Patientensicherheit in der Anästhesie und Intensivmedizin

Maßnahmen zur Verbesserung
Übersichten

Zusammenfassung

Dank der raschen technischen Entwicklung sowie diverser Strategien zur Fehlerbeobachtung und -vermeidung gilt die Intensivmedizin und Anästhesiologie als ein sicheres Fach. Der Verabschiedung der „Patient Safety in the ICU: The Vienna Declaration“ der ESICM vom Oktober 2009 sowie der „Helsinki Declaration on Patient Safety in Anaesthesiology“ der ESA und EBA vom Juni 2010 ist es zu verdanken, dass europaweit festgelegt wurde, welche der erprobten Sicherheitskonzepte als unerlässlich zu werten sind. Viele der allgemein bekannten Strategien haben ihren Ursprung in primär nichtmedizinischen Bereichen, wie beispielsweise der zivilen Luftfahrt, und sind dort nicht mehr wegzudenken. Solche „high reliability organisations“ können diesbezüglich als Vorbilder für das Gesundheitswesen angesehen werden. Critical-Incident-Reporting-Systeme zur Meldung von Beinahezwischenfällen, Crisis-Resource-Management zur Verbesserung von Teamwork und kommunikativen Fähigkeiten sowie Checklisten, wie die WHO-Checkliste, zählen zu konkreten Umsetzungen dieser Art. Des Weiteren wurden standardisierte Medikamentenbeschriftungen, Händedesinfektion, Techniken für die Patientenübergabe und die realitätsnahe Ausbildung am Simulator als Maßnahmen zur Verbesserung der Patientensicherheit exemplarisch für diesen Beitrag ausgewählt.

Schlüsselwörter

Qualitätssicherung Simulationsbasierte Ausbildung Checkliste Perioperative Phase Fehler in der Medizin 

Patient safety in anesthesiology and intensive care medicine

Measures for improvement

Abstract

Technical improvements as well as various strategies for error detection and error prevention have made intensive care medicine and anesthesiology a safe medical specialty. Due to the introduction of “Patient safety in the ICU: the Vienna declaration” of the European Society of Intensive Care Medicine (ESICM) from October 2009 and the “Helsinki declaration on patient safety” of the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology (EBA) from June 2010, there are now specific recommendations for all hospitals in Europe concerning the safety measures that are considered to be of essential importance. Many of today’s well-known safety strategies have been originally developed in non-medical environments, as for instance civil aviation. Such high reliability organizations may serve as examples in the medical domain. Critical incident reporting systems, crisis resource management and checklists, e.g. the World Health Organization (WHO) checklist, are safety approaches of this kind. In addition to these, standardized drug labelling, hand disinfection, techniques for patient handover and simulation-based training have been exemplarily selected for this article as measures that can increase patient safety.

Keywords

Quality control Simulation-based training Checklist Perioperative period Medical errors 

