Anspruch und Wirklichkeit: Umsetzung der G-BA Qualitätsmanagement-Richtlinie bezüglich der Anwendungspraxis der OP-Checkliste – Status Quo an einem universitären Maximalversorger

2020 ◽  
Author(s):  
Ralf Weckenbrock
Keyword(s):  
Status Quo ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Team Time Out ◽  
Perioperative Morbidität

ZusammenfassungChirurgische Behandlungspfade können die Entstehung von Unerwünschten Ereignissen (UE) durch die immanente Komplexität ihrer Leistungserbringung begünstigen. Die »Surgical Safety Checklist« (SSC) der Weltgesundheitsorganisation (WHO) ist ein Instrument, das die perioperative Morbidität und Mortalität wirksam senkt. Vor diesem Hintergrund hat der Gemeinsame Bundesausschuss (G-BA) 2016 in einer Qualitätsmanagement-Richtlinie (QM-RL) die Anwendung von OP-Checklisten bei chirurgischen Eingriffen verpflichtend vorgeschrieben. Ziel der Untersuchung war deshalb, die vergleichende Erfassung der Checklisten-Compliance an allen 10 chirurgischen Organisationseinheiten der Universitätsmedizin Mainz in der zweiten Jahreshälfte 2017 und 2018. Neben der Anlage der SSC wurde die Bearbeitung der Unterpunkte »Sign-In«, »Team-Time-Out« und »Sign-Out« ausgewertet. Im Vergleich von 2017 zu 2018 zeigten alle Parameter Steigerungen (»Anlage der Checkliste (94,2 / 96,5%), »Sign-In« (81,4 / 84,4%), »Team-Time-Out« (56,8 / 62,4%) und »Sign-Out« (50,7 / 57,9%) ohne statistische Signifikanz (p>0,05). Demgegenüber ergaben sich signifikante Unterschiede zwischen zertifizierten und nicht zertifizierten Chirurgischen Betriebseinheiten. 2017 wiesen die Parameter »Sign-In« (87,9 / 71,8%; p=0,034), »Team-Time-Out« (68,4 / 39,4%; p=0,029) und »Sign-Out« (62,1 / 33,6%; p=0,029) und 2018 das »Team-Time-Out« (76,2 / 41,7%; p=0,019) und das »Sign-Out« (71,3 / 37,9%; p=0,019) signifikante Unterschiede zwischen zertifizierten und nicht zertifizierten Betriebseinheiten auf. Von 2017 zu 2018 konnte die Implementation der SCC insbesondere in zertifizierten Einrichtungen gesteigert werden. Demnach scheint die externe Kontrolle vorgeschriebener Qualitätsmerkmale z. B. im Rahmen eines Zertifizierungsverfahrens als ein geeignetes Instrument zur Steigerung der Checklisten-Compliance.

scholarly journals Writing’s on the wall: improving the WHO Surgical Safety Checklist

2021 ◽  
Vol 10 (1) ◽  
pp. e001086
Author(s):  
Claire Cushley ◽  
Tom Knight ◽  
Helen Murray ◽  
Lawrence Kidd
Keyword(s):  
Patient Safety ◽  
Online Survey ◽  
Improve Patient Safety ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Mandatory Requirement ◽  
Who Checklist ◽  
Improve Patient ◽  
Theatre Team

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.

Audit of compliance with WHO surgical safety checklist and building a shared mental model in the operating theatre

BMJ Leader ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. 132-135
Author(s):  
James Todd
Keyword(s):  
Mental Model ◽  
Patient Death ◽  
Shared Mental Model ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Full Compliance ◽  
Time Out ◽  
Who Checklist ◽  
Grade 3 ◽  
Minor Operations

BackgroundThe use of the checklist has been shown to reduce patient death and postoperative complications and is mandated for use with all National Health Service (NHS) surgery. The aim was to obtain quantitative and qualitative data on compliance with WHO surgical safety checklist during operations in an NHS hospital.MethodData collection was by prospective observational audit of 34 operations using WHO checklist and 5 qualitative criteria to establish efficacy of use: (a) Staff stopped tasks to engage; (b) Staff attentive and listening; (c) Audible to all team; (d) Understanding was checked in briefs and questions/feedback asked; (e) All required staff present.Categorisation: grade 3 (all criteria), grade 2 (three to four of criteria), grade 1 (one to two of criteria). Checklist use was recorded by stage use (eg, Sign In) and component steps.ResultsChecklist stages used were Brief (7/8), Sign In (32/34), Time Out (30/34), Sign Out (18/34) and Debrief (2/8). Checklist component steps were completed more fully in major versus minor operations (17.3/28 vs 8.4/28). Mean qualitative grade was greatest in major surgeries (2.2 vs 1.6) and using general anaesthesia (1.8 vs 1.3). 3/34 of operations achieved Grade 3.ConclusionSign Out and Debrief compliance was low, as was full compliance with component steps of the WHO checklist, especially during minor operations. A focused checklist specific for minor operations could be introduced to remove unnecessary steps and mitigate against excessive omission. Improved qualitative use of the checklist is required to maximise effectiveness and facilitate a shared mental model.

