Health Organization Surgical Safety Checklist Research Articles

EP335 - Audit of the Use of WHO Surgical Safety Checklist and its Awareness, Perception and Acceptability Amongst Theatre Personnel in a Tertiary Hospital in Sub-Saharan Africa

Abstract Aims The World Health Organization Surgical Safety Checklist (SSC) was developed to prevent perioperative adverse events. This study aimed to assess the utilization of the SSC and evaluate awareness and acceptability among theatre staff at a tertiary centre in sub-Saharan Africa. Methods We conducted a prospective audit of the SSC utilization during elective and emergency surgery, and a survey of awareness, perception and acceptability amongst theatre personnel (nurses, surgeons and anaesthetists) using a 15-item self-administered questionnaire between May 2022 and January 2023. Results 117 surgeries were observed for compliance with SSC and 81 theatre personnel took part in the survey. The checklist was used in 52.1% of all surgeries, 80% and 5.4% of major and minor surgeries respectively. In Time Out phase, activities were stopped in 23% of cases, and scrub nurses were asked relevant questions 31-47% of the time. Sign Out was the least completed phase. Three of five questions were asked 23-48% of the time. 28% of respondents who previously witnessed adverse events agreed that they could have been prevented by proper implementation of the SSC. 65.4% of members of the surgical team had not had any formal training on the SSC. There was no difference in its awareness, perception and acceptability based on profession of the respondents. Conclusion SSC was not fully utilized during the audit period. Lack of formal training may be contributory. There is broad awareness of SSC and its ability to prevent advert events. Key words: WHO, Surgical Safety Checklist, Awareness

Visual Mapping of Operating Theater Team Dynamics and Communication for Reflexive Feedback and Surgical Practice Optimization.

Effective operating theater (OT) communication and teamwork are essential to optimal surgical outcomes. We mapped the OT team dynamics and infection control practices using visual methods to guide reflexive feedback and optimize perioperative practices. Data were gathered from adult gastrointestinal surgical teams at a tertiary hospital in India using observations, sociograms (communication mapping tool), and focus group discussions (FGDs). Our methods aimed to map team communication, roles and responsibilities in infection-related practices, and door openings. Qualitative data were thematically analyzed. Quantitative data were analyzed using descriptive statistics. Data were gathered from 10 surgical procedures (over 51 hours) using 16 sociograms, 15 traffic flow maps, and 3 FGDs. Senior surgeons directly influence team hierarchies, dynamics, and communication. While the surgeons, anesthetic residents, and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating activity among role players across hierarchies. Failing to provide the scrub nurse with complete details of the planned surgery leads to multiple door openings to fetch equipment and disposables. Traffic flow observed in 15-minute intervals corresponds to a mean frequency of 56 door openings per hour (min: 16; max: 108), with implications for infection control. Implementing the World Health Organization surgical safety checklist was inconsistent across pathways and does not match reported compliance data. Human factors research is important in optimizing surgical teamwork. Using visual methods to provide feedback to perioperative teams on their communication patterns and behaviors, provided an opportunity for contextualized enhancement of infection prevention and control practices.

Adapting the World Health Organization's Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol.

The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC. A pre-post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites' health surveillance systems. Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.

Role of the WHO Surgical Safety Checklist in Reducing Morbidity and Mortality Among Obstetrics and Gynecology Patients Undergoing Surgery: A Prospective Comparative Study.

As surgery is an essential aspect of healthcare around the globe, it is necessary to consider complications related to it. Therefore, this study was conducted to evaluate the impact of the World Health Organization Surgical Safety Checklist (WHO SSC) on reducing the incidence of postoperative complications Methods: This single-center, prospective, comparative study was conducted at the Department of Gynecology and Obstetrics in a government hospital in Patna, Bihar. To assess the efficacy of the WHO SSC, the patients were divided into two groups, in which one group undergoing surgery was assessed with the checklist, and the other group was not. The rates of surgery-related complications were then compared in both groups. Our results showed a reduction in surgery-related complications in patients assessed with the WHO SSC. No statistically significant difference in duration of surgery was found between the groups. However, a statistically significant difference was observed in the rates of surgery-related complications between groups, especially in sepsis (p=0.0009), hemorrhage (p<0.0001), and infection at the site of surgery (p<0.0001). Mortality rates were not affected by the use of the SSC. The WHO SSC is a simple yet effective tool for reducing postoperative complications by improving communication between the various team members working in the operation theatre, although it has no effect on reducing mortality. Further research is needed to enhance its successful implementation and ensure its sustained use.