Literatur

  1. 1.
    deVries EN, Ramrattan MA, Smorenburg SM et al (2008) The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 17:216–223, doi:10.1136/qshc.2007.023622CrossRefGoogle Scholar
  2. 2.
    Mellin-Olsen J, Staender S, Whitaker DK et al (2010) The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol 27:592–597PubMedCrossRefGoogle Scholar
  3. 3.
    Schaffartzik W, Neu J (2007) Schäden in der Anästhesie. Ergebnisse der Hannoverschen Schlichtungsverfahren 2001–2005. Anaesthesist 56:444–448PubMedCrossRefGoogle Scholar
  4. 4.
    Gottschalk A, Van Aken H, Zenz M, Standl T (2011) Ist Anästhesie gefährlich? Dtsch Arztebl Int 108:469–474, doi:10.3238/arztebl.2011.0469PubMedGoogle Scholar
  5. 5.
    Bothner U, Georgieff M, Schwilk B (2000) Building a large-scale perioperative anaesthesia outcome-tracking database: methodology, implementation, and experiences from one provider within the German quality project. Br J Anaesth 85:271–280PubMedCrossRefGoogle Scholar
  6. 6.
    Roberts KH (1990) Some characteristics of one type of high reliability organization. Organ Sci 1:160–176, doi:10.1287/orsc.1.2.160CrossRefGoogle Scholar
  7. 7.
    Sutcliffe KM (2011) High reliability organizations (HROs). Best Pract Res Clin Anaesthesiol 25:133–144, doi:10.1016/j.bpa.2011.03.001PubMedCrossRefGoogle Scholar
  8. 8.
    Vogus TJ, Sutcliffe KM, Weick KE (2010) Doing no harm, enabling, enacting, and elaborating a culture of safety in health care. Acad Management Perspectives (AMP) 24:60–77Google Scholar
  9. 9.
    Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499PubMedCrossRefGoogle Scholar
  10. 10.
    Vogus TJ, Sutcliffe KM (2007) The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Med Care 45:997–1002 doi:10.1097/MLR.0b013e318053674fPubMedCrossRefGoogle Scholar
  11. 11.
    Roberts KH, Madsen P, Desai V et al (2005) A case of the birth and death of a high reliability healthcare organisation. Qual Saf Health Care 14:216–220, doi:10.1136/qshc.2003.009589PubMedCrossRefGoogle Scholar
  12. 12.
    Valentin A, Ferdinande P, Improvement EWGoQ (2011) Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med 37:1575–1587, doi:10.1007/s00134-011-2300-7PubMedCrossRefGoogle Scholar
  13. 13.
    Rhodes A, Moreno RP, Azoulay E et al (2012) Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM). Intensive Care Med 38:598–605, doi:10.1007/s00134-011-2462-2463PubMedCrossRefGoogle Scholar
  14. 14.
    Mahajan RP (2011) The WHO surgical checklist. Best Pract Res Clin Anaesthesiol 25:161–168PubMedCrossRefGoogle Scholar
  15. 15.
    Vats A, Vincent CA, Nagpal K et al (2010) Practical challenges of introducing WHO surgical checklist: UK pilot experience. BMJ 340:b5433PubMedCrossRefGoogle Scholar
  16. 16.
    Valentin A, Capuzzo M, Guidet B et al (2009) Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 338:b814PubMedCrossRefGoogle Scholar
  17. 17.
    Orser BA, Chen RJ, Yee DA (2001) Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth 48:139–146PubMedCrossRefGoogle Scholar
  18. 18.
    Puttick N (2003) A response to ‚Syringe labelling in critical care areas’, Souter A, Anaesthesia 58:713. Anaesthesia 58:1149PubMedCrossRefGoogle Scholar
  19. 19.
    Sybrecht GW, Prien T (2010) Arzneimittelsicherheit: Standard-Spritzenaufkleber in der Akutmedizin. Dtsch Arztebl 107:A-1031/B-1907/C-1895Google Scholar
  20. 20.
    Porat N, Bitan Y, Shefi D et al (2009) Use of colour-coded labels for intravenous high-risk medications and lines to improve patient safety. Qual Saf Health Care 18:505–509PubMedCrossRefGoogle Scholar
  21. 21.
    Jennings J, Foster J (2007) Medication safety: just a label away. AORN J 86:618–625PubMedCrossRefGoogle Scholar
  22. 22.
    Cooper JB, Newbower RS, Long CD et al (1978) Preventable anesthesia mishaps: a study of human factors. Anesthesiology 49:399–406PubMedCrossRefGoogle Scholar
  23. 23.
    Vincent C, Stanhope N, Crowley-Murphy M (199) Reasons for not reporting adverse incidents: an empirical study. J Eval Clin Pract 5:13–21CrossRefGoogle Scholar
  24. 24.
    Rall M, Reddersen S, Zieger J et al (2008) Incident reporting systems in anesthesiology – methods and benefits using the example of PaSOS. Anasthesiol Intensivmed Notfallmed Schmerzther 243:628–632, doi:10.1055/s-0028-1090025CrossRefGoogle Scholar
  25. 25.
    Sorgatz H, Dichtjar T (2010) Critical incident reporting system anästhesiologie. Anasthesiol Intensivmed 3:193–194Google Scholar
  26. 26.
    Gastmeier P, Brunkhorst F, Schrappe M et al (2010) How many nosocomial infections are avoidable? Dtsch Med Wochenschr 135:91–93, doi:10.1055/s-0029-1244823PubMedCrossRefGoogle Scholar
  27. 27.
    Harbarth S, Sax H, Gastmeier P (2003) The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 54:258–266; quiz 321PubMedCrossRefGoogle Scholar
  28. 28.
    Pittet D, Hugonnet S, Harbarth S et al (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection control programme. Lancet 356:1307–1312PubMedCrossRefGoogle Scholar
  29. 29.
