, and the operating room nurse. 2.2.2 Before positioning, the circulating nurse will preside over and the three parties will jointly check the identification of the surgical site, especially unilateral surgery with left and right organs on both sides and surgery on two or more sites. The circulating nurse and the instrument nurse are both responsible for checking the instruments and dressings used during the operation, and completing the inventory records in a timely manner. The records include the patient's hospitalization number, department, bed number, name, operation date, operation name, and the equipment used during the operation. Inventory and verification of the number of instruments and dressings, signature of the verifier, etc.

2.2.3 Before the operation starts, there is a pause (Time Out) before skin incision. The surgeon presides over and is responsible for verifying the patient's identity, operation name, operation site, operation identification, confirming risk warnings, etc., and ensuring that the patient, operation site, operation name, etc. Correct; the operating room nurse verifies the preparation of surgical items and reports to the surgeon and anesthesiologist. The verification results will be confirmed and signed by the three parties. Encourage patients to participate in healthcare safety. 2.2.4 At the end of the operation, before closing the body cavity, the surgeon announces the name of the operation and the status of drainage; the circulating and instrument nurses will simultaneously check the instruments and dressings used during the operation before and after closing the body cavity, and report the results to the surgeon and Anesthesiologist, complete inventory records in a timely manner. The surgical inventory record is made in duplicate, one for the operating room archive and one for the medical record. If you have any doubts, please ask the Radiology Department to take X-rays for verification. 2.2.5 Before the patient leaves the operating room, the operating room nurse presides over and is responsible for verifying the patient's identity, actual name of the operation, counting surgical supplies, confirming surgical specimens, checking skin, arteriovenous access, drainage tubes, monitoring instrument lines, and confirming the patient's whereabouts wait. The results were unanimously confirmed by three parties. 2.3 Detailed management of surgical safety inspection 2.3.1 Medication and blood transfusion safety Heparin, insulin, chemotherapy drugs, drugs requiring skin testing, anesthetic drugs, pressure-generating drugs, 10% potassium chloride, hypertonic electrolyte solution, etc. Store them in categories, and clearly mark the placement area. When administering medication, it must be checked by two people; when medication is administered on the operating table, the circulating nurse and the instrument nurse must check together. During the check, the name, dosage, and expiration date of the drug must be read out. , skin test results and dosage, if correct, use a sterile syringe to draw it and place it on the table, and mark it for later use. The circulating nurse accurately records the name of the drug, dosage, route of administration and time. When a patient needs blood transfusion due to his condition during the operation, he should first check whether the bed number, name, hospital number, blood type and other information on the blood type test report are accurate and consistent with the information in the medical record, and then check the results of the cross-matching blood test. Check whether there are any cracks in the bag to ensure that the blood is within the validity period. Before blood transfusion, two people need to check the information again before transfusion. After the blood transfusion is completed, the blood bag should be kept for 24 hours in case of necessary inspections. And sign in the corresponding position on the blood transfusion application form. 2.3.2 Storage and inspection of specimens Surgical specimens are irreplaceable, and biopsy pathology diagnosis is the first diagnosis in surgery and is the gold standard [8]. With the increasing number of surgeries in hospitals, multiple surgeries are generally scheduled in one operating room. If verification is not strengthened, improper specimen management will bring great difficulties to clinical diagnosis and cause serious losses to patients. Strictly implement the specimen storage and inspection system, and implement the "one-on-one, double-signature, three-complete" measures, that is: the postoperative roving nurse will hand over the specimen to the physician in charge, both the person who sent the specimen and the person who received the specimen will sign, and the pathological examination application form, pathology The specimen registration book and pathological specimen label must be filled in completely and correctly. 2.3.3 Inventory of surgical supplies Implement the "four counts and three clears" system for surgical supplies, that is, count surgical instruments, dressings, etc. four times "before surgery, before closing the body cavity, after closing the body cavity, and after the surgery", and count them in person , record on the spot, retell and check the number of records, so that the "instrument nurse, circulating nurse, and second assistant" are clear and accurate, and prevent items from being left in the body cavity; and strengthen risk prevention for endoscopic instrument accessories and gauze used in body cavity surgery. 2.3.4 To prevent patients from falling, falling off the bed, detachment, and pressure sores, the operating room has designated personnel to regularly inspect the flat carts and operating beds used to transport patients, assist patients in getting into bed, guard at the bedside, and add bed stalls during the transfer of patients. Patients are escorted to the restroom before surgery and asked to wear non-slip shoes. Before moving the patient, a dedicated person will check and organize the pipelines. When moving the patient, all staff will coordinate. After moving the patient, three parties will jointly check whether the pipelines are safe, smooth, and firmly fixed. Assess the patient's skin before surgery, properly fix the patient's position during surgery, pay attention to observing and caring for the compressed skin, and move the patient gently, accurately, and steadily. Use and manage the electric knife correctly during surgery to avoid electric knife burns. 