Safety of surgery: quality assessment of meta-analyses on the WHO checklist.

To assess the quality of the meta-analyses that review the WHO surgical safety checklist. A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.

Going beyond compliance: A qualitative study of the practice of surgical safety checklist

BackgroundThe World Health Organization Surgical Safety Checklist (SSC) is a tool designed to enhance team communication and patient safety. When used properly, the SSC acts as a layer of defence against never events. In this study, we performed secondary qualitative analysis of operating theatres (OT) SSC observational notes to examine how the SSC was used after an intensive SSC re-implementation effort and drew on relevant theories to shed light on the observed patterns of behaviours. We aimed to go beyond assessing checklist compliance and to understand potential sociopsychological mechanisms of the variations in SSC practices. MethodsDirect observation notes of 109 surgical procedures across 13 surgical disciplines were made by two trained nurses in the OT of a large tertiary hospital in Singapore from February to April 2022, three months after SSC re-implementation. Only notes relevant to the use of SSC were extracted and analyzed using reflexive thematic analysis. Data were coded following an inductive process to identify themes or patterns of SSC practices. These patterns were subsequently interpreted against a relevant theory to appreciate the potential sociopsychological forces behind them. ResultsTwo broad types of SSC practices and their respective sub-themes were identified. Type 1 (vs. Type 2) SSC practices are characterized by patience and thoroughness (vs. hurriedness and omission) in carrying out the SSC process, dedication and attention (vs. delegation and distraction) to the SSC safety checks, and frequent (vs. absence of) safety voices during the conduct of SSC. These patterns were conceptualized as safety-seeking action vs. ritualistic action using Merton's social deviance theory. ConclusionRitualistic practice of the SSC can undermine surgical safety by creating conditions conducive to never events. To fully realize the SSC's potential as an essential tool for communication and safety, a concerted effort is needed to balance thoroughness with efficiency. Additionally, fostering a culture of collaboration and collegiality is crucial to reinforce and enhance the culture of surgical safety.

The Relevance of World Health Organization Surgical Safety Checklist to Spinal Surgery

Across the 193 member states of the World Health Organization (WHO) an estimated 234 million operations were conducted worldwide in 2008 (1 per every 25 human beings on the planet). These numbers have continued to increase to 312.9 million by 2016. Surgical errors involving the wrong site, wrong procedure or wrong patient occur at a rate of 1 in 112,000. This equates to 2,000 estimated ‘never events’ every year with a significant associated physical and psychological burden on patients and surgeons and financial and reputational burden on health organisations involved in litigation for such errors. The WHO Surgical Safety Checklist (WHOSSC), produced in 2009 is now synonymous with safety in the operating theatre. This checklist imposes a process of scrutiny at the key steps of the patients journey through theatre. The key details scrutinised have been shown to improve patient outcomes and theatre efficiency. Several studies have looked at adapted checklists specific to different specialties and it is becoming clearer that whilst the overall benefit of the original checklist is undeniable, in some speciality areas a more deliberate and nuanced application of the checklist to address specific problems could be of value. As a specialism, spinal surgery differs from others with a significant risk of a perioperative complication leading to harm and morbidity, permanent disability or even death. Iatrogenic spinal cord injury requires high-level resources and prolonged, sometimes lifelong rehabilitation. Other complications include cerebrospinal fluid leak, blood loss, new neurologic deficit, hardware failure, proximal junctional failure, pseudarthrosis, and surgical site infection. Wrong level spinal surgery (WLSS) is a complication specific to spinal surgery and studies have reported WLSS effecting 50-68% of spinal surgeons at some point in their career. The risks of these complications can be mitigated by factors, some of which are included in the WHOSSC and others with are lacking. This scoping review looks at how surgical checklists; both the original and modified versions have and could be used to address the surgical safety challenges specific to spinal surgery.

