scholarly journals Using the WHO Surgical Safety Checklist to Direct Perioperative Quality Improvement at a Surgical Hospital in Cambodia: The Importance of Objective Confirmation of Process Completion

2017 ◽  
Vol 41 (12) ◽  
pp. 3012-3024 ◽  
Author(s):  
Naomi Y. Garland ◽  
Sokhavatey Kheng ◽  
Michael De Leon ◽  
Hourt Eap ◽  
Jared A. Forrester ◽  
...  
BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022882 ◽  
Author(s):  
Jennifer M Weller ◽  
Tanisha Jowsey ◽  
Carmen Skilton ◽  
Derryn A Gargiulo ◽  
Oleg N Medvedev ◽  
...  

While the WHO Surgical Safety Checklist (the Checklist) can improve patient outcomes, variable administration can erode benefits. We sought to understand and improve how operating room (OR) staff use the Checklist. Our specific aims were to: determine if OR staff can discriminate between good and poor quality of Checklist administration using a validated audit tool (WHOBARS); to determine reliability and accuracy of WHOBARS self-ratings; determine the influence of demographic variables on ratings and explore OR staff attitudes to Checklist administration.DesignMixed methods study using WHOBARS ratings of surgical cases by OR staff and two independent observers, thematic analysis of staff interviews.ParticipantsOR staff in three New Zealand hospitals.Outcome measuresReliability of WHOBARS for self-audit; staff attitudes to Checklist administration.ResultsAnalysis of scores (243 participants, 2 observers, 59 cases) supported tool reliability, with 87% of WHOBARS score variance attributable to differences in Checklist administration between cases. Self-ratings were significantly higher than observer ratings, with some differences between professional groups but error variance from all raters was less than 10%. Key interview themes (33 interviewees) were: Team culture and embedding the Checklist, Information transfer and obstacles, Raising concerns and ‘A tick-box exercise’. Interviewees felt the Checklist could promote teamwork and a safety culture, particularly enabling speaking up. Senior staff were of key importance in setting the appropriate tone.ConclusionsThe WHOBARS tool could be useful for self-audit and quality improvement as OR staff can reliably discriminate between good and poor Checklist administration. OR staff self-ratings were lenient compared with external observers suggesting the value of external audit for benchmarking. Small differences between ratings from professional groups underpin the value of including all members of the team in scoring. We identified factors explaining staff perceptions of the Checklist that should inform quality improvement interventions.


2021 ◽  
Vol 10 (4) ◽  
pp. e001593
Author(s):  
Brigid Brown ◽  
Sophia Bermingham ◽  
Marthinus Vermeulen ◽  
Beth Jennings ◽  
Kirsty Adamek ◽  
...  

Despite good quality evidence for benefits with its use, challenges have been encountered in the correct and consistent implementation of the surgical safety checklist (SSC). Previous studies of the SSC have reported a discrepancy between what is documented and what is observed in real time. A baseline observational audit at our institution demonstrated compliance of only 3.5% despite a documented compliance of 100%. This project used quality improvement principles of identifying the problem and designing strategies to improve staff compliance with the SSC. These included changing the SSC from paper-based to a reusable laminated form, a broad multidisciplinary education and marketing campaign, targeted coaching and modifying the implementation in response to ongoing staff feedback. Five direct observational audits were undertaken over four Plan–Do–Study–Act cycles to capture real-time information on staff compliance. Two staff surveys were also undertaken. Compliance with the SSC improved from 3.5% to 63% during this study. Staff reported they felt the new process improved patient safety and that the new SSC was easily incorporated into their workflow. Improving compliance with the SSC requires deep engagement with and cooperation of surgical, anaesthesia and nursing teams and understanding of their work practices and culture. The prospective observational audit highlighted an initial 3.5% compliance rate compared with 100% based on an audit of the patient notes. Relying solely on a retrospective paper-based model can lead to hospitals being unaware of significant safety and quality issues. While in-person prospective observations are more time-consuming and resource-consuming than retrospective audits, this study highlights their potential utility to gain a clear picture of actual events. The significant variation between documented and observed data may have considerable implications for other retrospective studies which rely on human-entered data for their results.


2016 ◽  
Vol 1 (3) ◽  
pp. 173
Author(s):  
Suryanti Klase ◽  
Rizaldy Taslim Pinzon ◽  
Andreasta Meliala

