Bakgrund: En bra kommunikation är en förutsättning för god kvalitet och patientsäkerhet i vården och när två olika system används har vi funderat över vad som händer med omvårdnadsdokumentationen när patienten förflyttas mellan vårdenheterna. Syftet: Vårt syfte med studien var att undersöka om de omvårdnadsåtgärder som operations-sjuksköterskan dokumenterat i operationsplaneringssystemet och rapporterat vidare, återfinns i omvårdnadsjournalen. Metod: En kvalitetsgranskning av journalanteckningar har utförts. Inklusionskriterierna var att patienterna opererats under minst tre timmar och att vårdtiden efter operationen var minst 24 timmar, då det var det första dygnets journalföring som kvalitetsgranskades. Sammanlagt granskades 40 stycken journaler. Resultat: I studien granskades sex stycken sökord ur operationsplaneringssystemet, vilka var; hudstatus, operationsläge, dränage, KAD, förband samt hudsuturer. Studien visade att överföringen av informationen var bristfällig. I en del fall framkommer det att information saknades eller förändrades när patienten förflyttades från operationsavdelningen till vårdavdelningen. Vidare framkom det att patienten förflyttades mer än en gång mellan vårdenheter. Slutsats: Resultatet i vår studie anser vi tyder på att en gemensam standardiserad journal med tydliga riktlinjer skulle underlätta för informationsöverföringen mellan de olika enheterna. Klinisk betydelse: Risken för att fel eller missförstånd uppstår minskar om ett gemensamt journalsystem används, vilket vi anser ökar patientsäkerheten. / Background: Good communication is prerequisite for good quality and patient safety in health care and when two different systems are used, we wondered what happens to the nursing documentation when the patient moves between different care units. Aim: The aim of the study was to examine whether the operation theatre nurses nursing care documentations in the operations planning system was reported on and can be found in the nursing journal. Method: A quality review of nursing care journal documentations was performed. Inclusion criteria was that the patient should have had an operation for at least three hours and aftercare for at least 24 hours, since it was the nursing care documentation that were done during the first day that were being quality reviewed. A total of 40 journals were examined. Results: Six keywords out of the operation planning system were examined, which are; skin status, operation position, drainage, KAD, dressing and skin sutures. Result of the study showed that the transfer of data was incomplete. In some cases it revealed that information was missing or altered when the patient was moved from the surgical ward to the care unit. Furthermore, it was found that the patient was moved more than once between different units. Conclusion: According to our study, we suggest that a common standardized journal with clear guidelines could make it easier to transfer the information between the different units. Clinical significance: Risk of error or misunderstandings are reduced in a common journal system, which we believe increases the patient safety.

A infecção de sítio cirúrgico é um dos principais problemas que pode acometer o paciente no perioperatório. Este tipo de infecção em cirurgia ortopédica consiste em problema grave devido à sua morbidade e custos elevados. O presente estudo teve como objetivo geral analisar a ocorrência e os fatores predisponentes de infecção de sítio cirúrgico em pacientes submetidos a cirurgias ortopédicas. Para tal, realizou-se estudo na abordagem metodológica quantitativa, com delineamento de pesquisa não-experimental, do tipo correlacional e longitudinal. A amostra foi composta por 93 pacientes submetidos a cirurgias ortopédicas limpas e eletivas. Para a coleta de dados, um instrumento foi elaborado e submetido à validação aparente e de conteúdo. A coleta de dados ocorreu no período de outubro de 2011 a março de 2012, em hospital privado filantrópico da cidade de Franca, estado de São Paulo. Na análise estatística dos dados empregou-se a análise bivariada (por meio de odds ratio, intervalo de confiança, teste Qui-quadrado com correção de Yates, teste t de \"Student\" e Mann-Whitney), regressão múltipla e regressão logística binária. A infecção de sítio cirúrgico foi detectada em 16 pacientes participantes da pesquisa, sendo a sua ocorrência de 17,2%. As variáveis investigadas relacionadas ao paciente foram a idade, Índice de Massa Corpórea, classificação ASA e a presença de doenças crônicas. As variáveis estudadas relacionadas ao procedimento anestésico cirúrgico foram a duração da anestesia, duração da cirurgia, uso de antibioticoprofilaxia e tempo total de internação. Os resultados evidenciaram diferença estatisticamente significante entre o grupo com e o grupo sem infecção, quando testado associação com a infecção de sítio cirúrgico e as variáveis classificação ASA e o tempo total de internação. Após ajuste do modelo de regressão logística binária, apenas a variável