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EW CATARACT 38 October 2018 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer occurrence or potential outcome, so things do not turn out as bad as they might. Taking an example from aviation, I think we should bring these things into medicine, especial- ly into the operating room." Airlines have a system by which they score different types of events according to their safety/risk proba- bility. The scores reflect the frequen- cy with which events are encoun- tered (frequent to inconceivable) and their severity, which grades events as catastrophic, hazardous, major, minor, and negligible. A catastrophic event is associated with multiple deaths and the destruction Checklists and routine safety reports promote increased safety and fewer mistakes in cataract surgery S afety precautionary mea- sures should be much the same in cataract surgery as in aviation, according to a presentation given at the 22nd ESCRS Winter Meeting. Like in medicine, the aviation industry addresses technical, human, and organizational factors to maintain utmost safety. According to Vlad- imir Pfeifer, MD, University Eye Hospital, Ljubljana, Slovenia, who is also a pilot and spoke on the topic of "The pilot and the cataract sur- geon: minimizing risk and avoiding complications," there needs to be a careful balance between protection and production. If production out- weighs protection, aviation safety may be in jeopardy. The same is true of the opposite; if protection costs too much, the company can go bankrupt. "Flight companies have safety controls that reduce the possibility of an undesirable hazardous event," Dr. Pfeifer said. "The safety controls reduce the severity of a hazard- ous consequence and eliminate or diminish hazards. If they do occur, there are tools used to mitigate the Cataract surgery would be well served by cockpit discipline With a single pilot crew, multitasking is necessary: navigation, communication, awareness, and flying the plane. The situation is similar in cataract surgery. When instructing beginners, the exact plan is written, and time is reserved for every exercise by the aviation training organization. All the trainees have to pass the same training. Source (all): Vladimir Pfeifer, MD Presentation spotlight continued on page 40 of equipment. Hazardous events are associated with a large reduction in safety margins with serious injuries. A major event means a significant reduction in safety margins and a reduction in the ability of the oper- ators to cope with adverse operating conditions as a result of an increase in workload or resulting from con- ditions that impair their efficiency. Minor and negligible events present far less challenges to overall safety and can be dealt with more easily. "These factors are assessed together and graded from 5A, a frequent catastrophic risk, to 5E, a frequent risk of negligible impor- tance, to 1A, an extremely improba- ble risk of catastrophic proportions, to 1E, an extremely improbable risk of negligible repercussions, and everything in between," Dr. Pfeifer explained. "The risks fall into three basic categories: acceptable, toler- able, and unacceptable. Tolerable risks require management decisions and are based on risk mitigation, while unacceptable risks cannot be allowed to occur." Safety reporting in medicine needs to follow similar guidelines. "Safety reporting is very import- ant," Dr. Pfeifer said. "In aviation, if someone reports an event, it is analyzed to prevent it from happen- ing again. This should happen in medicine. People are knowledgeable about the human, technical, and or- ganizational factors that determine the safety of a system as a whole and need to report events that affect safety. Effective safety reporting is associated with information, flexi- bility, learning, accountability, and willingness." He explained that airlines have both voluntary and mandatory safety reports, some of which are anonymous. This allows airline personnel to report events, without individuals suffering the conse- quences, and help build up security to a higher level. Reports include voluntary safety reports, occurrence " In aviation in general, we have checklists. Every procedure that is done goes through a mandatory checklist, beginning with starting the plane and taking off. We should also do this in our operating rooms. " —Vladimir Pfeifer, MD

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