Errors in packaging surgical instruments based on a surgical instrument tracking system: an observational study.
Central sterile supply department
Package
Surgical instrument
Traceability information management system
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
19 Mar 2019
19 Mar 2019
Historique:
received:
02
04
2018
accepted:
13
03
2019
entrez:
21
3
2019
pubmed:
21
3
2019
medline:
9
5
2019
Statut:
epublish
Résumé
Surgical instrument processing is important for improving the safety of surgical care in hospitals. However, it has been rarely studied to date. Errors in surgical instrument processing may increase operative times and costs, and increase the risk of surgical infections and perioperative morbidity. We aimed to investigate the errors occurred in packaging surgical instruments. Surgical instrument tracking system in a central sterile supply department (CSSD) was used to collect the packaging data during January-August 2016 in the First Affiliated Hospital of Soochow University, Suzhou City, China. Data on 33,839 surgical instrument packages were collected. A total of 398 (1.18%) errors occurred, including incomplete packages (n = 70), instrument missing (n = 77), instrument malfunction (n = 27), instrument in wrong specification (n = 175), wrong packaging tag (n = 8), box and cover mismatched (n = 14), wrong packing material (n = 15), indicator card missing (n = 6), and wrong count of instruments (n = 6). The highest error rates were observed among least experienced nurses (N1 level) and during the 16:00-20:00 time period (both p < 0.05). A relatively high error rate was detected in the Department of Orthopedics as well as in the Department of Gynecology and Obstetrics. Wrong instrument specifications were the primary packing error identified in the current study. Further effort is needed to standardize the packing procedure for instruments under the same category and more effort is required to reduce the error rate during high risk times, or in the surgery department.
Sections du résumé
BACKGROUND
BACKGROUND
Surgical instrument processing is important for improving the safety of surgical care in hospitals. However, it has been rarely studied to date. Errors in surgical instrument processing may increase operative times and costs, and increase the risk of surgical infections and perioperative morbidity. We aimed to investigate the errors occurred in packaging surgical instruments.
METHODS
METHODS
Surgical instrument tracking system in a central sterile supply department (CSSD) was used to collect the packaging data during January-August 2016 in the First Affiliated Hospital of Soochow University, Suzhou City, China.
RESULTS
RESULTS
Data on 33,839 surgical instrument packages were collected. A total of 398 (1.18%) errors occurred, including incomplete packages (n = 70), instrument missing (n = 77), instrument malfunction (n = 27), instrument in wrong specification (n = 175), wrong packaging tag (n = 8), box and cover mismatched (n = 14), wrong packing material (n = 15), indicator card missing (n = 6), and wrong count of instruments (n = 6). The highest error rates were observed among least experienced nurses (N1 level) and during the 16:00-20:00 time period (both p < 0.05). A relatively high error rate was detected in the Department of Orthopedics as well as in the Department of Gynecology and Obstetrics.
CONCLUSION
CONCLUSIONS
Wrong instrument specifications were the primary packing error identified in the current study. Further effort is needed to standardize the packing procedure for instruments under the same category and more effort is required to reduce the error rate during high risk times, or in the surgery department.
Identifiants
pubmed: 30890128
doi: 10.1186/s12913-019-4007-3
pii: 10.1186/s12913-019-4007-3
pmc: PMC6425664
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
176Subventions
Organisme : Health and Family Planning Commission of Jiangsu Province Youth Research Subject
ID : Q201606
Organisme : the Suzhou Applied Basic Research
ID : Sys201535
Organisme : Jiangsu province commission of health and family planning research funding
ID : H2017064
Organisme : Suzhou science and technology development plan
ID : SS201864
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