tempo total de internação mostrou-se com relação estatisticamente significativa com a presença ou não de infecção. Ressalta-se ainda que 75% dos casos de infecção foram diagnosticados após a alta hospitalar dos pacientes indicando a importância da vigilância epidemiológica pós- alta. / Surgical site infection is one of the main problems that can occur to patients in the perioperative period. This type of infection in orthopedic surgeries is a severe problem due to its morbidity and high costs. This quantitative, correlational, non- experimental and longitudinal study aimed to analyze the incidence and predisposing factors for surgical site infection in patients who underwent orthopedic surgery. The sample consisted of 93 patients who underwent clean and elective orthopedic surgeries. For data collection, an instrument was developed and submitted to face and content validation. Data collection occurred between October 2011 and March 2012, in a private philanthropic hospital in the city of Franca, state of São Paulo. Bivariate analysis (by means of odds ratios, confidence intervals, Chi-squared test with Yates correction, Student\'s t and Mann-Whitney tests), multiple regression and binary logistic regression were used for statistical analysis. Surgical site infection was detected in 16 patients who participated in the research, with an incidence of 17.2%. The variables investigated related to patients were age, Body Mass Index, ASA score and the presence of chronic diseases. Variables related to surgical anesthesia were the duration of anesthesia, duration of surgery, use of antibiotic prophylaxis and total length of hospitalization. The results showed statistically significant difference between the groups with and without infection, when testing association with surgical site infection, ASA score variables and total length of hospitalization. After adjustment of the binary logistic regression model, only the variable total length of hospitalization was statistically significant regarding the presence or not of infection. It is worth noting that 75% of infections were diagnosed after discharge from hospital, indicating the importance of epidemiological surveillance after discharge.

Bakgrund: År 2008 gav Världshälsoorganisationen (WHO) ut en checklista för säker kirurgi. Syftet med denna checklista var att öka patientsäkerheten. Efter införandet av checklistan har antalet dödsfall och komplikationer efter kirurgi minskat. Flera studier visar att checklista inte följs fullt ut trots det goda resultatet. Det finns dock få studier som har undersökt följsamheten till den sista fasen i checklistan, signout. Syfte: Att beskriva operationsteamets följsamhet till signout. Metod: Studien genomfördes som en icke-deltagande observationsstudie med kvantitativ, deskriptiv ansats. Med hjälp av ett observationsformulär genomfördes totalt 24 observationer på två operationsenheter. Resultat: Följsamheten till signout var medelgod, 42 %. Vissa delmoment kontrollerades mer frekvent än andra och några berördes inte alls. Operatören var den som initierade i mer än hälften av observationerna och anestesisjuksköterskan hade högst frekvens i pausning. Slutsats: Vid initiering, pausning och specifika delmoment var det främst operatören som utmärkte sig. Här sågs ett tydligt samband av operatörens roll i studiens resultat. Det finns skillnad mellan den dokumenterade och den faktiska följsamheten till checklistan. För att öka följsamheten och därmed patientsäkerheten, behövs tydligare riktlinjer kring vem som ska ansvara och när signout ska genomföras. / Background: In 2008, the World Health Organization (WHO) released a checklist for safe surgery. The purpose of this checklist was to increase patient safety. Since the introduction of the checklist mortality and complications after surgery has decreased. Several studies show that the checklist is not fully followed despite the good results. However, there are few studies that have examined compliance with the final phase of the checklist, signout. Aim: To describe the surgical team's compliance to signout. Method: The study was conducted as a non-participant observational study with a quantitative, descriptive strategy. Using an observation form, a total of 24 observations were performed on two operating units. Result: The signout compliance was average, 42%. Some sub-parts were checked more frequently than others and some were not confirmed at all. The surgeon was the one who initiated in more than half of the observations and the anesthesia nurse had the highest frequency at pausing. Conclusion: In the initiation, pause and specific sub-parts, it was mainly the surgeon who distinguished himself. Here, a clear connection was seen between the surgeon's role and the result of the study. There is a difference between the documented and the actual compliance to the checklist. To increase compliance and thereby patient safety, clearer guidelines are needed regarding who should be responsible and when to start signout.