scholarly journals Internal Audit of Compliance with a Perioperative Checklist in a Tertiary Care Neurosurgical Unit

2015 ◽  
Vol 43 (1) ◽  
pp. 87-92
Author(s):  
Jean-François Gagné ◽  
Moujahed Labidi ◽  
André Turmel
Keyword(s):  
Compliance Rate ◽  
Tertiary Care ◽  
Internal Audit ◽  
The United States ◽  
World Health ◽  
Institute Of Medicine ◽  
Independent Observer ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out

AbstractBackground: In 1999, the Institute of Medicine reported that, in the United States, 44,000 to 98,000 people die annually as a result of avoidable medical errors. Among the many initiatives undertaken to stem avoidable surgical errors, the World Health Organization (WHO) Surgical Safety Checklist has certainly been one of the most successful. Many surgical units have implemented adapted versions of the WHO Surgical Safety Checklist, audited their performance and discussed issues relating to the implementation process. However, such literature is still lacking in neurosurgery. Methods: A prospective observational study of 171 neurosurgical cases was conducted over an 8-week period. An independent observer assessed compliance with and completeness of the three steps in the perioperative checklist: Sign-in, Time-out and Sign-out. Factors that may reduce compliance were also analyzed. Results: Compliance with the Sign-in, Time-out and Sign-out steps was 82%, 99% and 93% respectively. On average, 92% of the Time-out elements were verified. The emergent nature of a surgery was the only factor that caused a statistically significant reduction in compliance with the checklist. Overall compliance diminished during the observation period. Conclusion: In this internal audit study, compliance with the preoperative checklist reached a satisfactory level. Further work is still needed, however, on some aspects of our surgical strategy, namely, a relatively low compliance rate with the Sign-in process was recorded and emergent cases were associated with decreased performance.

scholarly journals Observations of Pre-operative Teamwork and Communication During the Implementation of a City-Wide Surgical Safety Checklist

2012 ◽  
Vol 5 (4) ◽  
pp. 117-133
Author(s):  
Terry Leonid Hansen ◽  
Kyle Goerl ◽  
Reginald Fears ◽  
Tim Nguyen ◽  
Traci Hart ◽  
...  
Keyword(s):  
World Health ◽  
Medical Society ◽  
Convenience Sample ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Wrong Site Surgery ◽  
Time Out ◽  
Who Checklist ◽  
Sedgwick County ◽  
Surgical Teams

BACKGROUND: Use of the World Health Organization's (WHO) perioperative safety checklist has been shown in prior studies to reduce morbidity and mortality. In 2009, the Medical Society of Sedgwick County, Kansas, developed a modified version of the WHO checklist for city-wide implementation. This study evaluated how the checklist was used at a Wichita hospital. METHODS: An observational tool was developed to evaluate time-outs at the beginning of surgical procedures. A convenience sample of cases was evaluated across surgical specialties and procedures. Observations included: 1) when the time-out was done, 2) who led the time-out, 3) which items on the checklist were addressed, 4) how much time was spent, and 5) whether problems were identified or adverse events prevented. RESULTS: Data were collected from 121 observations. Only one of the surgical teams was observed to refer directly to the checklist posted in the OR to conduct their time out. The time-out was done before induction (3%), drape (19%), incision (77%), and after incision (1%). The process was led by the circulating nurse (92%), surgeon (7%), and circulating nurse and surgeon together (1%). The percent of completed checklist items was: patient identity (96%), procedure (96%), antibiotics (87%), site (80%), allergies (75%), position (70%), equipment (60%), DVT prevention (50%), images (40%), surgeon concerns (36%), and anesthesia provider concerns (34%). On average, seven (SD = 2.5) of 11 items on the checklist were addressed. Time spent ranged from less than one minute to five minutes; 78% took one minute or less. Problems were identified in 7% of cases. In one case, a wrong site surgery was prevented. CONCLUSIONS: Despite the intention to implement a city-wide surgical safety checklist, the checklist rarely was used in its entirety to conduct the observed time-outs in the subject hospital. Although the checklist was under-utilized, safety benefits were observed from the time-out process. These would likely be enhanced and extended by consistent use of a checklist.

scholarly journals The surgical safety checklist: a quantitative study on attitudes and barriers among gynecological surgery teams

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Junming Gong ◽  
Yushan Ma ◽  
Yunfei An ◽  
Qi Yuan ◽  
Yun Li ◽  
...  
Keyword(s):  
Surgical Patient ◽  
Gynecological Surgery ◽  
Surgical Team ◽  
Demographic Information ◽  
Subjective Ratings ◽  
Team Members ◽  
Factors Affecting ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out

