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Use of a Time Out Checklist Identifies Deficiencies in Obstetric Preanesthetic Preparation
Abstract Number: T-66
Abstract Type: Original Research
Background: In 2008, the World Health Organization (WHO) published the Surgical Safety Checklist (CL) for operating room (OR) use1 and recent studies attest to its effectiveness in improving patient safety2. Adaptation of the “Sign In” portion of the WHO list to improve preanesthetic (PA) induction safety detects a significant rate of missed checks3. The ACOG has described a patient safety CL specific for cesarean section (CS)4; only one other author describes an obstetric (OB) PA CL5. No study reports on its effectiveness. We recently adopted use of an OB PA CL and recorded data on its ability to identify deficiencies in PA preparation.
Methods: IRB approval was obtained. The CL was developed in mid-2013 using a Delphi method among 6 obstetrical anesthesiologists who attend in the obstetrical suite 84% of the time. The CL was identified with the acronym ACED with the following elements: A: Anesthesia (type), Allergies, Antibiotics, Airway; C: Consent, Co-morbidities; E: Eat (NPO status), Equipment (pulse ox, suction, O2 delivery); D: Drips (IV access adequate), Drugs (MgSO4, pitocin, insulin, vasopressor). Two authors (CB & JB) recorded instances of deficiencies detected by CL use for all obstetric anesthesia procedures. Fisher’s exact test was used to compare rates of deficiencies between neuraxial labor analgesia (EPI) and OR procedures (CS, cerclage, D&E, tubal ligation).
Results: Data on 225 procedures were collected in this ongoing observational study (Table 1). 32 deficiencies were detected overall (14.7%) with higher rates noted for (EPI) compared to CS/other (18.4% vs. 9.0%, P = 0.04). Incorrect or unavailable antibiotics were detected in 3.3% of patients for CS/other, while lack of suction, pulse ox, and oxygen delivery system were detected in EPI (5.1%, 2.9%, 0.7% respectively), but not in CS/other.
Discussion: We observed an overall rate of in OR deficiencies (9.0%) similar to that reported by others (11.2%) (3). The rate of deficiencies was higher for EPI compared to CS/other, with differences in the types of deficiencies. Our data suggests that widespread implementation would identify a significant number of PA preparation errors. However, others have noted significant CL infidelity occurs when CLs are widely adopted into clinical use (6).
Ref: 1)Lancet2008;86:1; 2)N Engl J Med2009;360:491; 3)Anesth Anlag2011;113:84; 4)Obstet GYN2011;118:1471; 5)IJOA2010;19:235; 6)Surgery2012;152:331