2.3.5 Effective communication and verification under special circumstances Oral medical orders and important test reports during first aid must be read again. The sender of the information clearly sends the message, prohibits abbreviations, unifies the dosage unit of the drug, requires the party receiving the information to confirm and repeat the content, and immediately records the received phone call or verbal message on paper, and then re-reads the recorded content and confirms it is correct by the sender of the message. Only then can it be executed and officially recorded. 3. Effect evaluation In order to evaluate the implementation of patient safety goals, we evaluated the implementation effect from the following aspects. A. Eliminate patient identification errors; B. Medication and blood transfusions are safe and correct; C. Effective communication and correct implementation of medical orders; D. The surgical patients, surgical sites, and surgical procedures are correct; E. The item inventory is accurate; F. The storage of surgical specimens and It is safe to submit for inspection; G. The surgical inventory record is timely and accurate; H. Reduce the risk of patients falling and falling off the bed; I. Avoid the risk of tube compression, tube detachment, and tube folding; J. Eliminate pressure sores and burns for patients. Among them, the target implementation rate of A~E projects is 100%, while other projects are still unsatisfactory, with the target implementation rate of 97~99.5%. 3.1 Establish a sound and feasible check-up system. Problems in any link can lead to serious medical care deficiencies. Control or eliminate unsafe factors from all aspects to ensure patient safety. A large number of studies have shown that the lack of information exchange or insufficient communication between the surgical team is one of the risk factors leading to incorrect surgery [9].

In 2001, Meir Medical Cardiology in the United States conducted a multi-factor, cross-departmental intervention study related to perioperative patient safety. Significant errors identified in this study include: patient error, patient record folder or record error in the record folder, no informed consent form or incorrect informed consent form, no identification wristband or incorrect identification wristband, no identification label or incorrect identification Labeling, unmarked surgical site or incorrectly labeled surgical site, etc. [10]. To this end, the implementation of the "Surgical Safety Checklist" in our hospital has made up for the system shortcomings and clarified the responsibilities of anesthetists, surgeons, and circulating nurses to check together, so that the information exchange or communication of the surgical team can be effectively guaranteed. In the previous working model, the surgeon checked the patient in the ward, the anesthesiologist checked the patient during the preoperative visit, and the circulating nurse checked again when picking up the patient. The procedures were cumbersome, and the patient was prone to boredom and suspicion, and was unwilling to communicate with the nurse. , which violates the authenticity of the verification. The implementation of the surgical safety checklist reduces the number of checks, but greatly improves work efficiency and makes the checks more effective and accurate. 3.2 Patient surgical safety is guaranteed. We advocate surgical safety verification and implement patient safety goals, aiming to maximize the collective strength and wisdom through collaboration and encouragement among teams or members, and highlight the themes of operating room nursing safety, quality, and care. Ensure surgical safety. By implementing the "three-party and five-party" verification process of nurses' self-checks and the surgical team, patient surgical safety is guaranteed. For example: 5 During the preoperative visit and verification, the nurse in the operating room found that the patient's condition was inconsistent with the operation notice. She asked the doctor in charge and confirmed that the bed was temporarily adjusted before the operation but the operation notice was not rewritten. The doctor corrected the operation notice and notified the anesthesia. Doctor, an error was avoided; in another case, a nurse found an error during the operation handover check with the ward on the morning of the operation. It was found that she changed from the bed by the door to the bed by the window. After the operation room nurse, ward nurse, and the physician in charge, After the three-party verification is correct, the patient will be admitted to the operating room. It is precisely because of the strict implementation of the verification process and content of each link that timely discovery and avoidance of errors that ensure patient safety. In order to eliminate such hidden dangers from the source, the Medical Office stipulates that after the operation notice is sent to the operating room, the bed must not be changed at will. When it is necessary to change the bed, it must be negotiated by the director of surgery, the director of the anesthesiology department, and the head nurse of the operating room. After consent, the director of surgery will use red Rewrite the surgery notice with pen and sign. The ward has strengthened management and explained to patients the risks of changing beds at will, so that patients can consciously abide by the ward management system and actively participate in surgical safety verification. Similar hidden dangers have not occurred again in the future. Through the implementation of the surgical safety verification system, the surgical team gradually realized that ensuring patient safety requires everyone to pay full attention and implement verification measures in accordance with the process to the letter. 