Refrigerated Stability of Diluted Succinylcholine, Pancuronium, and Atracurium. T. Archibald1, S. Brown1, A. Gonzalez-Estrada2 1College of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN2Quillen College of Medicine, Allergy and Clinical Immunology, East Tennessee State University, Johnson City, TN The purpose of this study is to investigate the stored stability of dilutions of neuromuscular blocking agents (NMBAs), namely succinylcholine, pancuronium, and atracurium, for skin prick/intradermal testing. Concentrations of NMBAs were monitored by liquid chromatography-mass spectrometry (LC-MS/MS) for a period of 14 days. Dilutions of NMBAs were prepared in saline by factors of 10x, 100x, 1,000x, 10,000x, and 100,000x as sensitivity of the assay allowed. Each drug was prepared with an n = 5 for each dilution, using a different newly opened product for each series. Diluted drug products were stored in a laboratory refrigerator until sampling. On sampling days (day 0, 1, 2, 4, 7, and 14), one milliliter aliquots of each dilution were removed, filtered, and analyzed against freshly prepared set of reference dilutions. The results are expressed as beyond use date (BUD), defined as recovery of drug versus the reference (90-110%). Based on the LC-MS/MS data, the BUD for succinylcholine diluted by 10x and 100x is 48 and 24 hours, respectively. The1000x dilution is also stable for 24 hours.Higher dilutions of succinylcholine (10,000x to100,000x) should be used immediately following preparation (within less than 24 hours), as the potency of these dilutions had decreased below 90% at the 24 hr sampling. .Pancuronium diluted by 10x and 100x, had a BUD of 48 hours, and the1,000x dilution was stable for 24 hours.As with the succinylcholine, the 10,000x and 100,000x dilutions expressed potency of <90% at 24 hours. .Atracurium diluted to 10x had a BUD of 96 hours, the100x dilution is stable for 24 hours yet higher dilutions (1,000x to 10,000x) do not persist beyond 24 hours. . The 100,000x dilution of atracurium was unknown, given than the signal intensity was too weak to monitor by our LC-MS/MS method. With increasing dilution factors, the stability of these drugs in saline decreases, associated with an increasing deviation between samples and freshly prepared references. The most stable dilutions for each of the drugs tested were 10x and 100x. Stability of these drugs is likely compromised by hydrolysis of the ester bonds in the drug molecules.

