Elevated Standards of Surgical Safety: What Patients Truly Deserve
Testament to their collaborative commitment of providing better safety for patients during surgical procedures, members of multi-stakeholder institutions, medical groups, and advocate organizations gathered in a press conference on Friday to discuss the patients’ full surgical journey and to decide on the crucial steps that need to be undertaken to make surgeries safer, with the aim of saving more lives.
The forum, attended and supported by the Philippine College of Surgeons (PCS), the Philippine Society of Anesthesiologists (PSA), Philippine Alliance of Patient Organizations (PAPO), and global healthcare company MSD in the Philippines, was inspired in part by a global urging from the World Health Organization (WHO) and Member States to pay the closest possible attention to the issues of patient safety and welfare.
The patient-centered approach is paramount, the forum experts and participants say, as patients deserve the highest levels of safety in the surgical perioperative period, and as unsafe surgical care can undoubtedly cause substantial harm.
The WHO, for instance, reported that surgical complications can harm a minimum of seven million patients globally each year, with at least one million patients that could be at risk of death during or immediately following a procedure.
These facts underscore the need to shape practices that improve on patient outcomes, and that the time to act on them is now, through concerted efforts.
Leaders Speak Up On Patient Safety
Dr. Alejandro Dizon, President of the PCS, shared about methods that are currently being employed by the St. Luke’s Medical Center-QC to ensure that less post-surgical complications occur, to push for the bigger goal of patient safety.
He explained and stressed the need for a “checklist” prior to surgery, which covers the essential items for a smooth procedure. A great example of this, he says, is the WHO Surgical Safety Checklist which covers three phases: the period prior to induction of anesthesia, the period after induction and before surgical incision, and the period during or immediately after wound closure. Confirmation of the completion of tasks per phase is necessary before the procedure moves onward.
He reinforced the requirement for greater quality assurance protocols within the hospital setting, which would vastly improve the monitoring of procedures.
To further drive the discussion, Clinical Quality Director of The Medical City, member of the Philippine Society of Anesthesiologists, and Philippine representative to the Safety and Quality of Practice Committee of the World Federation of Societies of Anesthesiologists, Dr. Erlinda Oracion, gave a multitude of insights on patient safety from the perspective of an anesthesiologist.
She echoed the need for more consistent usage of the surgical checklist, and potentially building comprehensive guidelines for high volume procedures to help focus on successful patient outcomes.
Together with fellow PSA member Dr. Claudia Rafanan, Chairman of the Anesthesia Department of Cebu’s Chong Hua Hospital, Oracion highlighted the importance of responsible use of anesthesia, a drug that causes insensitivity to pain, which allows for a more controlled environment that benefits both the patient and the doctor during surgical procedures.
Dr. Rafanan afterward shared current practices that have helped the Chong Hua Hospital become an example for other medical centers that desire to give their patients the safest and best care possible. She expounded further on anesthesia, and the right use of muscle relaxants and reversal agents that significantly helped lessen surgical risks during high volume cases such as abdominal procedures.
A muscle relaxant, she explained, is used during surgery to gain a variety of benefits such as the maximization of surgical space and patient relaxation. It also affords easy intubation – or the placement of an endotracheal tube into the trachea – to maintain an open airway so that the patient can be placed on a ventilator that will assist with breathing.
Reversal agents, on the other hand, function to diminish the effects of muscle relaxant, enabling the patient to recover functions faster. Reversal agents significantly lessen the risk of residual paralysis – a dangerous situation where patient functionality is severely hindered, which may lead to critical respiratory events or CREs that can be fatal.
There have been studies on the effects of reversal agents on patients compared to those who received just the usual care. In the 2015 British Journal of Anesthesia, the effect of reversal agent sugammadex was investigated among patients in a randomized, controlled study. Out of 74 sugammadex patients, there were no cases of residual neuromuscular blockade compared with the 33 out of 76 “usual care” patients who developed the condition. The patients who had the reversal agent administered to them were also discharged from the hospital earlier.
A National Commitment
Since 2008, the DOH has been implementing the National Policy on Patient Safety to ensure that patient safety is institutionalized as a fundamental principle of the health care delivery system in improving health outcomes.
The representative leaders closed the conference with a commitment exercise that symbolically marked the united efforts of the group. Together, they pledged a promise to make patient surgical safety a priority, as well as to empower decision makers to seriously consider the steps they presented during the conference.