Implementation and evaluation of an international standardized operating protocol for the prevention of wrong site surgery in Germany

Article type
Authors
Fishman L1, Renner D1, Kolbe M2, Lessing C2, Thomeczek C1
1Agency for Quality in Medicine, Germany
2Coalition for Patient Safety c/o Institute for Patient Safety, University of Bonn, Germany
Abstract
Background: The objective of the WHO initiative 'Action on Patient Safety: High 5s' is to implement and evaluate standardized operating protocols (SOPs) in a multi-national learning community in order to improve patient safety in hospitals. High 5s SOPs have been developed for three topics, namely 1) correct site surgery (CSS), 2) safe management of concentrated injectable medicines, and 3) medication reconciliation.

Methods: In Germany the SOPs are implemented successively, beginning with the CSS SOP. In 2009 to 2010, 17 German hospitals of various levels of care were recruited to participate in the CSS module. The core element of this SOP is a surgical checklist used both for SOP implementation and data collection. In hospital workshops the SOP and checklist, which were developed in the USA, were adapted nationally and locally to the preoperative processes in the participating German hospitals while maintaining standardisation as according to the minimum High 5s criteria. The surgical checklists are distributed to the hospitals as carbon copies. After completion of the process, the copies are transferred for data analysis. Five internationally standardised process and outcome indicators are generated from the checklist data on a monthly basis. These allow a continuous assessment of the degree of realisation and the effects of the SOP, and are complemented by qualitative evaluation components addressing barriers and success factors for implementation.

Results and Conclusion: Adaptations at both a national and hospital level are necessary in order to ensure acceptance and thus successful implementation of the SOPs. The comprehensive evaluation concept within the High 5s Project, which is applied in numerous hospitals in varying healthcare systems, provides an unprecedented opportunity to analyse the feasibility and impact of specific standardised patient safety solutions locally, nationally and internationally. First evaluation results will be presented at the conference.