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726 / Prevention of wrong site surgery or insufficient excision in dermatology

FRANCE
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Surgical / Invasive procedures
Communication There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
This patient safety practice aims at reducing wrong site surgery or insufficient excision in dermatology
Description of the Patient Safety Practice
 
Safe Clinical Practice: Prevention of wrong site surgery or insufficient excision in dermatology

Context:
Risk factors:
-    Type of lesions
o    Multiple lesions in different sites (i.e. face and body)
o    Additional lesions modifying the aspect of the target lesion (scars, other malignant lesions)
o    Lesions difficult to see after biopsy (current on the nose or for small lesions)
-    Multiple health care professionals involved (primary care physician, surgeon, carers)
-    Insufficient patient involvement/empowerment: confused patient, insufficient information, communication difficulties.
Consequences:
-    Surgical revision immediate or delayed.
-    Incomplete excision leading to a loss of chance and an aggravation of the disease.


Risk factors:
Communication issue:
-    Between primary care physician (GP or dermatologist) and surgeon.
-    Particularly due to an inaccurate localisation of the lesion.
Inadequately planned surgery (short notice programming).
-    Insufficient pre-operative assessment (no consultation with the surgeon before surgery)
-    Insufficient pre-operative site localisation/marking (more difficult to realise in ambulatory surgery).
Failure in post operative laboratory and pathology specimen processing, tracking, and communication of results.

Actions proposed to decrease risk:
Prevention:
    -standard communication form (attached):
.comes in addition to the usual referring letter sent by the primary care physician to the surgeon.
.provides a description and a drawing of the lesion site. Comments can be added on the back side.
.should be initially filled out by the physician who makes the diagnostic. Complementary Information could be added after each further consultation. The same form is used during the all pathway. It is transmitted between professionals by letter or by the patient himself and included in the hospitalisation file. The form
.is available during surgery and a copy of the form is included in the operating report sent by the surgeon to the primary care physician.
.Given to the patient, this form could promote patient involvement and empowerment as it pushes practitioners to provide complete information to the patient.
    -Digital pictures of the lesion
        .realised before surgery, they complement the communication form and have a legal value.
        .2 pictures of the marked lesion are recommended:
            A picture of the anatomical region illustrating the localisation of the lesion.
            A close-up picture of the lesion showing its shape, colour and size (measuring tape included).
            .the patient can be involved: if pictures are made with his own camera, he will have to provide them to the practitioners. Medical confidentiality is garanted.
            . the practitioner can also use his own camera.


Error recovery: systematic follow-up of post operative laboratory and pathology specimen processing results. Discordant results can sometimes help to identify site errors.
    - tracking results: quantitative follow-up, registries of prescribed exams and results
    - review of all results by the surgeon
    - reviewed results are systematically included in the medical file of the patient
    - a copy of the results is sent to the primary care physician.

Summary:
    -promote patient involvement
        . above proposed actions improve the level of information of the patient and his empowerment.
        . a mirror will support patient involvement during consultation and surgery (patient spectacles should be taken to the operating room if necessary.
        . If any doubt occurs, the intervention should be postponed.
    -strengthen the following operating phases:
        .systematic marking of the lesion with patient involvement any time it is possible (surgery must be stopped in case of discordance).
        .checking of patient file before surgery
        .safe surgery check list including time-out must be performed.
-    strengthen post operative follow-up and in case of discordant pathology results:
o    contact the primary care physician
o    new consultation with the patient
o    patient must be informed of any error and consequences
surgical revision must be programmed
Attachment of relevant written information and/or photos, as appropriate
81_WP4_2012-10-27_SSP_erreur_exerese.pdf
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Not known
A baseline measurement before implementation of the reported practice was obtained
Not known
A measurement after full implementation of the reported practice was obtained
No
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
There is no specified text here
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Health care assistants
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Point of time in which service user or their reprasentatives' involvement takes place
During implementation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Collaboration, such as co-designing a Patient Safety Practice or active partnership in implementation
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Not known
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Not known or not relevant
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Jean Bacou
Country: FRANCE
Organisation: HAS
E-mail: j.bacou@has-sante.fr
Phone: +33 1 55 93 73 37
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