Audit of the use of WHO surgical safety checklist and assessment of attitudes towards it among surgical team personnel in a Tertiary Hospital in Nigeria

Introduction: The World Health Organization (WHO) Surgical Safety Checklist (SSC) launched in 2009 was developed to address preventable causes of morbidity and mortality in the perioperative period by promoting communication among all team members and ensuring that all necessary safety checks are done as and when due and that they are done appropriately. Studies have shown that implementation of the WHO checklist reduces the risk of SSI and preventable deaths by about 50%. Thus, it is encouraged that all hospitals, domesticate the tool to improve patient safety. The study aims to assess the level of usage of the WHO SSC, the gaps in its implementation and to evaluate the awareness, perception and acceptability of this tool among theatre staff personnel at a tertiary hospital in Nigeria. Materials and methods: We prospectively conducted an audit of the use of the WHO SSC at the main and emergency theatres, University College Hospital, Ibadan by observing the level of implementation of the different events in the WHO SSC using a pre-developed questionnaire. We subsequently conducted a survey on the awareness, perception and acceptability of the WHO SSC among the operating team personnel using a 15-item self-administered questionnaire. The data were analysed with SPSS. Results: A total of 117 surgeries were observed during the audit and 81 surgical team personnel took part in the survey. The WHO SSC was used in about half (52.1%) of the surgeries and it was sparingly used during minor surgeries (5.4%). The Sign Out Phase was the least completed phases of the checklist. The personnel administering the check list (usually the circulating nurse) did not ask the scrub nurse the required questions in more than half of the time (53.1–58.7%) in the Time Out Phase and this was significantly higher when compared with unasked questions to other professionals of the team (11.3–15.6%). In the Sign Out Phase, of the five questions, four questions were barely asked in about half of the time (44.6–76.8%). Eighty-one per cent personnel were surveyed, half (50%) were surgeons and about a quarter were anaesthetists (23%) and Nurses (27%). More than half of respondents (58%) have more than 5-year work experience in the hospital. Majority (65.4%) of members of the surgical team had not had any formal training on the WHO SSC. About a third of respondents (28%) who had made an error in surgery agreed that it could have been prevented by proper implementation of the WHO SSC. The respondents also agree that the sign out phase was completed in less than a third (27.2%) of the time. There was no difference in its awareness, perception and acceptability based on profession of the respondents. Conclusion: The WHO SSC should be made available at all theatres in the hospital and should be administered during all surgeries. There should be more formal training of members of the surgical team to improve implementation. Assessing for the barriers to the implementation of the WHO Safety Surgical Checklist is the logical next step to improve the use in our theatre.

Assessment of Knowledge and Attitude Regarding World Health Organization (WHO) Surgical Safety Checklist (SSC) in Operating Room Personnel of Medical Teaching Institutes (MTIS) Peshawar Pakistan

Background: World health organization surgical safety checklist is basically the guideline for the operating room personnel. These guidelines are properly started by WHO in 2007-8. The purpose was to improve the outcomes of the surgical procedures, communication, decline the mortality and morbidity ratio perioperatively. Using WHO checklist plays a very important significant role in patient safety especially in perioperative time. One study shows that about 47 % reduction occur in mortality and 36 % in morbidity while using the SSC. In the developed countries having proper safety system and knowledge complication rate was reported 0.4 to 0.8% while in the developing countries this ratio was about 3 to 16 % (2004 report). Objective: To Assess the knowledge and attitude regarding WHO SSC of operating room personnel of MTIs Khyber teaching hospital (KTH) and Hayat Abad medical complex (HMC) of Peshawar Pakistan. Methods: Cross sectional study conducted. Data collected through semi structured questionnaire from operating room personnel including surgeons, anesthesia provider, surgical technician, technologist, and OT nurses working in MTI KTH and MTI HMC. Results: According to the study about 30(14.6%) OT personnel having good knowledge,115(56%) having average and 60(29.2%) of personnel having poor knowledge regarding WHO SSC. The result of the attitude of OT personnel regarding safety checklist was 141(6.7%) positive means they agreed with WHO rules and want them to be implemented in the OT while 64 (31.2%) showed negative attitude. Conclusion: Adverse events are common in the preoperative period. This is due to poor organizational, limited, knowledge respect less attitude of the staff toward their duty, and patient self-mistakes. But the great responsibility of the staff is to care for the patient in the proper while according to the rules and regulation set by the WHO in the form of surgical safety checklist. By using safety checklists properly, the adverse events can minimize up to a great number. For the best result the personnel must have proper knowledge, awareness, importance and need of practical implementation. By default, our health system is still going on previous knowledge base and not properly adjusted in the advanced system. In these two hospitals most of the HCPs are not aware of the importance of the WHO checklist and some are against the practical implementation of the checklist. This is an amazing and questionable point that can be overcome through education.

