The core and purpose of medical safety is first and foremost patient safety [1]. Currently, tens of millions of people around the world undergo surgical procedures each year for a variety of reasons, and one in ten of them has experienced a medical error [2]. Of the 5,632 hazardous events reviewed by the Joint Commission on Health Care Organizations in the United States from 1995 to 2008, "surgical site errors" accounted for 13.2%, topping the list [3]. Therefore, effective verification of surgical safety and elimination of wrong surgery are issues that need to be discussed worldwide. For this reason, the Chinese Hospital Association (CAN) revised and improved the formation of the "2009 Patient Safety Targets", the State Ministry of Health, the Central Quality Committee also promulgated the "Surgical Safety Verification System" implementation rules, intended to protect the safety of surgery, our hospital since January 2010, in the study of the above objectives and systems based on the implementation of the further refinement of the safety verification process and content, and analyze the specific implementation of the effects of which is now reported as follows. I. Implementation of the surgical safety verification system 1 Establishment of the surgical safety verification system 1.1 Publicity and training Organization of surgery-related personnel to carefully study the "2009 Patient Safety Objectives", to understand its importance, explain the use of the surgical verification form, active cooperation of the operating room, anesthesiologists, surgeons, operating room nurses actively participate in the large number of personnel, must be coordinated with each other, and mutual coordination, in order to successfully complete the work. 1.2 Verification Responsible Person and Duties The safety verification of surgical patients is a complex process of multiple departments, multiple personnel, and multiple links, involving surgical patients, ward nurses, operating room nurses, anesthesiologists, and surgeons, and each department coordinates and cooperates with each other in order to complete the verification of different periods [4]. From the time the patient enters the operating room before any medical operation performed on him or her, the verification must be performed [5]. 1.3 Contents of Surgical Safety Verification 1.3.1 Patient Verification Verification of the patient's name, gender, department, hospitalization number, bed number, age, name of the procedure, procedure, surgical site, surgical site markings, history of drug allergies, skin condition, examination report, informed consent, and the wearing of a marking band on the wrist or ankle. 1.3.2 Intraoperative verification Completed by the surgeon, tour nurse, and hand-washing nurse*** with: (1) counting all items before the start of the operation, counting them for the second time before closing the body cavity, counting them for the third time after closing the body cavity, and counting them again after skin suturing at the end of the operation; (2) checking the surgical specimens, filling in the labels accurately and correctly and checking the application form for pathology delivery, the hand-washing nurse doing the fixation of specimens and The hand-washing nurse fills in and signs the registration book, and the roving nurse confirms and signs again; (3) checking the implant certificate and bar code during the operation. 1.3.3 Verification of instruments and equipments Various instruments and equipments required for surgery shall establish a register of use, and the itinerant nurse shall fill in the operation status in time after use, in addition to normal operation, and shall also propose whether the equipment needs overhaul and maintenance in a foreseeable way. 2. Surgical safety verification process 2.1 Nurses to verify the process and content of their own Overseas data show that nurses began to perform double checks through handheld PC / scanner ... Specifically code scanning, visual confirmation [6]. 2．1．1 First verification of preoperative visit In the afternoon of the 1st preoperative day, the visiting nurse visited the patient to find out the patient's identity (department, bed number, case number, name, age and gender), preoperative diagnosis, name of the operation, surgical site and marking, results of the necessary tests, cross-matching of blood, the presence of any specific infections, history of allergies and surgical history, and so on. 2.1.2 The second verification during the handover between the ward and the operating room, the morning of the operation day, in accordance with the surgical notification form, the surgical patient handover record sheet and the ward nurse handover verification, the patient is conscious and has the ability to answer by the patient's own statement of identity, the meaning of the unclear, the inability to answer the person and the infants and young children through the wristband identification, and confirmed by their legal relatives. The operating room nurses and ward nurses sign the handover record sheet after there is no error. 2.1.3 For the third verification in the operating room, a reminder board for elective surgeries [7] was hung at the entrance of the operating room, stating the operating room, name, diagnosis, name of the surgery, instruments, and roving nurse for each surgery on that day; a reminder board for surgeries was also placed at the eye-catching place in the operating room, and the nurses who received the patients and the roving nurses*** verified the corresponding contents, and the identity of those who were not clear in their meanings or infants were identified with wristbands. 