The core and purpose of medical safety is patient safety first [1]. At present, tens of millions of people in the world receive surgical treatment for various reasons every year, among which 10 people have experienced medical errors [2]. Of the 5632 dangerous incidents examined by the Joint Committee of American Medical Institutions from 1.995 to 2008, "surgical site error" accounted for 1.3.2%, ranking first [3]. Therefore, how to effectively verify the safety of surgery and prevent misoperation is a global problem. Therefore, the Chinese Hospital Association (CAN) revised and improved the patient safety target in 2009, and the Central Quality Committee of the Ministry of Health also promulgated the implementation rules of the surgical safety verification system, aiming at ensuring the surgical safety. Since 20 10 0 1, our hospital has further refined the implementation process and content of safety verification on the basis of learning the above objectives and systems, and analyzed the specific implementation effect. 1. Implement the operation safety verification system 1 Establish the operation safety verification system 1. 1 Promote and train the operation-related personnel to seriously study the patient safety goal in 2009, understand its importance, explain the use of the operation checklist, actively cooperate with the operating room, and the anesthesiologists, surgeons and nurses in the operating room actively participate. There are many people, so they must cooperate with each other. 1.2 the safety verification of the person in charge of verification and the person in charge of operation is a complicated process with multiple departments, personnel and links, involving patients in operation, ward nurses, operating room nurses, anesthesiologists and surgeons. Only by mutual coordination can we complete the inspection in different periods [4]. After the patient enters the operating room, he must be examined before any medical operation [5]. 1.3 contents of surgical safety verification 1.3. 1 Patient verification Check the patient's name, gender, department, hospital number, bed number, age, surgical name, surgical method, surgical site, surgical site marking, drug allergy history, skin condition, inspection report, informed consent, wrist or ankle. 1.3.2 During the operation, the surgeon, visiting nurse and hand-washing nurse * * * jointly completed: (1) All items were counted together before operation, the second time before the body cavity was closed, the third time after the body cavity was closed and the second time after the skin was closed; (2) Check the surgical specimens, fill in the labels accurately, and check the application form for pathological examination. Hand-washing nurses should fill in and sign the specimen fixation register, and visiting nurses should reconfirm and sign; (3) Check the certificate and bar code of the implant during operation. 1.3.3 Verification of instruments and equipment Establish the use registration book of various instruments and equipment required for operation, and fill in the running status in time after use by visiting nurses. In addition to normal operation, it is also necessary to predict whether the equipment needs overhaul and maintenance. 2. Operation safety verification process 2. 1 Nurses' self-verification process and contents Foreign data show that nurses began to double-check through handheld PC/ scanner ... static code analysis and visual confirmation [6]. 2. 1. 1 Visit the first examination before operation. On the afternoon of 1 day, the visiting nurse came to the door to find out the patient's identity (subject, bed number, medical record number, name, age and sex), preoperative diagnosis, operation name, operation site and identification, necessary examination results, cross matching, special infection, allergic history and operation history. 2. 1.2 The second examination was made when the ward was handed over to the operating room. On the morning of the operation, check with the ward nurse according to the operation notice and the handover record of the surgical patient. Those patients who are conscious and able to answer are identified by the patients themselves, while those patients who are unconscious and unable to answer are identified by wristbands and confirmed by their legal relatives. After it is correct, the nurses in the operating room and ward sign the handover record sheet. 2. 1.3 During the third inspection of the operating room, a notice board [7] for elective surgery was hung at the door of the operating room, indicating the operating room, name, diagnosis, operation name, instruments and visiting nurses of each operation that day; The operation prompt board is also placed in an eye-catching place in the operating room, and the nurses who pick up the patients and the visiting nurses * * * check the corresponding contents. Those who are unclear or babies are identified by wristbands. 2.2 Procedure and contents of "three parties and five times" verification in the operation group 2.2. 1 Before anesthesia, the anesthesiologist presided over and was responsible for verifying the patient's identity (the same as the contents of the pre-operation nurse's visit verification), operation name, informed consent, operation site and identification, anesthesia safety inspection, skin, venous access, preoperative blood preparation, patient allergy history, skin test results of antibacterial drugs and infectious disease screening. It is checked and signed by the surgeon, anesthesiologist and operating room nurse. 