Chapter 10 – Perioperative Patient Safety

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1、CHAPTER10PERIOPERATIVEPATIENTSAFETYR.DanielBeauchampandMichaelS.Higgins1.Transparencymustbeapracticedvalueineverythinghistoryandperspectivewedo.surgicalinfectionpreventionandsurgicalcare2.Caremustbedeliveredbymultidisciplinaryteamsimprovementprojectworkinginintegratedcareplatforms.cr

2、eatinganorganizationalstructuretopromote3.Patientsmustbecomefullpartnersinallaspectsofpatientsafetyandqualitycarehealthcare.4.Healthcareworkersneedtofindjoyandmeaningintheirwork.5.MedicaleducationmustberedesignedtoprepareHISTORYANDPERSPECTIVEnewphysicianstofunctioninthisnewenvironmen

3、t.Patientsafetyinthehealthcareenvironmentisrecognizedaslessthanoptimalordesirable.Aseriesofeye-openingreportsSURGICALINFECTIONPREVENTIONANDwerepublishedinthe1990sandprovidedclearevidenceofhighSURGICALCAREIMPROVEMENTPROJECTratesofseriousadverseeventsthatresultedinseriousharmtoBecauses

4、urgicalsiteinfections(SSIs)wererecognizedasthehospitalizedpatients.TheInstituteofMedicine(IOM),initssecondmostcommonsiteofnosocomialinfectionsandamajorlandmarkreport,ToErrisHuman,publishedin1999,estimatedcauseofmorbidity,readmissions,excessivecosts,anddeath,thethatasmanyas1millionpeo

5、ple/yearwereinjuredanduptoCentersforMedicareandMedicaidServices(CMS)and198,000diedannuallybecauseofmedicalerrors.WhenthetheCentersforDiseaseControlandPrevention(CDC)initiatedfocuswasspecificallyturnedtosurgicalpatients,surgicalcaretheNationalSurgicalCareImprovementProject(SCIP)in4acc

6、ountedforbetween48%and66%ofadverseeventsamong2002.Thegoalofsurgicalinfectionprevention(SIP)wasto2nonpsychiatrichospitaldischarges.Inregardtooperativepro-reducetheincidenceandimpactofSSIsinsurgicalpopulations,ceduresanddeliveries,3%resultedinadverseevents,andsurgi-particularlyinhigh-v

7、olumeprocedures.In2003,thenationalcaladverseeventswereassociatedwitha5.6%mortalityrate,SIPprojectconvenedameetingoftheSurgicalInfectionPreven-accountingfor12.2%ofhospitaldeaths.Furthermore,54%oftionGuidelineWritersWorkgroupofexpertsandrepresentativessurgicaladverseeventswerejudgedtob

8、epreventable