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EW CATARACT 40 October 2018 reports, safety improvement reports, suggestions, hazard/ risk reports, and identification reports. Every step of the way leading up to and away from a flight has mandatory documentation and checklists. Dr. Pfeifer said, "In avia- tion 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. We have standard operating proce- dures, and we need to write down the procedure for every surgery and check things off one by one. This procedure is standard in Slovenia for all doctors, nurses, and technicians. There are also standard protocols for machine calibration, etc. Each ma- chine has detailed instructions for use, so there cannot be unnecessary confusion. In medicine, however, unlike aviation, it can be difficult to persuade personnel to adhere to check lists, and consequently, things can be forgotten." Effective safety management is data driven. The sound manage- ment of an organization's databases is fundamental to ensuring the effective and reliable safety analysis of consolidated sources of data. The establishment and maintenance of a safety database provide an essen- tial tool for personnel monitoring system safety issues. Dr. Pfeifer ob- served that a wide range of relatively inexpensive electronic databases capable of supporting an organi- zation's data management require- ments are commercially available. Depending on the size and com- plexity of the organization, system requirements include capabilities to effectively manage safety data. In general, the system should: have user friendly data entry, be able to transform large amounts of safety data into useful information that supports decision making, reduce the workload for managers and personnel, and operate at relatively low cost. "Surgical steps are also spelled out on the checklist, so the nurse can remind us and the other nurses of completed and upcoming steps in the procedure," Dr. Pfeifer said. "At the operating table, we identify the patient on the operating table. We make sure to identify the eye that needs to be operated, which lens will be used, what the refrac- tion is, etc. Also, the operating work place needs to be practical and comfortable, for the surgeon and the patient. The surgeon needs good back support, and holding the phaco handpiece and I/A should be comfortable and secure. Emergency procedures are on the doors of the cabinet in the OR. No one should have to rely on memory in case of emergency." Dr. Pfeifer said that skill and procedure adherence are hallmarks of both the pilot and the cataract surgeon. "We teach young people how to fly and we teach young people how to perform cataracts. The procedures are similar. We should allow young candidates to learn, and although we know when they are going to make a mistake, we need to allow them more time to realize and find out on their own, before we stop them. Meanwhile, our checklists are in place to ensure high safety for our patients," he explained. EW Editors' note: Dr. Pfeifer has no finan- cial interests related to his comments. Contact information Pfeiffer: pfeifer@ pfeifer.si Cataract continued from page 38

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