2.2.2 Before posing, it shall be presided over by the visiting nurse, and the three parties shall check the surgical site identification, especially the unilateral operation of the left and right bilateral organs and the operation of more than two parts. Visiting nurses and equipment nurses are responsible for counting the instruments and dressings used in the operation, and completing the counting records in time, including the patient's hospitalization number, department, bed number, name, operation date, operation name, the number of instruments and dressings used in the operation, the signature of the counting person, etc. 2.2.3 Before the operation, pause for a moment (pause time) before peeling, and the surgeon shall preside over and be responsible for checking the patient's identity, operation name, operation site and operation identification, confirming the risk warning, and ensuring that the patient, operation site and operation name are correct; Operating room nurses check the preparation of surgical items and report to surgeons and anesthesiologists. The verification results shall be confirmed and signed by three parties. Encourage patients to participate in medical safety. 2.2.4 The surgeon announces the name of the operation and the drainage before closing the body cavity after operation; Before and after closing the body cavity, the visiting nurse and the instrument nurse will check the instruments and dressings used in the operation, report the results to the surgeon and anesthesiologist, and complete the inventory record in time. The operation inventory record is made in duplicate, one for the operating room and the other for the medical record. If in doubt, please ask the radiology department to take X-rays to help check. 2.2.5 Before the patient leaves the operating room, the nurse in the operating room presides over and is responsible for checking the patient's identity, actual operation name, counting operation materials, confirming operation specimens, checking the skin, arteriovenous access, drainage tube, monitoring instrument circuit, and confirming the patient's whereabouts. This result was confirmed by the three parties. 2.3 Detailed management of surgical safety verification 2.3. 1 Safety of medication and blood transfusion Heparin, insulin, chemotherapy drugs, drugs requiring skin test, narcotic drugs, positive inotropic drugs, 10% potassium chloride, hypertonic electrolyte solution, etc. Classified storage, and clearly marked in the place where it is placed, and strictly checked by two people when giving medicine; When using drugs on the operating table, visiting nurses and instrument nurses should check the name, dosage, expiration date, skin test results and dosage of drugs, put them on the table with sterile syringes and mark them for later use. Visiting nurses should accurately record the name, dosage, route and time of drug administration. When patients need blood transfusion due to illness during operation, they should first check whether the bed number, name, hospitalization number, blood type and other information on the blood type test report are accurate and consistent with the information on the medical record. Then, they should look at the results of cross-matching test to see if there are any cracks in the blood bag to ensure that the blood is within the validity period. Before blood transfusion, the two should check the information again before blood transfusion. After blood transfusion, blood bags should be kept for 24 hours for necessary inspection. And sign the blood transfusion application form at the corresponding position. 2.3.2 Specimen preservation and submission of surgical specimens are irreplaceable, and pathological diagnosis of living tissue is the first diagnosis of surgery, which is the golden index [8]. With the increasing number of operations in hospitals, it is generally necessary to arrange multiple operations in an operating room. If verification is not strengthened, improper specimen management will bring great difficulties to clinical diagnosis and serious losses to patients. Strictly implement the system of specimen storage and inspection, and implement the measures of "one-to-one, double signature and three completeness", that is, the visiting nurse will hand over the specimen to the competent doctor after the operation, and the personnel who send and receive the specimen will sign it, and the pathological examination application form, pathological specimen register and pathological specimen label will be filled in completely. 2.3.3 The inventory of surgical materials shall be based on the system of "four inventory and three cleaning", that is, the surgical instruments and dressings shall be counted four times before, before, after and after body cavity sealing, and the number shall be recorded face to face, and the number shall be recorded on the spot and repeated, so as to ensure that the "instrument nurses, visiting nurses and second assistants" are clear and correct and prevent articles from being left in the body cavity; And strengthen the risk prevention of endoscopic instrument accessories and gauze used in body cavity surgery. 2.3.4 In order to prevent patients from falling, falling off the bed, falling off the tube and bedsore, the operating room should be regularly overhauled by special personnel, and the patients should be transported to and from the flat car and operating bed, so as to be familiar with the situation, assist the patients to go to bed, be monitored by the bedside, and add a bed stall on the way to transport the patients. Before the operation, the patient was escorted to the toilet and asked to wear non-slip shoes. Before moving the patient, a special person will be appointed to check and tidy the pipeline. When moving patients, all the staff should coordinate. After moving the patient, the three parties will check whether the pipeline is safe, unobstructed and firmly fixed. Evaluate the patient's skin before operation, fix the patient's position reasonably during operation, pay attention to observe and care for the compressed skin, and move the patient gently, accurately and steadily. Proper use and management of electrosurgical excision procedure during operation can avoid electrocautery and scald. 