Laceration: Clinical and System Review Incident Analyses

​Given the broad range of potential causes of laceration/puncture, clinical and system reviews should be conducted to identify potential causes and determine appropriate recommendations.

Occurrences of harm are often complex with many contributing factors. Organizations need to:

1. Measure and monitor the types and frequency of these occurrences.
2. Use appropriate analytical methods to understand the contributing factors.
3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
4. Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the Hospital Harm Improvement Resources Introduction.

If your review reveals that your cases of laceration-puncture are linked to specific processes or procedures, you may find these resources helpful:

• Agency for Healthcare Research and Quality - https://www.ahrq.gov/
  • Toolkit for using the AHRQ quality indicators:  How to improve hospital quality and safety. Selected best practices and suggestions for improvement PSI 15: Accidental puncture or laceration (Last reviewed 2017). https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4l_combo_psi15-accidentalpuncturelaceration-bestpractices.pdf
• Association of periOperative Nurses (AORN) - www.aorn.org
  • Can you hear me? 3 Reminders to reduce OR distractions. (2019). 
  • AORN Position statement on managing distractions and noise during perioperative patient care (2020).
  • AORN Position statement on patient safety (2017). https://www.aorn.org/-/media/aorn/guidelines/position-statements/posstat_pt_safety.pdf
• Canadian Medical Protective Association - https://www.cmpa-acpm.ca/en/home
  • Working with medical equipment - Reducing the risks. 2012. Available at: https://www.cmpa-acpm.ca/en/safety/-/asset_publisher/N6oEDMrzRbCC/content/working-with-medical-equipment-reducing-the-risks
  • Managing the medico-legal risks of placing a central line. 2011. Available at: https://www.cmpa-acpm.ca/en/duties-and-responsibilities/-/asset_publisher/bFaUiyQG069N/content/managing-the-medico-legal-risks-of-placing-a-central-line
• Canadian Patient Safety Institute 
  • Surgical Safety Checklist
  • Surgical Safety in Canada: A 10-year review of CMPA and HIROC medico-legal data. (2016).
• National Health Services - https://naturalhealthservices.ca/
  • Chest drains: risks associated with the insertion of chest drains (2008). Archived 2010. Available at https://webarchive.nationalarchives.gov.uk/20100312170233/http://www.nrls.npsa.nhs.uk/resources/search-by-audience/hospital-nurse/?entryid45=59887&p=1&char=ShowAll   
• NICE – https://www.nice.org.uk/
  • NICE interventional procedures guidance -  https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-interventional-procedures-guidance
  • Guidance on the use of ultrasound locating devices for placing central venous catheters (Published 2002; Reviewed
  • 2016) https://www.nice.org.uk/guidance/ta4Snip – it Safety (2004). Available at http://patientsafety.pa.gov/ADVISORIES/Pages/200412_04.asp
  • Robotic-assisted surgery: Focus on training and credentialing. 2014. http://patientsafety.pa.gov/ADVISORIES/Pages/201409_93.aspx
  • Distractions in the operating room.  2014. Available at http://patientsafety.pa.gov/ADVISORIES/Pages/201406_45.aspx
  • Fetal lacerations associated with cesarean section (2004). Available at http://patientsafety.pa.gov/ADVISORIES/Pages/200412_09.aspx
• The American College of Surgeons (ACS) - https://www.facs.org/
  • Statement on patient safety in the operating room: team care (2018). Available at https://www.facs.org/about-acs/statements/113-patient-safety
  • Statement on distractions in the operating room (2016). Available at https://www.facs.org/about-acs/statements/89-distractions
  • Statement on documentation and reporting of accidental punctures and lacerations during surgery (2016). 
  • Revised statement on recommendations for use of real-time ultrasound guidance for placement of central venous catheters (2011). Available at https://www.facs.org/about-acs/statements/60-real-time-ultrasound
  • Revised statement on sharps safety (2016). Available at https://www.facs.org/about-acs/statements/94-sharps-safety
• The New England Journal of Medicine: Videos in Clinical Medicine https://www.nejm.org/multimedia/medical-videos 
  • Chest-Tube insertion (2007). Available at https://www.nejm.org/doi/full/10.1056/NEJMvcm071974
  • Central venous catheter insertion:
  • Ultrasound-guided internal jugular vein cannulation (2010). Available at https://www.nejm.org/doi/full/10.1056/NEJMvcm0810156#figure=preview.jpg
  • Placement of a femoral venous catheter (2008).  Available at https://www.nejm.org/doi/full/10.1056/NEJMvcm0801006
  • Central Venous catheterization — subclavian vein (2007). Available at https://www.nejm.org/doi/full/10.1056/NEJMvcm074357
  • Ultrasound-guided cannulation of the subclavian vein (2018). Available at https://www.nejm.org/doi/full/10.1056/NEJMvcm1406114