In this thesis, we will discuss issues related to risk analysis in health care facilities, focusing on risk management policies, aimed at the prevention of avoidable error is that the containment of their harmful effects, and thus in the final analysis, to guarantee patient safety. Taking a cue from the situation of a specific health facility ( the Neurological Institute “Carlo Besta” of Milan), identifies the general risk factors in the hospital and into the path of acceptance accompanying the patient identification; a special case the surgical unit, which is characterized by the complexity of all surgical procedures, even the most simple: the number of people and professionals involved, acute conditions of patients, amount of information required, the urgency with which the processes must be performed, the “high level of technology, the multiplicity of critical points of the process that can cause seriou harm to patients (from patient identification to correct surgical site, the proper sterilization of instruments, induction of anesthesia, etc..). Become important processes of comunication within the operating team, the surgeon, anesthesiologist and nurses do not work in isolation from each other but must ensure a climate of collaboration, essential to prevent accidents and perioperative the success of the intervention. For this reason, the perspective of improving quality of care, it is necessary for patient safety policies of the Executive Board would also include the formalization of adequate training for professionals and training activities included in the operation room. The management of health systems today sees the improvement of the quality and safety of the delivery of the benefits provided by basic levels of care as a basic element in integrated clinical governance perspctive, which identifies a comprehensive approach to management of health services, focusing on the needs people, in planning policies and management of clinical services based on choices that enhance the role and responsibility of physicians and other health professionals. Surgery for volumes of business and the inherent complexity of all procedures related to it, requires planned and shared actions and behaviors, aimed at preventing the occurrence of dangerous accidents operators and the success of the interventions. In this sense, it is essential to develop and implement an appropriate training strategy aimed at all those involved in activities with the goal of surgery is to increase the technical skills that cognitive behavioral ones. In this regard, will discuss recommendations and checklists developed by the World Health Organization under the “Safe Surgery Saves Life” and adapted to national context.
In questo lavoro di tesi, si tratterà delle problematiche inerenti l’analisi dei rischi nelle strutture Sanitarie, focalizzando l’attenzione sulle politiche di gestione del rischio, volte sia alla prevenzione degli errori evitabili che al contenimento dei loro effetti dannosi e, quindi in ultima analisi, alla garanzia della sicurezza dei pazienti. Prendendo spunto dalla situazione di una specifica struttura Sanitaria ( l’Istituto Neurologico “Carlo Besta”), vengono individuati i fattori generali di rischio in ospedale e all’interno del percorso che accompagna il paziente dall’accettazione all’identificazione. Un caso particolare è il blocco operatorio, che si contraddistingue per la complessità di tutte le procedure chirurgiche, anche quelle più semplici: numero di persone e professionalità coinvolte, condizioni acute dei pazienti, quantità di informazioni richieste, urgenza con cui i processi devono essere eseguiti, elevato livello tecnologico, molteplicità di punti critici del processo che possono provocare gravi danni ai pazienti (dalla identificazione del paziente alla correttezza del sito chirurgico, alla appropriata sterilizzazione dello strumentario, all’induzione dell’anestesia, ecc.). Assumono importanza i processi di comunicazione all’interno dell’équipe operatoria; il chirurgo, l’anestesista e l’infermiere non lavorano isolatamente l’uno dall’altro ma devono assicurare un clima di collaborazione, indispensabile per prevenire incidenti peri-operatori e per la buona riuscita dell’intervento. Per questo motivo, nell’ottica del miglioramento qualità dell’assistenza, è necessario che le politiche per la sicurezza dei pazienti delle Direzioni Aziendali prevedano anche la formalizzazione degli adeguati percorsi formativi e di addestramento per i professionisti inseriti nelle attività di sala operatoria. La gestione dei sistemi sanitari vede oggi il miglioramento della qualità e della sicurezza della erogazione delle prestazioni previste dai livelli essenziali di assistenza quale elemento fondante nella prospettiva del governo clinico integrato, che identifica un approccio globale alla gestione dei servizi sanitari, ponendo al centro i bisogni delle persone, nell’ambito di politiche di programmazione e gestione dei servizi basate su scelte cliniche che valorizzino il ruolo e la responsabilità dei medici e degli altri operatori sanitari. La chirurgia per volumi di attività e per complessità intrinseca di tutte le procedure ad essa correlate, richiede azioni e comportamenti pianificati e condivisi, finalizzati a prevenire l’occorrenza di incidenti perioperatori e la buona riuscita degli interventi. In tal senso è fondamentale sviluppare ed attuare una appropriata strategia di formazione rivolta a tutti gli operatori coinvolti nelle attività di chirurgia con l’obiettivo di accrescere sia le abilità tecniche che quelle cognitivo comportamentali. A questo proposito si parlerà delle raccomandazioni e della checklist elaborate dall’Organizzazione Mondiale della Sanità nell’ambito del programma “Safe Surgery Saves Life” e adattate al contesto nazionale.
La gestione del rischio clinico. Un metodo per il miglioramento della sicurezza all'interno del blocco operatorio
PAVIA, ANTONINO
2010/2011
Abstract
In this thesis, we will discuss issues related to risk analysis in health care facilities, focusing on risk management policies, aimed at the prevention of avoidable error is that the containment of their harmful effects, and thus in the final analysis, to guarantee patient safety. Taking a cue from the situation of a specific health facility ( the Neurological Institute “Carlo Besta” of Milan), identifies the general risk factors in the hospital and into the path of acceptance accompanying the patient identification; a special case the surgical unit, which is characterized by the complexity of all surgical procedures, even the most simple: the number of people and professionals involved, acute conditions of patients, amount of information required, the urgency with which the processes must be performed, the “high level of technology, the multiplicity of critical points of the process that can cause seriou harm to patients (from patient identification to correct surgical site, the proper sterilization of instruments, induction of anesthesia, etc..). Become important processes of comunication within the operating team, the surgeon, anesthesiologist and nurses do not work in isolation from each other but must ensure a climate of collaboration, essential to prevent accidents and perioperative the success of the intervention. For this reason, the perspective of improving quality of care, it is necessary for patient safety policies of the Executive Board would also include the formalization of adequate training for professionals and training activities included in the operation room. The management of health systems today sees the improvement of the quality and safety of the delivery of the benefits provided by basic levels of care as a basic element in integrated clinical governance perspctive, which identifies a comprehensive approach to management of health services, focusing on the needs people, in planning policies and management of clinical services based on choices that enhance the role and responsibility of physicians and other health professionals. Surgery for volumes of business and the inherent complexity of all procedures related to it, requires planned and shared actions and behaviors, aimed at preventing the occurrence of dangerous accidents operators and the success of the interventions. In this sense, it is essential to develop and implement an appropriate training strategy aimed at all those involved in activities with the goal of surgery is to increase the technical skills that cognitive behavioral ones. In this regard, will discuss recommendations and checklists developed by the World Health Organization under the “Safe Surgery Saves Life” and adapted to national context.File | Dimensione | Formato | |
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2011_12_Pavia.pdf
Open Access dal 04/12/2012
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https://hdl.handle.net/10589/39242