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Table 2 Key risk elements for a patient surgical checklist

From: Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

CATEGORIESSUB-CATEGORYCODESEXAMPLE
Pre-operative informationContactDirect phone number
Ask questions
Clarify information
Write down information
Nurse; “That they have a number they can ring when they get back to them self after being informed about the surgery. Maybe it could be written a place that they get proper information under admission. I believe 90% of the patients do not remember anything.
Patient; “Before the operation I had no idea who to contact. I got referred here and there and suddenly I got a letter informing me about an operation”.
Medication safetyLack of medication lists
Updated medication list at general practitioners office
Little insight in own medication
Identify anticoagulants with their general practitioners
Learn their medications
Surgeon; “I don’t believe we always ask if they use anticoagulants and they don’t always understand that it is anticoagulants they are using. Patients often relate to the medication name and misunderstandings can often happen”.
Patient; “I wonder what kind of information the nurses have. When I came to the ward after my surgery, I was offered some pain relief and I am allergic to certain medications. Luckily I asked her because I did not recognise those tablets and asked what they were and it turned out I was allergic to them”.
Health statusEnsure correct treatment
Diabetes
High blood pressure
Cardio-Vascular disease
Chronic diseases
Non Healing wounds
Regular control at the general practitioners office
Test for multi resistance bacteria
Nurse; “I am thinking about our own health. Say, that someone is overweight; they might have diabetes that are not under control. That the general practitioners consider these things before the patients comes in for an operation.”
Nurse; “We have talked a lot about it in our ward. I believe it is very important because some patients come in a such a bad state. So I think the elective patients should consider own health and the general practitioners should be involved earlier and help them”.
Optimizing healthPatients responsibility
Contact with general practitioner
Inform patients
Exercise
Stop smoking
Stop drinking/drugs
Nutritional status
Surgeon; “We know that it’s documented that if you quit smoking the chances of complications reduce, but there is now culture for informing patients about it.
Nurse; “Most patients sit down in a chair and stay there, when they get informed about their surgery. I wish they could contact their general practitioner and ask how much activity they can have before surgery so they do not become passive. Because the whole thing is to optimize the patient health to prevent complications”.
Dental statusRegular dental checks
Recommend to check dental status
Poor dental status
Infections due to dental status
Extraction of teeth day before surgery
Surgeon; “I remember we had a patient who had to remove half of her teeth before we could operate. I believe people don’t understand how important it is that their teeth are well kept”.
Surgeon; “one patient had an old rote canal and at the bottom of the tooth there was a little thing that they had not manage to remove. He had to go to a specialist and it was not possible to get it done the week before the surgery”.
Read informationPatient need for encouragement
Accurate information
Don’t use google
Nurse; “I know there is a lot of the patients who don’t read the information given to them”
Patient; “When you receive all the papers before your surgery, it was too much I had no energy to read it all”
Pre-operative preparationsPreparations 2 weeks before surgeryType of surgery
Time of surgery
Bring close family/friend to information meeting
Clarify when to stop anticoagulants
Fill out required forms
Patient; “I should have stopped my blood thinners 2 days before my surgery, no one asked me so I stopped them the day before because I remembered it from my last operation, but it was too late”.
Ward doctor; “When you arrive at the hospital to the information meeting it is so important that the patients bring an up to date medication list so we know what kind of medication they are using and we don’t have to wonder if they are using anticoagulants. Yes that they bring an updated list maybe this can be one of the preparations the patients need to do before their surgery”.
Inform your surgical wardPatient forget to inform about important information
Don’t think it’s important
Other medical investigations
Cold our infections just before surgery
Patient; “If you use any form for medications or need something I believe we as patients’ needs to take some responsibility to inform before surgery. Something can happen and if you have not informed about it before your surgery it is kind of your fault”.
Nurse; “Or they actually are under investigation of other diagnoses, they have to let us know or their operation might have to be cancelled”.
Other Nurse: “or if they get sick with throat infections and can’t be operated on”.
