الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
SUMMARY
An estimated 234 million major surgical operations are performed annually worldwide and as volume and importance of surgery in global healthcare increase, patient safety and quality in surgical care gain more attention. Nearly one in 10 in-hospital patients experience iatrogenic events and more than half of them occur within perioperative care.
Multiple errors and improper practices that may affect patient safety and have adverse effect on patient outcomes including the potential for infection, hemorrhage, burns, physical injury or trauma, anesthesia related critical events, wrong-site surgery, or deaths. Therefore, perioperative nurses should be vigilant, highly skilled, and adhere to patient safety strategies during three phases of surgery (sign in, time out, sign out) to minimize occurring of such AEs and complications.
Aim of the study: This study aim was to assess the effect of intraoperative nurses’ safety practices on postoperative adverse events among surgical patients undergoing general anesthesia.
Subjects and method:
Design: Descriptive exploratory research design was utilized in this study.
Research question: To achieve the aim of this study the following research question was formulated:-
1- What is the effect of intraoperative nurses’ safety practices on postoperative adverse events among surgical patients undergoing general anesthesia?
Setting: This study was conducted at operating rooms of general surgery and Post-operative care departments at Benha University Hospital (from July 2016 to December 2016).
Subjects of the study: convenient sample consisted of two different groups had been recruited in the study those were:-
group I: All operating room nurses (19 nurses) who assigned for caring of intraoperative general surgical patients.
group II: All available surgical patients during 6 months (from July 2016 to December 2016) who had major general surgery, underwent to general anesthesia, and had experienced adverse events in post-operative care departments. Total number was 78 patients.
Tools of data collection
Two tools were constructed, tested and piloted by the investigator to collect data pertinent to the study those were:
The First Tool: ”Intraoperative Nurses’ Safety Practices Observational Checklist ”(Appendix I): It consisted of 2 parts:-
• Part one: Personal and background data sheet (gender, age, marital status, qualification, position, training programs, years of experience)
• Part two: Observational Checklist to assess nurses’ safety practices during three phases of surgery (sign in, time out, sign out).
The second tool:” Institute for Healthcare Improvement (IHI) Global Trigger Tool ”(Appendix II):- comprised of 2 parts:
• Part one: Demographic data of patients such as: age, sex, diagnosis, comorbid disease, type of operation, surgical history, and general anesthesia history.
• Part two: Trigger Tool to assess post-operative adverse events among surgical patients.
Pilot study: - It was conducted on 10% of study’ subjects (2 nurses & 8 patients) to test feasibility of the study, as well as objectivity of the tools. Needed modifications were done according to the result of pilot study. Additionally, the pilot study gave the investigator experience on how to deal with the included subjects, familiarity with the setting, and to estimate time needed fulfill tools used in data collection. Modifications were minor and did not affect the main data so that the subjects who shared in the pilot study were included in the actual sample.
The study findings of revealed that:
Less than two thirds of studied nurses (63.2%) within age of ≥ 30 years with the mean age 33.4±8.9 years old. Nearly most of them (89.5%) were female and nearly the majority (84.2%) was secondary school graduate and less than one half of them (47.4%) had experience less than 15 years with the mean years of experience 16.6±8.5 years.
Studied nurses had unsatisfactory level of practice (78.9%) regarding patient safety along three phases of surgery (sign in, time out, sign out) regardless their age, gender, qualification, and position. While there was statistically significant relationship between nurses’ safety practices scores and their attendance of training programs related to intraoperative care and years of experience.
More than one half of studied patient (57.5%) their age was 35 years or more and the mean age of them was 33.47±8.9 years. More than one half of them (52.6%) were female and more than one fifth (21.8%) had undergone to cholecystectomy operation.
One half of studied patients (50%) had experienced surgical wound infection or sepsis as adverse event in post-operative departments. While it was noticed that retention of surgical instrument, sponges, needles, towels didn’t take place at all among studied subjects (0.0%).
More than two thirds of studied patients (70.5%) had been experienced moderate level of harm (category F) that represents ’’ prolonged hospitalization as result of occurrence of adverse events’’. In addition, there is highly statistical significant positive correlation between occurrence adverse event and severity of patient harm as result of adverse events as (r=.71) at P ≤ 0.001.
The study concluded that:-
There is statistically significant negative correlation between intraoperative nurses’ safety practices and occurrence of post-operative adverse events among surgical patients undergoing general anesthesia (p-value ≤ 0.05).When intraoperative nurses’ safety practices regarding surgical patients was unsatisfactory along three phases of surgery (sign in, time out, sign out), those patients had experienced adverse events and harm in post-operative departments regardless their age, gender, type of operation, and pervious surgical and general anesthesia history.
The study recommended that:-Based on the results of the present study the following recommendations can be suggested:
There is a need for continuous monitoring and evaluating of operating room nurses ’performance regarding intraoperative patient’ safety and correction of poor performance is essential.
There is a need for continuous educational programs for operating room nurses to improve their knowledge and skills regarding patient safety.
Develop Arabic version of WHO surgical safety checklist as guidance for patient safety strategy in operating theatre.
There is a need for monitoring and intervention strategies for surgical related adverse events.
Establishing a data base for those patients who experienced adverse events in postoperative departments is necessary.