P149 Improving compliance with the World Health Organisation Surgical Safety Checklist

P149 Improving compliance with the World Health Organisation Surgical Safety Checklist

Transforming Team Performance Through Reimplementation of the Surgical Safety Checklist

Patient safety interventions, like the World Health Organization Surgical Safety Checklist, require effective implementation strategies to achieve meaningful results. Institutions with underperforming checklists require evidence-based guidance for reimplementing these practices to maximize their impact on patient safety. To assess the ability of a comprehensive system of safety checklist reimplementation to change behavior, enhance safety culture, and improve outcomes for surgical patients. This prospective type 2 hybrid implementation-effectiveness study took place at 2 large academic referral centers in Singapore. All operations performed at either hospital were eligible for observation. Surveys were distributed to all operating room staff. The study team developed a comprehensive surgical safety checklist reimplementation package based on the Exploration, Preparation, Implementation, Sustainment framework. Best practices from implementation science and human factors engineering were combined to redesign the checklist. The revised instrument was reimplemented in November 2021. Implementation outcomes included penetration and fidelity. The primary effectiveness outcome was team performance, assessed by trained observers using the Oxford Non-Technical Skills (NOTECH) system before and after reimplementation. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to assess safety culture and observers tracked device-related interruptions (DRIs). Patient safety events, near-miss events, 30-day mortality, and serious complications were tracked for exploratory analyses. Observers captured 252 cases (161 baseline and 91 end point). Penetration of the checklist was excellent at both time points, but there were significant improvements in all measures of fidelity after reimplementation. Mean NOTECHS scores increased from 37.1 to 42.4 points (4.3 point adjusted increase; 95% CI, 2.9-5.7; P < .001). DRIs decreased by 86.5% (95% CI, -22.1% to -97.8%; P = .03). Significant improvements were noted in 9 of 12 composite areas on culture of safety surveys. Exploratory analyses suggested reductions in patient safety events, mortality, and serious complications. Comprehensive reimplementation of an established checklist intervention can meaningfully improve team behavior, safety culture, patient safety, and patient outcomes. Future efforts will expand the reach of this system by testing a structured guidebook coupled with light-touch implementation guidance in a variety of settings.

The use of the World Health Organization Surgical Safety Checklist in operating theatres

Background: There is a global concern over intraoperative patient safety, as adverse events are on the rise. When the World Health Organization Surgical Safety Checklist (WHO SSC) is used correctly, it has the potential to prevent such events. Unfortunately, the intraoperative team in the designated hospital lacked the cooperation to successfully use the checklist.Aim: This study, therefore, aimed to explore and describe the factors that affect the use of the checklist in the operating theatres in a designated hospital.Methods: A qualitative research approach together with an implementation science strategy structured according to the Consolidated Framework for Implementation Research was used. Individual interviews with nine surgeons and focus group interviews with six operating theatre professional nurses provided sufficient data for inductive and deductive analysis.Results: A deeper understanding of the contextual and interventional factors that affect the use of the WHO SSC is provided by the findings. A high demand for surgery, the hierarchy in the surgical team, their uncertainty about hospital policies and reluctance to adjust to change contributed to the poor use of the checklist.Conclusion: A sustainable implementation process is crucial and should be embraced and promoted by the intraoperative team.Contribution: The article contributes a description of the factors that address the use of a checklist for intraoperative patient safety. It recommends that the factors that hinder the use of the checklist be timeously addressed.