2.2.1 Before anesthesia implementation The anesthesiologist presides over and is responsible for verifying the patient's identity (the same as the content of the pre-operative nurse's visit), the name of the operation, the informed consent, the surgical site and marking, the anesthesia safety check, the skin, the venous channel, the pre-operative blood preparation, the patient's allergy history, the patient's blood supply, and the patient's allergic history, and the patient's blood supply. Pre-operative blood preparation, patient's allergy history, antimicrobial skin test results, infectious disease screening results, internal values, and imaging data. The surgeon, anesthesiologist, and operating room nurse shall verify and sign the form. 2.2.2 Before placing the patient in the position, the visiting nurse will preside over and the three parties*** will verify the identification of the surgical site, especially for unilateral surgery where there is a difference between left and right organs, and for surgery of more than two sites. The itinerant nurse and the instrument nurse*** are responsible for the verification of the instruments and dressings used in the operation, and complete the inventory record in a timely manner, which includes the patient's hospitalization number, department, bed number, name, date of the operation, name of the operation, the number of instruments and dressings used in the operation, and the signature of the verifier. 2.2.3 Before the start of surgery Pause for a few moments before skin cutting (Time Out), the surgeon presides over and is responsible for verifying the patient's identity, the name of the surgery, the surgical site, the surgical marking, confirming the risk warning, etc., to ensure the correctness of the patient, the surgical site, and the name of the surgery, etc.; the nurse in the operating room verifies the preparation of surgical items and reports to the surgeon and the anesthesiologist. The verification results are confirmed and signed by all three parties*** together. Patient participation in medical safety is encouraged. 2.2.4 Before closing the body cavity at the end of the operation The surgeon announces the name of the operation performed and the placement of drainage; the circuit and instrumentation nurses check and verify the instruments and dressings used during the operation before and after closing the body cavity***, report the results to the surgeon and anesthesiologist, and complete the inventory record in a timely manner. Surgical inventory record in duplicate, a copy of the operating room archives, a copy into the medical record. If there is any doubt, please ask the radiology department to take X-rays to assist in the verification. 2.2.5 Before the patient leaves the operating room, the operating room nurse will preside over and be responsible for verifying the patient's identity, the actual name of the operation, counting the surgical supplies, confirming the surgical specimens, checking the skin, arterial and venous access, drainage tubes, monitoring instrument lines, and confirming the patient's destination, etc. The results will be recorded by the three parties*** together. The results are confirmed by the three parties*** together. 2.3 Detailed management of surgical safety verification 2.3.1 Safety of medication and blood transfusion Heparin, insulin, chemotherapeutic drugs, drugs requiring skin test, anesthesia drugs, pressurizing drugs, 10% potassium chloride, hypertonic electrolyte solution, etc. are classified and stored in a separate place with obvious marking on the placed part, and two persons check strictly when medication is given; when medication is given on the operating table, the itinerant nurse and instrument nurse **** check together, and the name, dose, validity date, skin test, and the result of the test must be read out by three parties***. When medication is administered on the operating table, the roving nurse and the instrumentation nurse **** check together, and during the checking, they must read out the name of the medication, dosage, expiration date, result of the skin test, and the dosage, and then place the medication on the table with a sterile syringe after it is correctly drawn and labeled. When intraoperative patients need blood transfusion due to their condition, firstly, we should check whether the bed number, name, hospitalization number, blood type and other information on the blood test report form are accurate, and whether they match with the information on the medical record, and then we should see the results of cross-matching test, whether there are cracks on the blood bag, and make sure that the blood is in the expiration date. Before transfusion, we need to double-check that the information is correct before transfusion, and after blood transfusion is completed, the bag of blood should be retained for 24 hours for necessary tests. After blood transfusion, the blood bag should be kept for 24 hours for necessary tests. After the blood transfusion, the blood bag should be kept for 24 hours for necessary tests. The applicant should also sign the blood transfusion application form. 2.3.2 Specimen storage and delivery Surgical specimens are irreplaceable, biopsy histopathologic diagnosis is the first diagnosis of surgery, is the gold index [8]. With the increasing volume of hospital surgery, generally a surgical room to arrange multiple operations, if not to strengthen the verification, improper management of specimens will bring great difficulties in clinical diagnosis, bringing serious losses to patients. Strict implementation of the specimen storage and delivery system, the implementation of "one to one, double signature, three complete" measures, namely: postoperative nurse will be handed over to the physician in charge of the specimen, the specimen delivery and receipt of specimens signed by both sides, the application form for pathological examination, pathological specimens and pathological specimens registered labeling three single content filled out completely. 2.3.3 Surgical inventory Implement the system of "four counts and three clear" for surgical supplies, i.e., count surgical instruments and dressings four times, i.e., "before the operation, before closing the body cavity, after closing the body cavity, and after the operation", and count them on the spot, record them on the spot, and review and check the record number. The number of records should be counted in person, recorded on the spot and double-checked, so as to ensure that "instrument nurses, itinerant nurses and second assistants" are clear and correct, and to prevent items from being left behind in the body cavity; and to strengthen the risk prevention of endoscopic instrument attachments and gauze used in body cavity surgery. 