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 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.

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.

scholarly journals Attitudes and compliance with the WHO surgical safety checklist: a survey among surgeons and operating room staff in 138 hospitals in China

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jie Tan ◽  
James Reeves Mbori Ngwayi ◽  
Zhaohan Ding ◽  
Yufa Zhou ◽  
Ming Li ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Operating Room ◽  
World Health ◽  
Surgical Patient ◽  
Local Data ◽  
Cross Sectional ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Operating Room Staff

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.

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 Modified surgical safety checklist (mSSC)- a must to avoid disaster in neurosurgical procedures!

2017 ◽  
Vol 14 (3) ◽  
pp. 7-12
Author(s):  
Amit Thapa ◽  
Bidur KC ◽  
Bikram Shakya ◽  
Shusma Bhurtyal
Keyword(s):  
Surgical Care ◽  
World Health ◽  
Surgical Patient ◽  
Neurosurgical Procedures ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Emergency Procedures ◽  
Machine Failure ◽  
Neurosurgical Patients ◽  
Health Organization

The World Health Organization (WHO) introduced surgical safety checklist (SSC) as a part of Second Global Patient Safety Challenge: Safe Surgery Saves Lives to address the safety of surgical care. Althoughfound to be benefi cial for general surgical patient, we introduced certain modification to suit neurosurgical patients and hereby present our experience with the modified checklist.We introduced the modified SSC in July 2012 for neurosurgical purpose after we identified minor but common errors in carefully audited 100 patients in our operating theatre. Modification included checklists in pre procedure room, during sign in enquiring for pulse oximeter (for local anesthetic procedures) and lastly during sign out an elaborated list of items to guarantee safe transfer of the patients. Nurses and doctors were trained and SSC was methodically administered.Outcome as number of complications was evaluated and graded according to no harm, low harm, moderated harm, severe harm and death. During last 5 years (July 2012 to June 2017), 1310 patients undergoing surgical procedures in neurosurgical theatre at KMCTH were studied. Modified SSC was used in both routine (50.5%) and emergency cases (49.5%), of which compliance was 80% and 55% respectively. Poor compliance was due to ignorance of its use, emergency nature of procedure, change of staff. Completeness of mSSC was found in 70% cases with most left out part of mSSC was during signing out (i.e during transfer of patients). Use of mSSC identified many common but minor negligent acts on part of doctors, nurses and OR technicians which could be rectified in time and hence avoided any major mishaps. Age of the patients ranged from newborn to 98 year old. There were no major mishaps including death on table events. Despite confirming during mSSC checklist, machine failure occurred in 10 cases (0.8%) which were of low harm category. The total time taken for performing and filling the checklist took roughly 7 minutes.We modified WHO surgical safety checklist to include post operative transfer out to recovery room and used it in both routine and emergency procedures. This has helped us to avoid major mishaps during and after the neurosurgical procedures. We recommend stringent use of SSC in all neurosurgical centre and advise suitable local modifications according to prevailing conditions for special procedures or locations.Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page: 7-12

scholarly journals How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties in Norway

2020 ◽  
Author(s):  
Hilde Valen Wæhle ◽  
Arvid Steinar Haugen ◽  
Siri Wiig ◽  
Eirik Søfteland ◽  
Nick Sevdalis ◽  
...  
Keyword(s):  
Risk Management ◽  
Performance Indicator ◽  
Management Strategies ◽  
Ethnographic Study ◽  
World Health ◽  
Management Tool ◽  
Team Members ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Risk Management Strategies

Abstract Background The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staffʼs perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored – yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisiplinary perioperative team integrate the SSC within their risk management strategies. Methods An ethnographic case study including observations (40h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. Results We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSCʼs practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. Conclusion When the SSC is not integrated within existing risk management strategies, but perceived as an “add on”, its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.

Improving surgical safety checklist completion using distributed responsibility of checklist item completion among operating room team members: A quality improvement project

2020 ◽  
Vol 10 (1) ◽  
pp. 40-46
Author(s):  
Mehr Jain
Keyword(s):  
Operating Room ◽  
Intervention Group ◽  
Perioperative Outcomes ◽  
Checklist Item ◽  
Improvement Project ◽  
Team Members ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Operating Room Team ◽  
Questions And Responses

Background. Surgical safety checklists are a standard of care for safe operating room practice, but their use has not been associated with reductions in adverse perioperative outcomes in some settings. Non-adherence and partial checklist completion may contribute to this lack of effect. Objective. To examine whether a surgical safety checklist using distributed responsibility of checklist item completion, by allocation of questions and responses among operating room staff, increases surgical safety checklist compliance. Methods. With Quality and Risk Management approval, a multicomponent strategy consisting of novel surgical safety checklist focused on distributed responsibility of checklist item completion was evaluated in orthopaedic operating rooms at The Hospital for Sick Children, Toronto, from July to August 2016 using a before-and-after study design. The intervention consisted of a wall-mounted reusable checklist with questions and responses designated to specific operating room team members. Team training was provided beforehand, operating room team leaders were identified to promote the intervention, and revisions to the checklist content and process were implemented based on feedback on feasibility and clinical sensibility. Results. A total of 45 and 59 children were included in pre-intervention and intervention groups, respectively. Overall, 87% (1,354/1,560) of checklist items were observed. Checklist item completion was significantly increased in the post-intervention group (77% [615/802]) compared with the pre-intervention group (27% [150/522]) (P<0.001). Conclusions. These findings suggest that a multicomponent strategy of designating responsibility for item completion among operating room team members and using a memory aid can improve compliance with surgical safety checklist item completion.

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