September 2019 HSC Section 1 Congenital and Pediatric Problems

Volume 44, No. 9, September 2018

it

improved

communication,

quality

of

care,

and

patient

Acknowledgments. The authors thank the Perioperative Local Improve- ment Team for their help with the development of the enhanced pediatric Universal Protocol. Conflicts of Interest. All authors report no conflicts of interest.

7 In

disrupting work

flow.

addition,

the

ex-

safety without

tended

time-out

allowed

for more

time

to

correct

equip- admin-

ment ister

errors,

obtain

necessary

blood

products,

and

7 In

preoperative medications.

another

study, Norton

Rangel focused

described

a

pediatric

surgical

safety

checklist structured

and that

SUPPLEMENTARY MATERIALS Supplementary material

on

effective

communication

and

8 The

authors

suggested

that

verbalizing

the the

collaboration. verification

associated with

this

article

can

be

steps

for

team members 8 Although

to

review studies

is

key

in

found, in the online version, at doi:10.1016/j.jcjq.2018.03. 015 . Thomas J. Caruso, MD, MEd , is Clinical Associate Professor, Divi- sion of Pediatric Anesthesia, Department of Anesthesiology, Perioper- ative and Pain Medicine, and Physician Lead, Perioperative Improve- ment Team, Stanford University School of Medicine, Stanford, California. Farrukh Munshey, MD, FRCPC , is Pediatric Anesthesiology Fellow, Di- vision of Pediatric Anesthesia, Department of Anesthesiology, Periopera- tive and Pain Medicine, Stanford University School of Medicine. Brea Al- dorfer, MS, RN, CPHQ , is Director of Accreditation and Regulatory Com- pliance, Center for Quality and Clinical Effectiveness, Lucile Packard Chil- dren’s Hospital Stanford, Palo Alto, California. Paul J. Sharek, MD, MPH , is Professor and Chief Clinical Patient Safety Officer, Division of Hos- pitalist Medicine, Department of Pediatrics, Stanford University School of Medicine. Please address correspondence to Thomas J. Caruso, tjcaruso@stanford.edu . REFERENCES 1. Patel A, et al. An overview of the use and implementation of checklists in surgical specialties—a systematic review. Int J Surg. 2014;12:1317–1323. 2. WHO’s patient-safety checklist for surgery. Lancet. 2008 Jul 5;372:1. 3. World Health Organization. Who Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. 2009. Accessed May 11, 2018. http://whqlibdoc.who.int/publications/2009/ 9789241598552_eng.pdf?ua=1. 4. The Joint Commission. UP.01.01.01–UP.01.03.01. Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery TM . 2018 Comprehensive Accredita- tion Manual for Hospitals (E-dition). Oak Brook, IL: Joint Commission Resources, 2018. 5. Haynes AB, et al. Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mor- tality in a global population. N Engl J Med. 2009 Jan 29;360:491–499. 6. Skarsgard ED. Recommendations for surgical safety check- list use in Canadian children’s hospitals. Can J Surg. 2016;59:161–166. 7. Lee SL. The extended surgical time-out: does it im- prove quality and prevent wrong site surgery? Perm J. 2010;14(1):19–23. 8. Norton EK, Rangel SJ. Implementing a pediatric surgi- cal safety checklist in the OR and beyond. AORN J. 2010;92:61–71. 9. Sobek DK II, Smalley A. Understanding A3 Thinking: A Crit- ical Component of Toyota’s PDCA Management System. Boca Raton, FL: CRC Press, 2008. 10. Shah RK, et al. Variation in surgical time-out and site mark- ing within pediatric otolaryngology. Arch Otolaryngol Head Neck Surg. 2011;37:69–73. 11. Portela MC, et al. How to study improvement interventions: a brief overview of possible study types. BMJ Qual Saf. 2015;24:325–336.

population.

these

demonstrate

pediatric benefits pediatric

to

customization

of

the Universal

Protocol enhanced

to

the

population,

they

differ

from

our

pedi- reduc-

atric Universal

Protocol, which

directly

focused

on

ing

the

risk of wrong-site

and wrong-patient

surgeries prior

In

fact, despite use

of

the

extended

surgical

time-

to P&D. out, Lee tributed

reported a wrong-site to patient draping

surgery after P&D, partly at-

covering

the

surgeon

site mark-

7 Given

ing.

the

inherent

risk

of mistaking

sidedness

after

the

role of

the

safety

stop

in po- surgery

P&D of pediatric patients,

tentially helping

reduce wrong-site preparation

and

13

be

instrumental.

may

LIMITATIONS There were

several

limitations

to

this project. First, because

the

inability

to

use

electronic

charting

as

a

reliable

of

of

adherence

to

the

safety limited

stop, we were

reliant

on

measure in-person

auditing,

which

our

ability

to

provide

14 Because

tracking.

the

initial

audit pro-

longitudinal daily

cess, Universal Protocol

adherence

continues

to

be

tracked

intermittent

in-person

audits

as

part

of

a

bundle

of

via

safety

checks.

The

audit

sample

size

and size

perioperative

period

duration

presented were

limited. A

larger

audit

longer

duration

would

have

strengthened

the

results. devel-

and

although

surgical

concerns

prompted

the

Second, opment

of

the

safety

stop,

we

were

unable

to measure

an

reduction

in patient harm due

to

the

rare

incidence of surgeries. educational

actual

and wrong-patient

wrong-site, wrong-procedure,

the

novelty to OR trainees

of

the

safety

stop

presents rotating

Third,

personnel. Due

to

surgical

and

challenges anesthesia

and

traveling important

nurses,

incorporation

the

safety

stop

is

an

component

of

their slow

of

this,

lack

of

familiarity

leads

to

orientation. Despite

adoption.

CONCLUSION The checklist may cal

incorporation

of

the

safety

stop

in

the

pediatric

surgi-

reduce

the

risk of

adverse

events. Though to adoption chal- consideration

leads

the addition of a unique component

lenges,

the

potential pediatric

harm

reduction merits

other

surgical

centers

that

face

similar

risks

from

or wrong-patient

surgery

of wrong-site

4