Background Because of extreme population and a lack of resources the risk of beeing harmed while admitted to a hospital in Bangladesh is big. Mistakes made at operating theatres can result in devastating consequences, but by evaluating the patient safety that risk can be minimized. Right now Bangladesh is in the middle of an industrialisation that is contributing to the growing need for an expanding health care. The country is regularly suffering from cyclones, tsunamis and monsoon rains and there is an urgent demand for safe health care. Method The aim of this thesis was to study the physical structure, organisation and practice at operating theatres in Bangladesh. At three private and two public hospitals 14 operating rooms in total were visited and the basic equipment was examined. Managers, physicians, nurses and technicians were interviewed at all hospitals, 41 people in total participated in the study. Results The temperature control was not up to standard, bigger storages were needed and none of the public hospitals had enough washing equipment for proper scrubbing. Only one hospital could monitor the patient’s body temperature during surgery and proper resuscitation equipment was missing in half of the operating rooms. The autoclave process could not keep up with the surgeries and delays were not unusual. The cleaning staff had no training in patient safety and the staff found that the nurse’s education was not enough. The reporting of mistakes rarely reached the management and a written report was unusual. Discussion Most of the staff did not know what calibration meant and there were only biomedical departments at two of the hospitals. Even though training was re- quested by the staff the management did not plan for any changes. This shows that it is the organisation, not the human errors, that is the source to the unstable situation of health care. The lacking of the reporting system is an- other reason for the slow development. Staff with technical knowledge must be available at the hospitals in order to help prevent risks and all hospitals should establish a biomedical department. Patients had to lie on the floor, due to the shortness of space. This is not good for patient safety, but the alternative would be that they would end up with no help at all. The outcome of patient safety should always result in better health for the people. The personal had this view of thinking and they showed great engagement to their work. Key words: Patient safety, Bangladesh, operating theatres, operating rooms / Bakgrund På grund av extrem befolkningsmängd och brist på resurser är risken för att bli skadad av sjukvården i Bangladesh stor. Misstag inom kirurgin ger förödande konsekvenser, men genom att utreda patientsäkerheten kan risken minimeras avsevärt. Bangladesh befinner sig just nu i en industrialisering som bidrar till det ökande behovet av vård. Flodvågor, översvämningar och stormar drabbar landet regelbundet och efterfrågan på säker sjukvård är akut. Metod Patientsäkerheten analyserades genom att undersöka den fysiska miljön, organi- sationen och den praktiska utövningen i operationssalar. På tre privata och två statliga sjukhus i Bangladesh besöktes sammanlagt 14 operationsrum, där den grundläggande utrustningen utvärderades. Avdelningschefer, läkare, sköterskor och tekniker intervjuades på samtliga sjukhus, totalt är 41 anställda med i stu- dien. Resultat Temperaturkontrollen var bristfällig, bättre förvaringsmöjligheter efterfrågades och ingen av de statliga sjukhusen hade tillräcklig utrustning för att tvätta händerna rätt. Endast ett sjuhus kunde övervaka patientens kroppstemperatur och återupplivningsutrustning saknades på hälften. Sterilisering av instrument kunde inte ske i samma tempo som operationerna och förseningar var vanligt. Städpersonalen hade ingen träning i patientsäkerhet och det fanns ett missnöje över sköterskornas utbildning. Rapportering av misstag gick sällan till sjukhus- ledningen och skriftlig rapportering var sällsynt. Diskussion De flesta av de tillfrågade visste inte vad innebörden av kalibrering var och endast två av sjukhusen hade en medicinteknisk avdelning. Trots att vidareut- bildning efterfrågades av personalen hade ledningen inga planer på förändringar. Detta visar på att det är organisationen, inte de anställdas misstag, som är källan till den osäkra sjukvården. Den otillräckliga rapporteringen är också en anled- ning till varför utvecklingen hämmas. Tekniskt kunniga personer måste finnas tillgängliga på sjukhusen för att förebygga risker och varje sjukhus bör organi- sera en medicinteknisk avdelning. På grund av platsbrist låg många patienter på golvet. Detta är självklart inte bra för patientsäkerheten, men alternativet skulle vara att de inte fick någon hjälp alls. Synen på patientsäkerhet måste alltid inkludera att hälsan i sin helhet förbättras, den insikten hade personalen på sjukhusen och de visade stort engagemang. Key words: Patientsäkerhet, Bangladesh, operationsavdelningar, operations- salar

Preoperative safety procedure is a departmental safety goal laid down by the Ministry of Health of the Czech Republic. The providers of health care directly controlled by the Ministry of Health of the Czech Republic are obliged to putpreoperative safety procedure and its documentation into practice, other health care organizations are recommended this implementation. However, the Ministry does not specify the formof this procedure nor its process in the operating room, there is no uniform documentation prescribed and last but not least, it is not clearly laid down which person of the operational team is responsible for the correct implementation of this procedure. The goal of the research is to map the preoperative safety procedure in the operating theatres in selected hospitals, to compare the process of the preoperative safety procedures in the operating theatres among the addressed hospitals, to describe the competencies of perioperative nurses during the preoperative safety procedures in the operating theatres in the selected hospitals and to find out the attitude of the perioperative nurses to the preoperative safety procedure. In the selected hospitals the safety procedure is introduced and implemented in different ways. The preoperative safety procedure in the operating theatres is introduced as an administrative act, but not as a practical tool to improve patient safety. The competences of perioperative nurses in preoperative safety procedures are not clearly specified in all of the respondent hospitals. The perioperative nurses adopt entirely positive approach to that, in most cases they believe it is important for ensuring the safety of the patient.