2.3.5 Effective communication and verification under special circumstances Oral medical orders and important inspection reports must be repeated. The sender of the information clearly sends out the information, prohibits abbreviations, unifies the drug dosage unit, requires the receiver to confirm and repeat the content, immediately records the received telephone or oral information on paper, and then the repeated recorded content is confirmed by the sender of the information, and can be executed and formally recorded only after it is correct. 3. Effect evaluation In order to evaluate the implementation of patient safety objectives, we evaluated the implementation effect from the following aspects. First, put an end to patient identification errors; B, medication and blood transfusion are safe and correct; C, effective communication, the correct implementation of the doctor's advice; D, surgical patients, surgical site, operation is correct; E. Whether the inventory is accurate; F, the preservation and inspection safety of surgical specimens; G, timely and correct operation inventory records; H, reduce the risk of patients falling and falling out of bed; I. Avoid the danger of pipeline compression, pipeline falling off and pipeline folding; J, put an end to pressure ulcers and burn patients. Among them, the implementation rate of A~E target is 100%, and the implementation rate of other projects is still not ideal, with the implementation rate of 97~99.5%. 3. 1 Improve the feasible inspection system, and problems in any link may lead to serious medical defects. Control or eliminate unsafe factors from the link to ensure patient safety. A large number of studies show that the lack of information exchange or communication between surgical teams is one of the risk factors leading to wrong surgery [9]. In 200 1 year, Meir medical center in the United States conducted a multi-factor and inter-departmental intervention study related to perioperative patient safety. The main errors found in this study include: patient error, medical record error in patient's medical record folder or medical record folder, no informed consent or informed consent error, no identification wristband or wrist error, no identification tag or identification tag error, unmarked surgical site or marked surgical site error [10]. Therefore, the implementation of Operation Safety Checklist in our hospital makes up for the defects of the system, clarifies the responsibilities of anesthesiologists, surgeons and visiting nurses, and ensures the information exchange or communication of the operation team. In the previous working mode, the surgeon checked the patient in the ward, the anesthesiologist checked the patient during the preoperative visit, and the visiting nurse checked the patient again when picking up the patient. The procedure is cumbersome, and patients are prone to boredom and doubt, unwilling to communicate with nurses, and lose the authenticity of the examination. The implementation of the surgical safety checklist reduces the number of inspections, but greatly improves the work efficiency and makes the inspection more effective and accurate. 3.2 to ensure the safety of patients' surgery. We advocate surgical safety verification and carry out the patient's safety goal, aiming at exerting the collective strength and wisdom to the extreme through the cooperation and encouragement between teams or members, highlighting the theme of nursing safety, quality and nursing in operating room, and ensuring surgical safety. Through the implementation of "three parties and five times" verification process by nurses and surgical teams, the safety of patients' surgery is guaranteed. For example, when the nurses in the operating room visited and verified before operation, they found that a patient's condition was inconsistent with the operation notice, so they asked the competent doctor to confirm that the bed was temporarily adjusted before operation but the operation notice was not rewritten. The doctor corrected the notice of operation and informed the anesthesiologist to avoid mistakes. In another case, a nurse found a mistake when checking the handover with the ward on the morning of the operation. It was found that she changed from a bed near the door to a bed by the window. After being examined by the operating room nurse, ward nurse and doctor in charge, the patient was sent to the operating room. It is precisely because of the strict implementation of the check process and content of each link that errors are found and avoided in time and the safety of patients is guaranteed. In order to eliminate this hidden danger from the root, the medical department stipulates that after the notice of operation is sent to the operating room, the beds shall not be adjusted at will. If it must be changed, it must be negotiated by the director of surgery, the director of anesthesiology and the head nurse in the operating room. After agreeing, the operation director rewrites the operation notice with a red pen and signs it. Ward management should be strengthened, and the risk of changing beds at will should be explained to patients, so that patients can consciously abide by the ward management system and take the initiative to participate in surgical safety verification. There will never be similar hidden dangers in the future. Through the implementation of the surgical safety verification system, the surgical team gradually realized that ensuring the safety of patients needs everyone's full attention, and implemented the verification measures according to the process. 