Abstract Background Implementation of the surgical safety checklist (SSC) plays a significant role in improving surgical patient safety, but levels of compliance to a SSC implementation by surgical team members vary significantly. We aimed to investigate the factors affecting satisfaction levels of gynecologists, anesthesiologists, and operating room registered nurses (OR-RNs) with SSC implementation. Methods We conducted a survey based on 267 questionnaires completed by 85 gynecologists from 14 gynecological surgery teams, 86 anesthesiologists, and 96 OR-RNs at a hospital in China from March 3 to March 16, 2020. The self-reported questionnaire was used to collect respondent’s demographic information, levels of satisfaction with overall implementation of the SSC and its implementation in each of the three phases of a surgery, namely sign-in, time-out, and sign-out, and reasons for not giving a satisfaction score of 10 to its implementation in all phases. Results The subjective ratings regarding the overall implementation of the SSC between the surgical team members were different significantly. “Too many operations to check” was the primary factor causing gynecologists and anesthesiologists not to assign a score of 10 to sign-in implementation. The OR-RNs gave the lowest score to time-out implementation and 82 (85.42%) did not assign a score of 10 to it. “Surgeon is eager to start for surgery” was recognized as a major factor ranking first by OR-RNs and ranking second by anesthesiologists, and 57 (69.51%) OR-RNs chose “Too many operations to check” as the reason for not giving a score of 10 to time-out implementation. “No one initiates” and “Surgeon is not present for ‘sign out’” were commonly cited as the reasons for not assigning a score of 10 to sign-out implementation. Conclusion Factors affecting satisfaction with SSC implementation were various. These factors might be essentially related to heavy workloads and lack of ability about SSC implementation. It is advisable to reduce surgical team members’ excessive workloads and enhance their understanding of importance of SSC implementation, thereby improving surgical team members’ satisfaction with SSC implementation and facilitating compliance of SSC completion.

scholarly journals The second “time-out”: a surgical safety checklist for lengthy robotic surgeries

2013 ◽  
Vol 7 (1) ◽  
pp. 19 ◽  
Author(s):  
Joseph B Song ◽  
Goutham Vemana ◽  
Jonathan M Mobley ◽  
Sam B Bhayani
Keyword(s):  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Robotic Surgeries

scholarly journals University of California, Los Angeles, surgical time-out process: evolution, challenges, and future perspective

2012 ◽  
Vol 33 (5) ◽  
pp. E5 ◽  
Author(s):  
Nancy McLaughlin ◽  
Deborah Winograd ◽  
Hallie R. Chung ◽  
Barbara Van de Wiele ◽  
Neil A. Martin
Keyword(s):  
Los Angeles ◽  
Skin Incision ◽  
Cultural Practice ◽  
Future Perspective ◽  
Current Time ◽  
Current Form ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Surgical Checklist

Since the development of the WHO Safe Surgery Saves Lives initiative and Surgical Safety Checklist, numerous hospitals across the globe have adopted the use of a surgical checklist. The UCLA Health System developed its first extended Surgical Safety Checklist in 2008. Authors of the present paper describe how the time-out checklist used before skin incision was implemented and how it progressed to its current form. Compliance with the most recent version of the checklist has been closely monitored via documentation and observance audits. In addition, the surgical team's appreciation of the current time-out has been assessed. Cultural, practice, and human resource challenges are discussed, as are potential future avenues for innovations in the emerging field of the surgical checklist in neurosurgery.

scholarly journals Improving teamwork and communication in the operating room by introducing the theatre cap challenge

2022 ◽  
Vol 32 (1-2) ◽  
pp. 4-9
Author(s):  
Anne Sophie HM van Dalen ◽  
Jan A Swinkels ◽  
Stan Coolen ◽  
Robert Hackett ◽  
Marlies P Schijven
Keyword(s):  
Pilot Study ◽  
Operating Room ◽  
Medical Data ◽  
Operating Theatre ◽  
Team Members ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Theatre Team

Objective One of the steps of the Surgical Safety Checklist is for the team members to introduce themselves. The objective of this study was to implement a tool to help remember and use each other’s names and roles in the operating theatre. Methods This study was part of a pilot study in which a video and medical data recorder was implemented in one operating theatre and used as a tool for postoperative multidisciplinary debriefings. During these debriefings, name recall was evaluated. Following the implementation of the medical data recorder, this study was started by introducing the theatre cap challenge, meaning the use of name (including role) stickers on the surgical cap in the operating theatre. Findings In total, 41% (n = 40 out of 98) of the operating theatre members were able to recall all the names of their team at the team briefings. On average 44.8% (n = 103) was wearing the name sticker. Conclusions The time-out stage of the Surgical Safety Checklist might be inadequate for correctly remembering and using your operating theatre team members’ names. For this, the theatre cap challenge may help.

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