A retrospective analysis of the factors associated with surgical checklist compliance using data from a local health unit in Italy, 2018-2021.

Since its publication, the World Health Organization Surgical Safety Checklist (SSC) has been progressively adopted by healthcare providers around the world to monitor and safeguard the delivery of surgeries. In one Italian region's health system, the SSC and other two surgery-specific checklists were supplemented by a document that records any non-conformity (NC) arising from the safety checks. In this study, we investigated the factors associated with NCs using data from a local health unit (LHU). The secondary aim of this study was to explore the potential impact of the coronavirus crisis on surgical checklist compliance. We used data on surgical activity from the Modena LHU between 2018 and 2021 and the accompanying NC documents. The primary goal was to estimate the relative risk (RR) of NCs according to several factors, including checklist incompleteness and surgery class (elective, urgentor emergency), using Poisson regression. A similar analysis was performed separately for 2018-2019 and 2020-2021 to assess the COVID-19 potential impact. Checklist compliance in the LHU was 95%, with the presence of NCs in about 7% of surgeries. The factors that increased the RR were incompleteness of the checklist (adjusted RR = 3.12; 95% confidence interval [CI] = 2.86-3.40), urgent surgeries (adjusted RR[aRR] = 1.59; 95% CI = 1.47-1.72), emergencies (aRR = 2.09; 95% CI = 1.15-3.79), and surgeries with more than four procedures (aRR = 1.64; 95% CI = 1.41-1.92). Most notably, the RR for incomplete checklists showed a negative association with NCs before the COVID-19 outbreak but positive afterwards. Checklist compliance was overall satisfactory, though the observation of noncompliant checklists of about 1000 per year suggests there is still room for improvement. Moreover, attention to the checklist best practices and organization of outpatient workload may have been affected by the exceptional circumstances of the pandemic.

Compliance With the World Health Organization Surgical Safety Checklist at a Tertiary Care Hospital: A Closed Loop Audit Study.

The WHO launched the "Safe Surgery Saves Lives" campaign in 2008 to improve patient safety during surgery. The campaign includes the use of the WHO Surgical Safety Checklist, which has been proven effective in reducing complications and mortality rates in several studies. This article discusses a clinical audit at a tertiary healthcare facility that assesses compliance with all three components of the checklist to minimize errors and improve safety standards. This prospective, observational, closed-loop clinical audit study was conducted at Hayatabad Medical Complex, a tertiary care public sector hospital located in Peshawar, Pakistan. The audit aimed to assess compliance with the WHO Surgical Safety Checklist. The first phase of the audit cycle commenced on October 5, 2022, and involved collecting data from 91 surgical cases in randomly selected operating rooms. Following the completion of the first phase on December 13, 2022, an educational intervention was then conducted on December 15 to underscore the significance of adhering to the checklist, and the second phase of data collection began the following day, ending on February 22, 2023. The results were analyzed using SPSS Statistics version 27.0. The first phase of the audit showed that there was poor compliance with the latter two parts of the checklist. Certain components of the WHO Surgical Safety Checklist were well-complied with, including patient identity confirmation (95.6%), obtaining informed consent (94.5%), and counting of sponges and instruments (95.6%), while the lowest compliance rates were in recording allergies (26.3%), assessing blood loss risk (15.3%), introducing team members (62.6%), and inquiring about patient recovery concerns (64.8%, 34%, and 20.8% for surgeons, anesthetists, and nurses, respectively). In the second phase, after an educational intervention, compliance with the checklist improved significantly, particularly for those components with low compliance rates in the first phase, marking recording allergies (89.0%), introducing team members 91.2%), and inquiring about patient recovery concerns (79.1%, 73.6%, and 70.3% for surgeons, anesthetists, and nurses, respectively). The study showed that education is a critical factor in improving compliance with the WHO Surgical Safety Checklist. The study suggests that overcoming the obstacles to implementing the checklist requires a collaborative environment and effective instruction. It emphasizes the importance of adhering to the checklist in all surgical settings.