3.3 Cognition of the personnel of relevant departments on the operation safety checklist; Nurses in the operating room have a high awareness of the operation safety checklist [1 1]. Some hospitals have successively implemented WH O standardized surgical safety checklist. At the same time, more work is directed, organized and implemented by operating room nurses, so there is a problem that surgeons and anesthesiologists have low awareness of this work and mistakenly think it is the content of operating room nursing work. In the process of implementation, the previous work habits are not changed, but because of copying files, the implementation effect is not good and the effect cannot be achieved. 3.4 Problems existing in the implementation and corrective measures 3.4. 1 Operators can't participate in the pre-anesthesia examination in time: In the past, operators in our hospital often entered the operating room near the completion of anesthesia and could not participate in the pre-anesthesia examination in time. In order to urge the surgeons to arrive in the operating room on time for pre-anesthesia examination, our hospital stipulates that the operating room records the time when the surgeons enter the operating room, and the medical department regularly visits the operating room for supervision, and those who are late will be punished accordingly. 3.4.2 The operation safety checklist system was not strictly implemented according to the process: At the beginning of the trial of the operation safety checklist system, the relevant operators did not fully understand the importance of the operation safety checklist, did not conduct oral examination according to the process, and the anesthesiologist filled in the form by himself, making the work a mere formality. In this regard, our hospital took the following measures: ① The vice president of business went to the operating room from time to time to personally guide the operation safety verification work, and supervised it to be carried out in strict accordance with the process, so that this work could be carried out smoothly. (2) The Medical Department regularly goes to the operating room to supervise the implementation of this work, praising the departments and individuals who earnestly implement it in the whole hospital, and giving corresponding punishment to those who are not serious, so that the operation-related personnel can gradually form a habit and carefully check. (3) Taking two consecutive medical accidents in China as an example, the discussion was carried out in the surgical system of the whole hospital, and the medical department participated in the discussion of various departments, guiding the departments to attach importance to the surgical safety verification system and promoting the effective implementation of the system. 3.5 The detailed management of surgical safety verification needs to be strengthened. In the process of implementing the surgical safety verification system, we found that it is necessary to strengthen the detail management in the aspects of surgical specimen management, counting and recording, and avoiding the danger of tube pressure, tube folding and tube detachment. Any work accident is due to many details out of control and negligence [12]. For example, we have found that interns have made mistakes in filling in the labels of surgical specimens, and the pathology department found them in time, and the operators corrected them in time after checking. The implementation of "double signature and three integrity" measures for specimen submission can avoid this situation, and also remind operating room nurses to strictly implement the operation safety verification system in the clinical teaching process. Two patients with empyema had drainage tubes before operation, but when they moved to the operating table, they found that the drainage tubes were compressed. In one case, agitation during recovery from general anesthesia caused the drainage tube to be removed during transportation. In addition, we also found that the time of leaving the room recorded by one operation was inconsistent with the summary record of the surgeon, because the patient's condition changed when he was preparing to leave the operating room, and he was observed for another 30 minutes, while the summary record recorded the time of preparing to leave the room. This reminds us that we must pay attention to filling and checking records according to the actual time, emphasize the unity of multiple records, and follow the principle of recording afterwards. To sum up, on the basis of learning the above objectives and systems, the surgical team can refine and cooperate with the implementation of the procedures and contents of surgical safety verification, which can effectively ensure surgical safety, reduce surgical risks and improve the quality of medical services. However, security verification needs to be carefully implemented and accumulated in the work, which is also the most direct and effective method [13]. The key point of the safety verification of surgical patients is that the verifier should strengthen his sense of responsibility, enhance his sense of verification, and make it clear that he must be supervised all the time to ensure the safety of surgical patients. With the participation of all three parties, we should take the initiative to form the service concept of "patient-centered, ensuring patient safety".

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