Over 13 million adolescents sustain traumatic injuries yearly, resulting in functional disability, disfigurement, psychosocial problems and fractures. These fractures are increasingly being treated with orthopedic external fixation devices (EFDs). The purpose of this study was to describe the experience of traumatically injured adolescents treated with EFDs. The 4 aims of the study focused on the circumstances leading to the traumatic event, experiences following the traumatic event, the impact of EFD treatment, and adolescents’ role in pin-care self-management, which is crucial to preventing infection. This longitudinal, qualitative descriptive study used purposive sampling to recruit 5 male and 4 female adolescents, 13-20 years old, from a New England level-1 trauma center. Participants were injured in motor vehicle crashes (including an all-terrain vehicle), falls, by gunshot, trampoline and football trauma. Interview questions were framed by two themes from a study of adult recovery from physical injury, i.e., the event and fallout. Participants were interviewed within days of the injury, 2 weeks after returning home, and within one month of EFD removal. Data were coded from verbatim transcripts using NVIVO and organized into themes guided by the principles of qualitative analysis. An overarching theme of “old self no more; forever changed” emerged from 26 interviews. The participants’ experience affected all tasks of adolescence: independence from parents, accepting body image, peer relations, and forming an identity. Major themes included “what risk?”, regarding circumstances leading to the traumatic event, mastering the environment, was 2 part first, processing the event, where determining fault and realizing everything has changed, they were ambivalently lucky, and not invincible. Secondly “suck it up and deal with it”, where strategies to deal with traumatic injury emerged (i.e. medication, channeling outlets, and slow caution). EFD experience revealed “Space age robot” and “they’ll do it themselves” as emergent themes. EFDs were described as painless, robotic, no big deal and necessary. One draining pin-site was noted. Findings related to use of self-administered analgesics, information technology, recall of detail, and gender differences in coping may lead to future interventions. These findings lay the groundwork for future studies that may improve care of adolescents during acute recovery from traumatic injury.

Bakgrund: Flera tusen patienter drabbas årligen av vårdskador med lidande som följd. Checklistan för säker kirurgi har potential att minska detta om den används på rätt sätt. Checklistan bidrar till förbättrad kommunikation, samverkan i team och säkrare vård. Syfte: Att undersöka operationspersonalens följsamhet till WHO:s checklista för säker kirurgi. Metod: Kvantitativ deskriptiv tvärsnittsstudie. Datan samlades in på två sjukhus genom icke-deltagande strukturerade observationer med egenkonstruerade observationsprotokoll. Totalt inkluderades 38 observationer. Resultat: Sign in initierades i 39,5 % och utfördes komplett i 15,8 %. Time out initierades i 100 % och sign out i 94,7 %, men ingen utfördes komplett. I genomsnitt bekräftades 23,4 % av säkerhetskontrollerna i sign in, 40,5 % i time out och 56,6 % i sign out. Sign in och time out initierades oftast av anestesisjuksköterskan (86,7 % respektive 42,1 %) och sign out av kirurgen (88,9 %). Konklusion: Sign in utförs komplett i flest fall trots att delmomentet sällan initieras. Time out och sign out initieras alltid och nästintill alltid, men några säkerhetskontroller utelämnas alltid. Ytterligare forskning behövs för att undersöka om följsamheten till WHO:s checklista skiljer sig åt när patienten är ett barn eller när operationen sker på förmiddagen eller eftermiddagen. / Background: Every year thousands of patients are afflicted with adverse events and suffering. The surgical safety checklist has potential to decrease these negative effects if it’s used correctly. The checklist contributes to improve communication, teamwork and safer surgery. Aim: to examine the operating theatre personnel’s compliance with the WHO surgical safety checklist. Method: Quantitative descriptive cross-sectional study. The information was collected through non-participating observations with self-constructed observational protocols. A total of 38 observations were included. Result: Sign in was initiated in 39,5% and complete in 15,8%. Time out was initiated in 100% and sign out in 94,7% but none were properly completed. On average, 23,4% of the safety items were confirmed in sign in, 40,5% in time out and 56,6% in sign out. Sign in and time out were mainly initiated by the anaesthesia nurse (86,7% and 42,1%) and sign out by the surgeon (88,9%). Conclusion: Sign in is complete in most cases even though it's rarely initiated. Time out and sign out are always and almost always initiated, but some security checks are always omitted. Further research is needed to investigate whether compliance with the WHO checklist differs when the patient is a child or when surgery occurs in the morning or the afternoon.