Plan your dischargeLength of hospitalisation
Discharged before expected
Prolonged hospitalisation due to not having someone at home
Home care
Aids/bandages/medication
Planed discharge safer at home
Nurse; “the patients are very interested in the practical things before they come in, but we have to focus on the things that has to be ready before they get here and what they want after their surgery are they considering rehabilitation or do they live alone?”
Patient; “You are going to be reduced and it is wise to have someone that can look after you at home and then you have the chance to inform the nurses that you are alone and might need an extra night in the hospital”.
On admission to hospitalNeed for a checklist on important info
Patients can check and request missing info
Remove rings, necklaces, piercings
When to stop eating and drinking
Pre surgery shower routines
Allergies
Updated medication list
Natural medications or nutritional supplements
Are you informed about expected pain
Patient; “It was own times on drinking clear fluids, I remember it from last time I had surgery. I was told that I could drink clear fluids until a few hours before my surgery. This time I did not receive any information so I was a bit unsure when I should stop eating and drinking”.
Ward Doctor; “We do have a journal system that is supposed to be updated with patients’ current medicines but it’s not always updated. We often use old admission notes because the patients don’t have anything with them and the referral dose not usually contain a medication list”.
Just before surgeryAre operational are marked correctly?
Avoid getting cold
Ask surgical team to use safe surgery
Patient; “The surgical team was ready and they started to look for the marked surgical site which was not there. They got a bit quiet and then they asked control questions before the operation started”.
Post-operative informationPreventions and complicationsInformation about complications
Often unsure at home
What is normal or not
What to do in an emergency
Special considerations
Surgeon; “It is very important that patients contact us if they experiences complications and that they adhere restrictions”.
Patient; “I thought this does not feel normal and I was walking around thinking Oh my god this is not good. I called the ward all the time because it was so swollen and warm. Oh my god this is not right but it apparently was all normal”.
Restrictions and activityWhen to start exercising
Stayed in bed for weeks
Confusion about restrictions
Nurse; “Patients own efforts in relations to mobilisation and what they can do themselves to reduce hospitalisation time after their operation”.
Nurse; “At the same time it is this about training, how much can they do, because they are so scared that they will damage something or do too much. But it is important that they exercise and don’t sit down”.
Medication safetyStart new medications
Restart medications
Don’t remember information
Rushed information
Need a checklist
Ask for missing information
Medication side effects
New medication list
Surgeon; “it is very important to inform the patients. I believe it is the core reason for them taking their medicine and understanding their disease and that they contact their general practitioners”.
Patient; “I believe the most important thing the doctor did was to line up all my medications. Some of them I knew from before and some I did not know. I explained to me very clearly, what each medicine was for and how long I was going to use them. This was very useful for me especially when you take 5–6 different medicines it is easy to mix them up”.
Pain reliefTaking too little
Taking too much
Regular usage
When to stop
What to do if still in pain
Patient; “It is easy to forget when you are laying there and then suddenly you have to ouch!! You are in your own world and suddenly it is too painful and you take double the amount of pain relief you should”.
Nurse; “And it is reductions of pain relief, many patients have used large doses over longer time”.
Stomach functionsOften experiences stomach pains
Constipation
Prevention/medication
Worried something is wrong
Surgeon; “The day after it always take some time before the stomach functions work again. This is not a problem if the patients are informed about it”.
Patient; “I had problems with my stomach and I had to ask. I was informed that it was normal, I did not know that and it would have been good to know”.
Post-operative plans and follow-upFurther careWound care
Removal of sutures
Other treatment
Test results
Sick certificate
When can I shower; Whom to contact for questions
Nurse; “Further plan, times for things, how to treat the wound, showering, precautions and whom to contact”.
Patient; “I showered with the bandage and did not change it. I looked if there was something yellow on it because I was told to. There was some wound discharge on it the first days which made me unsure”.
AppointmentsExpected time and date
Referral to other specialities
What to do if not received
Nurse; “It is not always patients feel a responsibility to enquire about missing follow-up appointments. They have to take some responsibility too”.
Patient; “kind of trust that you will get an appointment and you don’t really think about it anymore. But of course if you had a checklist or something you would go Oh I haven’t got my appointment”.