Latar Belakang: Penerapan pemakaian Surgical Safety Checklist (SSC) dari World Health Organization (WHO) adalah untuk meningkatkan keselamatan pasien dalam proses pembedahan dikamar operasi dan mengurangi terjadinya kesalahan dalam prosedur pembedahan. Tingginya angka komplikasi dan kematian akibat pembedahan menyebabkan tindakan pembedahan seharusnya menjadi perhatian kesehatan global. Penggunaan checklist terstruktur dalam proses pembedahan akan sangat efektif karena standarisasi kinerja manusia dalam memastikan prosedur telah diikuti. Untuk itu diperlukan juga proses penerapan Surgical Safety Checklist WHO di RSUD Jaraga Sasameh Kabupaten Barito Selatan. Metode: Jenis penelitian ini adalah penelitian deskriptif dengan rancangan penelitian kualitatif, studi kasus. Subyek penelitian ini adalah semua personel kamar bedah RSUD Jaraga Sasameh Kabupaten Barito Selatan, Propinsi Kalimantan Tengah selama bulan Maret - Mei 2015. Kuesioner menjelaskan tentang karakteristik umum dari sampel (umur, jenis kelamin, pekerjaan, lama kerja di rumah sakit), pengetahuan tentang Surgical Safety Checklist WHO, penerimaan checklist dan penerapannya, dan kerja sama team kamar bedah. Hasil: Dari 21 personel kamar bedah yang menjawab kuesioner, 100% menyadari keberadaan Surgical Safety Checklist WHO dan mengetahui tujuannya. Kebanyakan personel berpikir bahwa menggunakan checklist keselamatan Bedah WHO bermanfaat dan pelaksanaannya di kamar bedah merupakan keputusan yang tepat. Ada 90,5% personel yang menyatakan bahwa penggunaan Surgical Safety Checklist WHO cukup mudah untuk dilaksanakan. Kesimpulan: Meskipun terdapat penerimaan yang besar terhadap pelaksanaan penerapan checklist ini diantara personel kamar bedah, tetapi terdapat sedikit perbedaan dalam pengetahuan tentang tata cara pengisian ataupun penggunaan checklist.


2019 ◽  
Vol 4 (3) ◽  
pp. 456
Author(s):  
Endang Yuliati ◽  
Hema Malini ◽  
Sri Muharni

<p><em><em>The use of the Surgical Safety Checklist (SSC) is associated with improving patient care according to nursing process standards includes the quality of work of the operating room nurse team. The form of professionalism in the operating room is how the application of a surgical safety checklist as the standard procedure for patient safety in the operating room. This study aims to determine the relationship of characteristics, knowledge, and motivation of nurses in the application of the surgical safety checklist in the operating room of a Batam city hospital. This research is quantitative using an observational analytic research design. This study was conducted on 67 nurses who were taken by total sampling. This research was conducted in three Batam City Hospitals, with hospital accreditation at the same level. Data were analysed by univariate and bivariate using the chi-square test. The results of the study found that most nurses had education at diploma level, with a working period experiences of &gt; 6 months (82%); good knowledge (53.7%) with low motivation (57.7%). There is a relationship between education (p = 0.042); length of work experience (p = 0.010); knowledge (p = 0.002); and motivation (p = 0.05) with the application of SSC. It is expected that health services carry out SSC following the applicable SOPs in the Hospital so that it can reduce work accident rates and improve patient safety.</em></em></p><p><em><br /></em></p><p><em>Penerapan Surgical Safety Checklist (SSC) berhubungan langsung dengan kualitas asuhan keperawatan yang termasuk adalah bagaimana perawat menerapkan fungsi sebagai bagian dari kamar operasi. Bentuk profesionalisme ini menjadi standar bagaimana kemampuan perawat menerapakan SSC. Tujuan penelitian adalah mengetahui hubungan karakteristik perawat, pengetahuan dan motivasi dengan penerapan SSC di kamar operasi. Penelitian ini menggunakan desain kuantitatif Cross Sectional dengan jumlah sampel 67 orang perawat kamar operasi. Data dianalisa dengan distribusi frekuensi dan uji hubungan bivariat. Didapatkan penerapan SSC perawat kota Batam masih kurang baik, dengan faktor yang mempunyai hubungan adalah Pendidikan, pelatihan dan pengetahuan. Diharapkan perawat mampu menerapkan SSC sesuai dengan Standar pelaksanaan fungsi perawat dikamar operasi.</em></p>


2021 ◽  
Vol 10 (1) ◽  
pp. e001086
Author(s):  
Claire Cushley ◽  
Tom Knight ◽  
Helen Murray ◽  
Lawrence Kidd

Background and problemThe WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved.AimThe aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019.MethodsIn April 2018, a prospective observational audit and online survey took place. The results showed compliance for the ‘Sign In’ section of the checklist was 55% and for the ‘Time Out’ section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of ‘Time Out’ to ensure it was done immediately prior to knife-to-skin.ResultsFollowing its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for ‘Sign In’ and to 94% for ‘Time Out’. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with ‘Sign In’ and to 100% with ‘Time Out’. Engagement was maintained at 100%.ConclusionsThe aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jie Tan ◽  
James Reeves Mbori Ngwayi ◽  
Zhaohan Ding ◽  
Yufa Zhou ◽  
Ming Li ◽  
...  

Abstract Background Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC. Methods A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components. Results A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety. 860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the ‘time-out’ component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction. Conclusion The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.


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