    Reichardt C, Eberlein-Gonska M, Schrappe M et al (2009) Clean hands campaign. No chance for hospital infections! Unfallchirurg 112:679–682, doi:10.1007/s00113-009-1631-0PubMedCrossRefGoogle Scholar
  30. 30.
    Kilpatrick C (2009) Save lives: clean your hands. A global call for action at the point of care. Am J Infect Control 37:261–262, doi:10.1016/j.ajic.2009.02.001PubMedCrossRefGoogle Scholar
  31. 31.
    AKTION Saubere Hände. http://www.aktion-sauberehaende.de. (Zugegriffen: 16.04.12)
  32. 32.
    Borowitz SM, Waggoner-Fountain LA, Bass EJ et al (2008) Adequacy of information transferred at resident sign-out (in-hospital handover of care): a prospective survey. Qual Saf Health Care 17:6–10PubMedCrossRefGoogle Scholar
  33. 33.
    Cleland JA, Ross S, Miller SC et al (2009) „There is a chain of Chinese whispers…“: Empirical data support the call to formally teach handover to prequalification doctors. Qual Saf Health Care 18:267–271PubMedCrossRefGoogle Scholar
  34. 34.
    Horn J, Bell MDD, Moss E (2004) Handover of responsibility for the anaesthetised patient – opinion and practice. Anaesthesia 59:658–663PubMedCrossRefGoogle Scholar
  35. 35.
    Manser T, Foster S (2011) Effective handover communication: an overview of research and improvement efforts. Best Pract Res Clin Anaesthesiol 25:181–191PubMedCrossRefGoogle Scholar
  36. 36.
    Catchpole KR, Leval MR, McEwan A et al (2007) Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Paediatr Anaesth 17:470–478PubMedCrossRefGoogle Scholar
  37. 37.
    Petersen LA, Orav EJ, Teich JM et al (1998) Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv 24:77–87PubMedGoogle Scholar
  38. 38.
    Flin R, Patey R (2011) Non-technical skills for anaesthetists: developing and applying ANTS. Best Pract Res Clin Anaesthesiol 25:215–227, doi:10.1016/j.bpa.2011.02.005PubMedCrossRefGoogle Scholar
  39. 39.
    Fletcher G, Flin R, McGeorge P et al (2003) Anaesthetists‘ Non-Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 90:580–588PubMedCrossRefGoogle Scholar
  40. 40.
    Manser T (2008) Team performance assessment in healthcare: facing the challenge. Simulation Healthc 3:1–3, doi 10.1097/SIH.0b013e3181663592CrossRefGoogle Scholar
  41. 41.
    Lingard L, Garwood S, Poenaru D (2004) Tensions influencing operating room team function: does institutional context make a difference? Med Educ 38:691–699, doi:10.1111/j.1365-2929.2004.01844.xPubMedCrossRefGoogle Scholar
  42. 42.
    Wayne DB, Didwania A, Feinglass J et al (2008) Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest 133:56–61, doi:chest.07-0131 [pii] 10.1378/chest.07-0131PubMedCrossRefGoogle Scholar
  43. 43.
    Morey JC, Simon R, Jay GD et al (2002) Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 37:1553–1581PubMedCrossRefGoogle Scholar
  44. 44.
    Robertson B, Schumacher L, Gosman G et al (2009) Simulation-based crisis team training for multidisciplinary obstetric providers. Simul Healthc 4:77–83, doi:01266021-200900420-00003 [pii] 10.1097/SIH.0b013e31819171cdPubMedCrossRefGoogle Scholar
  45. 45.
    Gardner R, Walzer TB, Simon R et al (2008) Obstetric simulation as a risk control strategy: course design and evaluation. Simul Healthc 3:119–127, doi:10.1097/SIH.0b013e3181671bbePubMedCrossRefGoogle Scholar
  46. 46.
    Neily J, Mills PD, Young-Xu Y et al (2010) Association between implementation of a medical team training program and surgical mortality. JAMA 304:1693–1700, doi:10.1001/jama.2010.1506PubMedCrossRefGoogle Scholar
  47. 47.
    Draycott T, Sibanda T, Owen L et al (2006) Does training in obstetric emergencies improve neonatal outcome? BJOG 113:177–182, doi:10.1111/j.1471-0528.2006.00800.xPubMedCrossRefGoogle Scholar
  48. 48.
    Bosse G, Breuer JP, Spies C (2006) The resistance to changing guidelines–what are the challenges and how to meet them. Best Pract Res Clin Anaesthesiol 20:379–395PubMedCrossRefGoogle Scholar
  49. 49.
    Nachtigall I, Tamarkin A, Tafelski S et al (2009) Impact of adherence to standard operating procedures for pneumonia on outcome of intensive care unit patients. Crit Care Med 37:159–166PubMedCrossRefGoogle Scholar
  50. 50.
    Lauterberg J, Blum K, Briner M, Lessing C (2012) Befragung zum Einführungsstand von klinischem Risiko-Management (kRM) in deutschen Krankenhäusern. Institut für Patientensicherheit der Universität BonnGoogle Scholar
  51. 51.
    Balzer F, Spies C, Schaffartzik W et al (2011) Patient safety in anaesthesia: assessment of status quo in the Berlin-Brandenburg area, Germany. Eur J Anaesthesiol 28:749–752, doi:10.1097/EJA.0b013e328348ee35PubMedCrossRefGoogle Scholar
  52. 52.
    Lombarts MJ, Rupp I, Vallejo P et al (2009) Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project. Qual Saf Health Care 18(Suppl 1):i28–37PubMedCrossRefGoogle Scholar
  53. 53.
    Farley DO, Haviland A, Champagne S et al (2008) Adverse-event-reporting practices by US hospitals: results of a national survey. Qual Saf Health Care 17:416–423PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin CCM/CVKCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinDeutschland

Personalised recommendations