2.3.4 Preventing patients from falling, falling out of bed, detachment of tubes, and pressure sores The operating room regularly overhauls the trolleys and operating beds for transporting patients, familiarizes itself with assisting patients to go to bed, and guards them by the bedside, and adds a bed stall on the way of transferring patients. Preoperative patients to go to the toilet when escorting patients and require the wearing of non-slip shoes. Before moving the patient, someone will check and organize the pipelines, and the whole team will coordinate with each other when moving the patient, and after moving the patient, the three parties*** will verify whether the pipelines are safe, smooth, and firmly fixed. Evaluate the patient's skin before operation, reasonably fix the patient's position during operation, pay attention to observation and care of the pressurized skin, and move the patient gently, accurately and steadily. Correctly use and manage the electric knife during operation to avoid electric knife burns. 2.3.5 Verification of effective communication in special circumstances Verbal medical instructions and important test reports during first aid must be repeated. The sender of the message clearly sends out the message, disables abbreviations, unifies the unit of drug dosage, requires the receiving party to confirm and repeat the content, records the received phone call or verbal message on paper immediately, and then repeats the content of the record to be confirmed by the sender of the message, and it is not executed and formally recorded until there is no error. 3. Evaluation of Effectiveness In order to evaluate the implementation of the patient safety goals, we have assessed the effectiveness of the implementation from the following aspects. A. Elimination of patient identification errors; B. Safe and error-free medication and blood transfusion; C. Effective communication and correct execution of medical instructions; D. Correct surgical patients, surgical sites, and surgical styles; E. Accurate and error-free inventory of items; F. Safe storage and delivery of surgical specimens for examination; G. Timely and error-free record of surgical inventory; H. Reduction of the risk of patients' falls and falling out of bed; I. Avoidance of pressure tubes, detachment, and folding of tubes; J. Elimination of the incidents of patients' pressure sores and burns. Pressure sores and burns. Among them, the implementation rate of A~E objectives is 100%, and other items are still unsatisfactory, and the implementation rate of the objectives is 97~99.5%. 3.1 Improve and perfect the practical checking system, any link problem can lead to serious medical care defects. Control or eliminate unsafe factors from the link to ensure patient safety. Numerous studies have shown that lack of information exchange or inadequate communication between surgical teams is one of the risk factors for wrongful surgery [9].In 2001, Meir Medical Electrocardiology in the United States conducted a multifactorial, cross-sectional, interventional study related to patient safety in the perioperative period. The significant error components identified in this study included: patient error, patient chart binder or incorrect chart in the binder, no informed consent or incorrect informed consent, no identifying wristband or incorrect identifying wrist, no identifying label or incorrect identifying label, and unmarked surgical site or incorrectly marked surgical site [10]. In this regard, the implementation of the "Surgical Safety Checklist" in our hospital has made up for the shortcomings of the system, clarified the responsibilities of anesthesiologists, surgeons, and visiting nurses*** in the same checklist, and provided a favorable guarantee for the exchange of information or communication among the surgical team. In the previous work mode, the surgeon in the ward check patients, anesthesiologists in the preoperative visit to check the patient, the circuit nurse in the patient to pick up the check again, the procedure is cumbersome, the patient is prone to boredom, skepticism, unwilling to communicate with the nurses, there is a loss of authenticity of the check. The implementation of surgical safety checklist reduces the number of checking, but greatly improves the efficiency of work, and makes the checking more effective and accurate. 3.2 Patient surgical safety is guaranteed Advocating surgical safety verification and implementing patient safety goals aims to maximize collective strength and wisdom through collaboration and encouragement among teams or members, highlighting the theme of safety, quality, and caring of nursing care in the operating room, and guaranteeing surgical safety. Patient safety is ensured through the implementation of the nurse self-verification and the surgical team's "three-way, five-time" verification process. For example: 5 operating room nurse preoperative visit verification had found a case of patient condition and surgical notification does not match, to find the physician in charge of inquiries, confirmed for the preoperative temporary bed but did not rewrite the surgical notification form, the doctor corrected the surgical notification form and notify the anesthesiologist, to avoid an error; the other case for the nurses on the morning of the day of the operation and the wards for the surgical handover verification found that there is a mistake, found to be self-exchange of beds from the door to the window, through the operating room nurse, the nurse, and the operating room team "tripartite five" verification process. In another case, the nurse found an error during the surgical handover verification with the ward on the morning of the operation day, and found that the patient was changed from a bed by the door to a bed by the window on his own. It is because of the strict implementation of the verification process and content of each link, timely detection and avoid the occurrence of errors, to ensure the safety of patients. In order to eliminate this kind of hidden danger from the root, the medical department stipulates that after the operation notice is sent to the operating room, the bed should not be transferred at will, and when it is necessary to transfer, it is necessary to be negotiated by the chief of the surgical department and the director of anesthesiology department, and the head nurse of the operating room, and the chief of the surgical department will rewrite the operation notice with a red pen and sign it after agreeing to the change. The ward strengthened the management and explained to the patients the risk of changing beds at will, so that the patients consciously complied with the ward management system and took the initiative to participate in the verification of surgical safety. No similar hidden danger occurred in the future. Through the implementation of the surgical safety verification system, the surgical team gradually realized that safeguarding patient safety required everyone's full attention and implementation of verification measures in accordance with the process without compromise. 