The Role of Checklists and Human Factors for Improved Patient Safety in Plastic Surgery

Common preventable errors in hand surgery: Analysis of NHS never events data and a proposed safety checklist

BACKGROUND

Hand surgical procedures are common interventions in elective and emergency settings. The complex nature of the injuries and management by multiple specialities could be a potential source of medical errors and never events (NEs). Awareness of the common NEs could potentially help prevent their occurrence in the future.

OBJECTIVE

To analyse the NHS England database to identify the common NEs in hand surgery and present a simple, practical safety checklist for hand surgery.

METHODS

The NHS NEs database from 2012 to 2021 has been analysed to identify the common hand surgery-related never events. We identified the common categories and themes within. Our theme development process is based on anatomical considerations and the nature of the incidents. Additionally, we designed a simple Safety Checklist for hand surgery.

RESULTS

We identified a total of 3742 never events with 50 incidents related to hand surgery, representing (1.3%). Wrong-site surgery was the commonest category (n = 30), representing 60% of the hand surgery-related NEs. We identified seven different themes under wrong-site surgery. Wrong finger or digit surgery was the commonest theme, with 17 reported incidents representing 57% of wrong-site surgeries. This is followed by five wrong digits injections and three wrong k wire placements representing 16.6% and 10%, respectively. The second most common category was wrong incisions (n = 15), representing 30%; 13 patients had wrong finger incisions. Two patients had carpal tunnel incisions before surgeons realised that the procedures were for trigger finger release. The third category included four wrong procedures, with two incidents of carpal tunnel release instead of trigger finger operation or Dequervain tendon release. Finally, one patient had an injection for carpal tunnel intended for another patient.

CONCLUSION

Hand surgery-related NEs represent a small fraction (1.3%) of all NEs within the NHS database. We identified 50 hand surgery-related NEs arranged into 14 different themes. Additionally, we proposed a hand surgery-specific safety checklist to reduce the incidence of these incidents in the future.

Medical Students' Insights Towards Patient Safety

Objectives

This study aimed to explore Saudi Arabian medical students' perceptions of patient safety.

Methods

A cross-sectional descriptive study was conducted in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, in September 2019. The Attitudes to Patient Safety Questionnaire (APSQ III) was used to explore undergraduate medical students' attitudes towards and knowledge of PS. The main outcomes measured were the APSQ III's nine domains. Data were analysed using Statistical Package for the Social Sciences and students' attitudes were communicated as mean scores ± standard deviations.

Results

A total of 301 participants were included in this study (response rate: 85.75%). Six domains reflected a positive attitude while three domains showed a neutral attitude. The domain of 'team functioning' had the highest mean score (5.8) followed by 'working hours as a cause of error' (5.6) and 'error inevitability' (5.4). There was a significant difference between gender in the domain 'patient involvement in reducing error' (P = 0.012) and 'importance of patient safety (PS) in the curriculum' (P = 0.001). In addition, the 'importance of PS in the curriculum' domain was significantly different across different age groups (P = 0.039).

Conclusion

Medical students were highly interested in PS and recommended implementing a comprehensive undergraduate PS programme to fulfil their educational needs.

Safety in Hand Surgery: Eliminating Wrong-Site Surgery

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Understand the definition of wrong-site surgery and what it may encompass. 2. State the causes of wrong-site hand surgery. 3. Give examples of initiatives used to prevent wrong-site surgery. 4. Describe a process to minimize the risk of performing wrong-site surgery.

SUMMARY

Wrong-site surgery remains a problem in our ever-evolving culture of surgical safety, and hand surgeons are at particularly high risk. Broadly speaking, wrong-site surgery is a procedure performed at an incorrect anatomical site. In hand surgery, this includes errors in laterality, wrong digit(s), wrong procedure(s), or even a failure to complete all indicated procedures. This article examines the scope of this safety issue, the current challenges to preventing wrong-site surgery, and the authors' proposed solutions to eliminating wrong-site surgery and establishing a culture of safety in hand surgery.

Patient Evaluation and Surgical Staging

Comprehensive evaluation of the massive-weight-loss patient is a key factor to minimize complications while optimizing surgical outcomes. Special attention is given to medical and weight loss history, nutritional status, and physical examination. Massive-weight-loss patients often present with multiple areas of concern and therefore benefit from staged procedures. Staging requires knowledge on how the tissues are affected by each procedure and an understanding of the patient's priorities and goals.