探讨脊柱手术器械清点的改进

Investigation on improvement of spinal surgical instruments sort and count

目的探讨减少脊柱手术器械清点失误,缩短清点耗时的规范化措施。方法 2016年7月-9月在我院实施的脊柱内固定手术158例,清点失误3例。采用鱼骨图分析法对造成失误的原因作分析。一方面根据原因分析制定改进措施;另一方面随机抽取脊柱内固定手术20台,测试清点耗时。2016年10月15日-2017年3月31日期间,落实所制定的改进措施(包括建立手术物品清点标准操作程序、精简手术器械、制订骨科脊柱手术外来器械分类包装指引、规范外来器械送货清点单、规范器械摆台)。同时观察所有施行的脊柱内固定手术器械清点失误发生情况,并于2016年11月~2017年3月随机抽取20例,记录手术器械清点耗时,以评估改进措施的成效。结果改进措施落实后清点失误发生率(改进前后为1.9%vs 0%)及清点耗时(改进前后为187±17秒vs 138±12秒)均明显减少(P<0.05)。结论通过建立手术物品清点标准操作程序、精简手术器械、制订"骨科脊柱手术外来器械分类包装指引"、规范外来器械送货清点单、规范器械摆台--五方面的措施,可提高清点的可靠性及清点效率。

Objective To explore the standardized measures to reduce the mistake in spinal surgical instruments sort and count,and also shorten the time-consuming of them.Methods From July to September 2016,158 cases of spinal internal fixation were performed in our hospital,and 3 cases of sort and count errors were found.Fishbone diagram was made to analyze the causes of the errors.On the one hand,according to the analysis of causes,improvement measures were designed;on the other hand,20 spine internal fixation operations were randomly selected to measure the sort and count time-consuming.Improvement measures--including establishment of standard operating procedure for surgical items sort and count,simplification of surgical instruments,to formulate aGuidelines for Classification and Packaging of Foreign Instruments for Spinal Surgery",standardization of foreign instruments delivery inventory,and standardizing the items positioning on operation instrument table--had been taken during the period from October 15,2016 to March 31,2017.In the same period,the occurrence of sort and count errors in all spinal internal fixation operations were observed.And from November 2016 to March 2017,20 operations were randomly selected for surgical instruments sort and count time-consuming.From the observations above,the effectiveness of the improvement measures was evaluated.Results Both the occurrence of errors(1.9% vs 0%,before and after improvements) and the time-consuming(187±17 seconds vs 138±12 seconds,before and after improvements) of surgical items sort and count are significantly reduced,after the implementation of the improvement measures.Conclusion Improvement measures on surgical items sort and count,as mentioned above,improved the sort and count reliability and efficiency.