The Role of an Assistant Nurse in Implementing the WHO Surgical Safety Checklist: Perception and Perspectives.

Introduction The World Health Organization (WHO) Surgical Safety Checklist is a tool developed by the WHO to promote safer surgical practices and reduce the incidence of surgical errors and complications. This study aims to describe the role of assistant nurses in the implementation of this checklist by surgical teams. Materials and methods This descriptive study utilized a questionnaire-based survey conducted between September 2018 and March 2019 among 196 healthcare professionals at two surgical units in a university hospital in Sweden.The questionnaire covered demographic information such as age, gender, and occupation, as well as details about their workplace, experience, education/training on using the WHO checklist, the adaptation of the checklist to their department, their responsibilities in implementing and using the checklist, the frequency of use in emergency situations, and the impact on patient safety. Results The results of the study showed that assistant nurses, despite having the lowest level of education among healthcare professionals, were highly trusted and valued by other members of the surgical team. Most healthcare professionals were unsure who was responsible for using the WHO checklistbut believed it was the assistant nurse's responsibility to ensure its implementation. Assistant nurses reported little to no training on using the checklist but noted that it had been adapted to the department's needs. Almost half (48.8%) of assistant nurses believed that the checklist was often used in emergency surgery, and most believed that it improved patient safety. Conclusions Improved understanding of the significance of assistant nurses in implementing the WHO Surgical Safety Checklist may enhance adherence to the checklist and potentially improve patient safety, as they were the most valued and trusted healthcare professionals in the surgical team according to the study's findings.

ASK! Preoperative Safety Checklist Protocol in Interventional Spine Procedures: A Quality Improvement Study Thirty Month Follow-up

Medical errors can have devastating consequences for patients. Therefore, it is crucial to prevent sentinel and wrong-side events in order to ensure patient safety. One effective tool for achieving this goal is the World Health Organization (WHO) Surgical Safety Checklist, which can be used in conjunction with a pre-procedural, multidisciplinary checklist and physician-led time-out. In a QI project that focused on interventional pain procedures, a pre-procedural, multidisciplinary checklist and physician-led time-out were implemented. Over a period of 30 months and 5,017 procedures, no near misses or incidents were recorded. These preliminary results suggest that the use of multi-disciplinary checklists and attending-led time outs can significantly improve patient safety in interventional pain procedures.

Determinants of the world health organization surgical safety checklist use among clinicians at Kenyatta National Hospital Nairobi, Kenya

Introduction: The World Health Organization Surgical Safety Checklist (SSC) minimizes harm to patients. Clinicians use the checklist to confirm and ensure that the correct surgical operation is performed on the correct patient at the correct location. There are limited studies done to assess the effectiveness of using SSC in the operating rooms at Kenyatta National Hospital (KNH) since its adoption in 2012.&#x0D; Objective: The broad objective of the study was to determine SSC use among clinicians at Kenyatta National Hospital in Nairobi, Kenya; and determine clinicians’ and institutional-related factors influencing its use at the same hospital.&#x0D; Methodology: A cross-sectional study was conducted in the operating theatres at KNH. The study recruited 178 consented clinicians who use SSC and excluded those on leave based on the multi-stage sampling technique and Yamane’s formulae. Collected data were processed using IBM SPSS version 20.&#x0D; Results: About 98% of the respondents were aware of SSC with 95% reporting its use during the interview day. Around 52% of the respondents had the clinical experience of over 10 years with 46% having theatre experience of over 10 years. Almost 95% of the respondents reported availability and its use with 99% confirming its mandatory usage in the operating theatres. Training and sensitization of clinicians on the use of the checklist were at 62% and 70%, respectively.&#x0D; Conclusion There was a recommendable utilization level of SSC at 95% influenced by clinicians’ and institutional related factors at Kenyatta National Hospital.