Safety and quality of care are considered to be one of the main priorities in anaesthesia and their management and monitoring should be continuous and systematic. Quality indicators in anaesthesia must be frequently evaluated. Their evidence and evaluation create not only safe environment for patients but also continuously improve quality of anaesthesiologic care. The main objective of this diploma thesis was to evaluate patient's satisfaction with provided anaesthesiologic care, one of the main quality indicators in anaesthesia. Other objectives were research of quality indicators recommended in the Czech Republic and quality indicators recommended by foreign medical societies. The last partial objective was to create quality indicators checklist tailored for specific department of anaesthesiology based on collected data. Quantitative method research was conducted, using unstandardised questionnaire for patients, hospitalized and anaesthetised. 140 questionnaires were distributed of which 117 questionnaires returned. Based on objective the author of diploma thesis found out that Czech society of anaesthesia, resuscitation and intensive care determines quality indicators monitored in the Czech Republic. Quality indicators in foreign countries are in form of criteria that are necessary to adhere to....

Bakgrund: Organdonation är en komplex operation som ställer höga krav på operationssjuksköterskan. I Sverige styrs donationsprocessen av lagar och regler och ett ställningstagande från patienten eller närstående är avgörande för processen att påbörjas. På operationssalen innebär det ett teamarbete från flera olika sjukhus med olika professioner närvarande och operationssjuksköterskans roll är att delta och assistera under ingreppet. Operationssjuksköterskans huvudansvar är omvårdnad av donatorn med fokus på värdighet, integritet och respekt. Det finns få studier om hur operationssjuksköterskan upplever ingreppet och det är viktigt att sammanställa befintlig forskning för att få en helhetsbild.  Syfte: Syftet var att beskriva operationssjuksköterskans upplevelse av att delta under en organdonation där livsuppehållande åtgärder avslutas.  Metod: En kvalitativ systematisk litteraturstudie med induktiv ansats. Insamlade data kvalitetsgranskades enligt Critical Appraisal Skills Programme [CASP] (2018) och en tematisk analys gjordes enligt Braun och Clarke (2006).  Etiska övervägande inför litteraturstudien fanns och det sågs ingen risk för skada hos tredje part. Alla inkluderade artiklar skulle redovisa etiskt godkännande.  Resultat: 11 artiklar inkluderades i studien, resultatet formades under tre huvudteman, att stå inför en surrealistisk situation, att hantera en svår situation och att finna mening i situationen.Slutsats: Operationssjuksköterskan upplevde ingreppet som psykiskt utmanande och brist på stöd från kollegor. Kränkande behandling av kirurger och brist på erfarenhet och kunskap om ingreppet påverkade hur operationssjuksköterskan hanterade situationen. Operationssjuksköterskorna såg det som sitt ansvar att bevara donatorns värdighet genom hela förloppet och fann därmed mening i en svår situation.

Introduktion: Dokumentation av omvårdnad är varje sjuksköterskas skyldighet och ansvar enligtPatientdatalagen (SFS 2008:355). Operationssjuksköterskan dokumenterar omvårdnad och information utifrån den perioperativa vårdprocessen. Tydlighet i dokumentationen kan säkerställainformationsflödet mellan olika vårdgivare. Syftet var att sammanställa forskning som beskriver operationssjuksköterskans uppfattningar om dokumentation av omvårdnad inom perioperativ vård. Metod: En integrativ systematisk litteraturstudie genomfördes enligt Statens Beredning för Medicinsk och Social Utvärdering [SBU]. Materialet analyserades med integrerad analys enligt Kristensson (2014). Resultatet baserades på åtta vetenskapliga artiklar. Tre kategorieri dentifierades utifrån analysen och var: varierande egenansvar och skiftande attityder till dokumentation av omvårdnad, påverkbara och skiftande förutsättningar för dokumentation av omvårdnad och i dokumentationen prioriterade omvårdnadsdiagnoser och omvårdnadsåtgärder. Konklusion: Standardiserad terminologi kan tydliggöra operationssjuksköterskans dokumentation av omvårdnad både för hen själv och för övriga vårdgivare. Ett för operationssjuksköterskan anpassat dokumentationssystem kan vara av betydelse för att dokumentationen av omvårdnad ska prioriteras. Ledarskapets inställning till dokumentation ansågs ha betydelse för om operationssjuksköterskan gavs förutsättningar till dokumentation av omvårdnad.

