EVIDENCE BASED PRACTICE IN TRAUMA AND ORTHOPAEDICS

Evidence Based Practice in Trauma and Orthopaedics

Evidence Based Practice in Trauma and Orthopedics

According to World Health Organisation guidelines, all surgical procedures must be preceded by certain safety measures. These safety measures or general guidelines are documented in the World Health Organisation's publication 'Surgical Safety Checklist'. Since the guideline is general, it is applicable to all procedures involving surgery that require anesthesia, skin incision and operating facility. The safety measures are formulated keeping in view many of the surgery associated risks such as hemorrhage, airway block and anti biotic prophylaxis. These measures are applicable to any health settings or health environment (WHO 2008). This assignment first provides a brief overview of the checklist and then critically appraises the pros and cons of the intraoperative safety measures related to orthopedics.

The safety measures are classified according to the procedures before, during and after the surgery. The preoperative surgical procedures are taken before the induction of anesthesia. According to the recommended guidelines, these procedures are to be performed with at least one nurse practitioner and an anesthetist (WHO 2009). Safety and precautionary measures in this phase include:

Ensuring patient's identity,

Obtaining his/her consent regarding the site and procedure being applied to the surgery

Confirming the site of operation and its mark

Checking the anesthesia machine and anesthetic medication

Ensuring an appropriate level of pulse oximeter

Confirming whether patient has any allergy, airway problems or aspiration risk

Risk of excessive blood loss: >700ml for adults and 7ml/kg for children

Safety and precautionary measure before skin incision are:

Confirmation of the team members, their names and their roles in the operation

Reconfirming the name of the patient, the applicable procedures and incision area(s)

Ensuring if antibiotic prophylaxis is being applied in the last one hour

Listing the Anticipated Critical Events as are applicable to the surgeon, the anesthetist and the nurse or the nurse teams (WHO 2008).

The surgeon must be clear about the blood loss and the non-routine steps. Anesthetist is required to point out any patient-specific concerns. In addition, the nursing staff must see that the equipment is working condition and that sterility is properly given to the medical aids (Lingard et al 2008 8). The applicable imaging must be properly displayed at the operation theater.

Another class of safety measures is listed under the head 'before patient leaves the operating room'. These measures take place in the presence of a surgeon, nurse and the anesthetist and include:

Reconfirmation of patient's identity and name of the procedure being applied

Counting of needles, sponge and other instruments used in the surgery

Pointing out any equipment problems, if any

Key concerns regarding the patients recovery are also identified and noted in this phase

The safety checklist document is not an all-comprehensive document. It says that these are only general guidelines and as such additions and/or modifications given the local conditions may take place (WHO 2008).

Worldwide, efforts are made to improve safety in the operating room. For example, the World Health Organization (WHO) recently published a checklist of surgical ...