3.3 Awareness of the surgical safety verification form among relevant departmental staff The nursing staff in the operating room had a high level of awareness of the surgical safety verification form [11]. A number of hospitals have successively implemented the WH O standardized surgical safety checklist. In the implementation of the same time more work by the operating room nursing staff to guide, organization, implementation, so that there are surgeons, anesthesiologists have a low level of cognition of this work, and mistakenly believe that this is the content of the operating room nursing work. In the implementation process does not change the previous work habits just copy the document caused by the implementation of poor results, thus failing to achieve results. 3.4 Problems and corrective measures in the implementation of 3.4.1 The surgeon can not participate in the pre-anesthesia check in a timely manner: in the past, the surgeon in our hospital tends to enter the operating room when the anesthesia is nearly completed, and can not participate in the pre-anesthesia check in a timely manner. In order to urge surgeons to arrive at the operating room on time to participate in pre-anesthesia checking, the hospital has stipulated that the operating room should record the time when surgeons enter the operating room, and the Medical Department should regularly inspect the operating room and penalize latecomers accordingly. 3.4.2 Failure to implement the Surgical Safety Verification Form system in strict accordance with the procedure: At the beginning of the trial implementation of the Surgical Safety Verification Form system, the relevant surgical staff did not fully understand the importance of the Surgical Safety Verification Form, and did not check the form verbally according to the procedure, and the anesthesiologists filled in the form by themselves, which made the work a mere formality. In this regard, our hospital has taken the following measures: ① The vice president of the business from time to time to the operating room to personally guide the surgical safety verification work, supervise its strict process, so that this work can be successfully implemented. ② Medical Department regularly to the operating room to supervise the implementation of this work, the serious implementation of the department and individuals in the hospital to praise, not seriously implement the appropriate penalties, so that the surgery-related personnel gradually develop the habit of seriously implement the verification. ③ Take the example of two consecutive medical accidents in China in which the left and right sides of the operation were not separated, and start a discussion in the whole hospital's surgical system, with the Medical Affairs Department taking part in the discussion of each department, to guide the departments to pay attention to the surgical safety verification system, and to promote the effective implementation of the system. 3.5 Detailed Management of Surgical Safety Verification Needs to be Strengthened In the process of implementing the surgical safety verification system, we have found that there is still a need to strengthen the detailed management in the management of surgical specimens, inventory records, and the avoidance of the dangers of tube compression, tube folding, and tube dislodgement. Any accident at work is caused by loss of control and neglect in many details [12]. For example, we have found that the intern filled in the labeling of surgical specimens on behalf of the error occurred, the Department of Pathology timely discovered and corrected by the surgical staff after checking. The implementation of the "double-signature, triple-completion" measure for specimen delivery can avoid such cases, and also reminds the operating room nursing staff to strictly implement the surgical safety verification system in the process of clinical teaching. In two cases of septic thorax patients with preoperative drainage tubes, the drainage tubes were found to be compressed when the patients were moved to the operating beds, and in one case, agitation during the awakening period of general anesthesia led to the removal of the drainage tubes during the transfer. In addition, we also found that in one case, the exit time recorded in the surgical inventory did not match the surgeon's operative summary because the patient was ready to leave the operating room after a change in condition and was observed for an additional 30 minutes, while the operative summary recorded the time of readiness to leave the room. This serves as a reminder of the need to be mindful of the importance of completing and checking records against actual times, emphasizing uniformity of multiple records and following the principle of recording after the fact. In summary, the surgical team can effectively guarantee surgical safety, reduce surgical risks and improve the quality of healthcare services by refining and cooperating in the implementation of the surgical safety verification process and content on the basis of learning the above objectives and systems. However, safety verification needs to be implemented to the details and needs to be accumulated in the work, which is also the most direct and effective method [13] . The focus of surgical patient safety verification work is that the verifier should strengthen the sense of responsibility, enhance the awareness of verification, and make it clear that safeguarding the safety of surgical patients must be prevented in the whole process. All staff participation, all three parties should be proactive, the formation of a "patient-centered, to protect patient safety" service concept.
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