Bakgrund: Vårdrelationen som etableras mellan patienten och specialistsjuksköterskan inom anestesi i det tidsbegränsade preoperativa mötet är en förutsättning för att specialist-sjuksköterskan ska kunna ge personcentrerad vård. Det har tidigare inte studerats hur vårdrelationen etableras utifrån ramverket Fundamentals of Care i den preoperativa kontexten. Syfte: Att beskriva hur vårdrelationen etableras i det tidsbegränsade preoperativa mötet mellan patienten och specialistsjuksköterskan inom anestesi utifrån Fundamentals of Care.  Metod: Litteraturstudie med systematisk ansats. Deduktiv innehållsanalys enligt Elo och Kyngäs. Resultat: Studiens resultat visar hur vårdrelationen kan etableras i det preoperativa mötet, beskrivet utifrån Fundamentals of Care, vilket inte gjorts tidigare. Resultatet visade på kunskap, erfarenheter, sinnen och förmågor som anestesisjuksköterskan behövde besitta för att etablera vårdrelationen. Det som kan lyftas fram var anestesisjuksköterskans speciella kommunikationsförmåga, mentala närvaro, metoder för att lugna patienten, olika sätt att visa fysisk närvaro samt hennes simultankapacitet för att etablera vårdrelationen preoperativt. Ramverket Fundamentals of Care gjorde det möjligt att överföra tidigare forskning för att beskriva etablerandet av vårdrelationen. Fortsatt fördjupning och forskning inom detta område skulle kunna ligga till grund för praktisk vägledning för specialistsjuksköterskan inom anestesi. Slutsats: Studien visar hur det är möjligt att etablera en vårdrelation i det tidsbegränsade preoperativa mötet mellan patienten och specialistsjuksköterskan inom anestesi, för att ge personcentrerad vård. Resultatet kan ses som en introduktion eller underlag för diskussion för nyexaminerade anestesisjuksköterskor om hur hon kan etablera en vårdrelation i det preoperativa mötet med patienten. / Background: The relationship established preoperatively between the patient and the nurse anesthetic specialist is a prerequisite for the nurse specialist to give person-centered care. The establishment of the caring relationship has not earlier been investigated using the Fundamentals of Care framework in the perioperative context. Aim: To describe the establishment of the relationship between the nurse anesthetic specialist and the patient within a limited period in the preoperative setting using Fundamentals of Care. Method: Literature review with a systematic approach. The collected data was analyzed with a deductive approach according to Elo and Kyngäs. Result: The result of the study shows how the establishment of the caring relationship in the preoperative setting, described from Fundamentals of Care, which have not been done before. The result brings forth knowledge, experiences, senses, and abilities that the nurse anesthetist needed to possess to establish the caring relationship. Skills worth mentioning are her specific communication skills, her mental attendance, methods of calming the patient, different ways of showing physical presence and her simultaneous capacity for establishing the perioperative relationship. The framework Fundamental of Care itself made it possible to transfer former research to describe the establishment of a caring relationship. Furthermore, in-depth research in this area could be the basis to practical guidance for the nurse anesthetist.  Conclusions: The study shows how it is possible to establish a caring relationship between the patient and the nurse anesthetist within the limited period in the preoperative setting in order to deliver person-centered care. The result can be an introduction or basis for discussion for the new graduate nurse anesthetist about the establishment of a caring relationship in the preoperative meeting with the patient.