Risks of Inaccurate or Incomplete Pre-operative Assessments in Freestanding ASCs

独立式 ASC 术前评估不准确或不完整的风险

• 批准号: 7363283
• 负责人: Nancy Jean Kupka
• 金额: $ 19.8万
• 依托单位: JOINT COMMISSION
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-04 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7363283
• 关键词: Risks; Inaccurate; Incomplete; Pre; operative

DESCRIPTION (provided by the applicant): The aim of this proposal is to model risks and weaknesses in pre-operative nursing assessments in the freestanding ambulatory surgery center (ASC) setting. Failure to conduct or act upon the findings of the assessment could result in an adverse event including perioperative complications, unanticipated transfer to a higher level of care, and even death. A widely used method to identify risks is "hazard analysis". One form of hazard analysis is the Failure Mode and Effects Analysis (FMEA) which is used to identify and quantify potential failures. Once potential failures are identified, organizations can make changes or put safeguards in place to prevent or lessen the possibility that the failure will occur. The risk analysis component of FMEA will be performed on pre-operative nursing assessments in ten Joint Commission accredited USPI ambulatory surgical centers to identify flaws and weaknesses that will inform prevention strategies. Multidisciplinary staff that play a direct role in, or are knowledgeable about, the pre-operative nursing assessment process from each center will be involved. This will include physicians, nurses and an administrator. A Joint Commission staff member who received specialized training, supported by an engineer from Battelle, will facilitate. The FMEA team and facilitator will examine the assessment process both as it was designed to work and as it is actually implemented. The team will map the assessment processes as they were designed and as they have been implemented, and examine process flow charts for missing steps, redundancies, barriers and other weaknesses. At the completion of the risk analysis, the FMEA team and facilitator will compile and discuss the results, identify process flaws and determine where the process is most vulnerable to breaking down. The remaining portions of the FMEA - root cause analysis of the problem, process redesign, and monitoring - are not a part of this study. However, participating ASCs will be expected to develop a process improvement plan based on the results of their risk analysis and to implement that plan. A copy of the plan will be submitted to the research team. Relevance: Freestanding ASCs are physically detached from inpatient hospitals, thus limiting access to emergency assistance if needed. Accurate pre-operative nursing assessment of a patient's candidacy for a procedure under these conditions is critical to providing safe care and preventing patient harm. Failure to conduct or act upon the findings of a pre-operative assessment could result in an adverse event including perioperative complications, unanticipated transfer to a higher level of care and even death.

描述(由申请人提供)：本提案的目的是在独立的门诊手术中心(ASC)环境中模拟手术前护理评估中的风险和弱点。未能根据评估结果进行评估或采取行动可能会导致不良事件，包括围手术期并发症、意外转移到更高水平的护理，甚至死亡。识别风险的一种广泛使用的方法是“风险分析”。危险分析的一种形式是故障模式和影响分析(FMEA)，它用于识别和量化潜在的故障。一旦确定了潜在的故障，组织就可以进行更改或实施保障措施，以防止或降低故障发生的可能性。FMEA的风险分析部分将在联合委员会认可的USPI门诊外科中心的十个手术前护理评估中进行，以识别缺陷和弱点，以便为预防策略提供信息。在每个中心的术前护理评估过程中发挥直接作用或了解情况的多学科工作人员将参与其中。这将包括医生、护士和一名管理员。在来自巴特尔的一名工程师的支持下，一名接受过专门培训的联合委员会工作人员将提供协助。FMEA团队和协调人将检查评估过程，无论是设计为工作的过程还是实际实施的过程。该小组将根据评估流程的设计和实施情况绘制评估流程图，并检查流程流程图中的遗漏步骤、冗余、障碍和其他弱点。风险分析完成后，FMEA团队和协调人将汇编和讨论结果，识别流程缺陷，并确定流程最容易出现故障的位置。FMEA的其余部分--问题根本原因分析、流程重新设计和监控--不是本研究的一部分。然而，预计参加的ASC将根据其风险分析的结果制定流程改进计划，并执行该计划。该计划的副本将提交给研究小组。相关性：独立的ASC在物理上与住院医院分离，从而限制了在需要时获得紧急援助的机会。准确的术前护理评估是提供安全护理和防止患者伤害的关键。未能根据术前评估的结果进行评估或采取行动可能会导致不良事件，包括围手术期并发症、意外转移到更高水平的护理，甚至死亡。