"No Go" in the operating theatre. How to reinforce the safety barriers ?

What is it about?

In surgery, “No Go” refers to the immediate interruption of a surgical procedure between the moment when the patient enters the operating theatre and the skin incision. This interruption is related to the fact that not all of the elements essential for correct anaesthesia or surgery are in place, or to a problem of organisation coordination, communication and verification of the conditions required for the procedure to proceed.

"No Go" have huge consequences and can disrupt the patient’s trust by cancelling the surgical procedure or realising a useless anaesthesia.

This Patient Safety Solution is intended to avoid or manage the occurrence of a "No Go" in the operating theatre. It lists the existing systems and tools available for risk management, emphasising the importance of correctly running through the check-list.

Target audience

This patient safety solution concerns all professionals involved in the care of the patient to operate: care service and operating theatre teams, along with professionals concerned by the management of surgical equipment and medical devices, etc.

Method

The analysis of the feedback database for the doctors and medical teams accreditation system allowed the identification of declarations pertaining to "No Go". Over a single year, between October 2014 and September 2015, 101 adverse events related to a "No Go" were declared by the physician members of Orthorisq (approved body of orthopaedic and trauma surgeons).

Moreover, a survey was sent out to the Orthorisq members to determine the frequency and incidence of "No Go" in orthopaedic surgery practice.

A literature search has been conducted by the approved accreditation body.

Risk reduction tools

The survey and adverse events in-depth analysis allowed identification of causes and circumstances of "No Go", resulting in the following solutions :

• Prevent: list essential elements for the successful completion of the preoperative check.
• Recover: use of the HAS “Patient safety in the operating theatre” check-list, updated with a section on justifying and tracing the "Go" or "No Go" decision.
• Attenuate: use of a cognitive aid, called the “POuR – DÉCider” (to decide) procedure, to structure the decision-making process in urgent and unexpected situation.