3.3 Relevant department personnel’s awareness of the surgical safety checklist The nursing staff in the operating room have a high awareness of the surgical safety checklist [11]. Some hospitals have implemented surgical safety checklists standardized by WHO. During the implementation, more work is guided, organized, and implemented by operating room nursing staff. As a result, surgeons and anesthesiologists have low awareness of this work and mistakenly believe that it is the content of operating room nursing work. During the implementation process, only copying files without changing previous working habits will result in poor implementation results and thus the results will not be achieved. 3.4 Problems in implementation and corrective measures 3.4.1 Surgeons cannot participate in pre-anesthesia check in time: In the past, surgeons in our hospital often entered the operating room when anesthesia was almost completed and could not participate in pre-anesthesia check in time. In order to urge the surgeons to arrive on time in the operating room to participate in the pre-anesthesia check, our hospital stipulates that the operating room records the time when the surgeon enters the operating room. The medical office regularly visits the operating room for supervision, and those who are late will be punished accordingly. 3.4.2 Failure to strictly implement the "Surgical Safety Checklist" system according to the process: At the beginning of the trial implementation of the "Surgical Safety Checklist" system, the relevant operating personnel did not fully understand the importance of the surgical safety checklist and did not verbally check according to the process. The anesthesiologist fills out the form himself, making the work a mere formality. In this regard, our hospital has taken the following measures: ① The vice president of operations will personally go to the operating room from time to time to guide the surgical safety verification work and supervise its strict execution according to the process, so that this work can be implemented smoothly. ② The Medical Office regularly goes to the operating room to supervise the implementation of this work, and commends departments and individuals who implement it conscientiously throughout the hospital, and imposes corresponding penalties on those who do not perform it conscientiously, so that surgery-related personnel can gradually develop a habit of conscientiously implementing and checking . ③ Taking two consecutive medical accidents in China in which left and right surgeries occurred as an example, discussions were held in the surgical system of the entire hospital. The Medical Office participated in discussions among various departments to guide departments to pay attention to the surgical safety verification system and promote the effective implementation of the system. 3.5 The detailed management of surgical safety verification needs to be strengthened. In the process of implementing the surgical safety verification system, we found that detailed management still needs to be strengthened in terms of surgical specimen management, inventory records, and avoidance of the risk of tube compression, tube folding and tube detachment. Any accident at work is caused by loss of control and neglect in many details [12]. For example, we once found that an intern made an error when filling in the label of a surgical specimen. The pathology department discovered it in time and corrected it promptly after being checked by the operating staff. The implementation of the "double signature, three completeness" measures for specimen submission can avoid such situations and also reminds operating room nursing staff to strictly implement the surgical safety verification system during clinical teaching. Two cases of empyema patients had drainage tubes before surgery, but the drainage tube was found to be compressed when the patient was moved onto the operating bed. In one case, the drainage tube was removed during the transfer due to agitation during the recovery period from general anesthesia.

In addition, we also found that the exit time recorded in the surgical inventory of one case was inconsistent with the surgical summary record of the surgeon. The reason was that the patient's condition changed when preparing to leave the operating room and he was observed for another 30 minutes, while the surgical summary recorded the time of preparing to leave the room. This reminds us that we must pay attention to filling in and checking records according to the actual time, emphasizing the unification of multiple records and following the principle of post-event recording. In summary, on the basis of learning the above goals and systems, the surgical team refines and cooperates to implement the surgical safety verification process and content, which can effectively ensure surgical safety, reduce surgical risks, and improve the quality of medical care services. However, safety verification needs to be carried out in detail and needs to be continuously accumulated during work. This is also the most direct and effective method [13]. The focus of surgical patient safety verification work is that the auditors should strengthen their sense of responsibility, enhance their awareness of verification, and make it clear that to ensure the safety of surgical patients, precautions must be taken throughout the entire process. All three parties should participate and take the initiative to form a service concept of "patient-centered and ensuring patient safety".

For more information about engineering/service/purchasing tender document writing and production to improve the bid winning rate, you can click on the official website customer service at the bottom for free consultation: /#/?source=bdzd