Adherence level to the World health Organization surgical safety checklist and associated factors in operating rooms in a county teaching and referral hospital in South-Western Kenya

IntroductionWorld Health Organization (WHO) introduced the Surgical Safety Checklist (SSC) in 2008 to assure safety in Operating Rooms (ORs). Globally, adherence level varies with developing countries having the lowest levels compared to their developed counterparts. ObjectivesWe aimed to assess the level of adherence and identify factors that influence adherence to the WHO SSC in a county teaching and referral hospital in South Western Kenya. MethodsThe study preferred a mixed method cross-sectional design. WHO SSC adherence level was assessed by conducting a retrospective review of 424 surgical files that were randomly selected. OR staff (40) were targeted using census method and 31of them were interviewed using structured interviews to determine qualitative data on staff and institutional factors that influenced adherence practices to the WHO SSC. Quantitative data was analysed using Statistical Package for Social Sciences (SPSS). Both descriptive and analytical statistics were generated with statistical significance set at p=<0.05. Content analysis was adopted for qualitative data. Study FindingsWHO SSC was present in 100 % of the post-surgical files. Filling of the WHO SSC was attempted in 7.1 % of the surgeries done. Better adherence was noted in elective surgeries (78 %) compared to emergency (22%) ones. There was a varying adherence level per the type of surgeries with adult general surgeries posting better adherence (40 %) and orthopaedic surgeries were least adherent at 4 %. A decreasing trend in adherence level was noted subsequently through the three moments of surgery (‘sign in’ (5.7 %); ‘Time out’ (1.8 %); and ‘Sign out’ (0.7 %)). The average adherence level was established to be 2.7 %. Key staff factors that influenced adherence practices included; years of experience (p = 0.004), attitude (p = 0.014) and perception(p = 0.009). Additionally, institutional factors were; lack of essential consumables and drugs (77.4 %), lack of refresher trainings (54.5 %), understaffing (48.4 %) and lack of management support (45.2 %). ConclusionThe level of adherence to the WHO SSC was critically low. The aforementioned staff and institutional factors influenced the level of adherence. The study recommends a structured health system-based quality improvement intervention to improve the outcome (adherence) by addressing the root causes (Staff and institutional) to promote patient safety in OR.

It’s time for the perioperative community to recommit to the WHO Surgical Safety Checklist

For over a decade, the World Health Organization (WHO) Surgical Safety Checklist has been recognised as an essential perioperative safety tool. The first landmark multi-national study demonstrated a remarkable 47 per cent reduction in mortality and a 36 per cent reduction in surgical complications, which was confirmed in subsequent studies. Although effective in a research environment, the checklist has been challenging to implement. Today, hospitals worldwide still struggle to use the checklist as designed and maintain enthusiasm for its sustained use. Is it time for the perioperative health care community to revisit the checklist and recommit to safer surgery?

Factors contributing to non-adherence of the peri-operative surgical team to WHO surgical safety checklist in the Kingdom of Saudi Arabia

IntroductionThe World Health Organization Surgical Safety Checklist addresses acceptable practices for patient safety. This paper aimed to explore and describe the factors that contribute to non-adherence of peri‑operative surgical team to WHO surgical safety checklist at the selected hospital in the Kingdom of Saudi Arabia. MethodsThe study adopted a qualitative design. The population consisted of a 12 peri‑operative surgical team with an average of 12 years’ experience in their respective medical fields. This population was purposely selected from a selected hospital operating theatres in Saudi Arabia. Non-probability purposive sampling was used to select the participants. Data was collected by means of semi-structured individual interviews. Content analysis was used to analyze data. ResultsThe findings revealed that peri‑operative surgical team experience challenges when implementing WHO SSC (2008). The challenges affect their adherence, which depends on a convergence of intertwined factors, such as the use of WHO SSC related to issues in the checklist steps and uncertainties regarding the safe use of WHO SSC, team factors, checklist items factors and procedural factors. ConclusionThe study clearly identified factors that contributed to suboptimal WHO SSC execution by peri‑operative surgical team in the Kingdom of Saudi Arabia, addressed at the institutional level. It is therefore important for the managerial teams to be supportive to the surgical perioperative team to improve adherence to WHO SSC. Support can be provided through continuous supervision, in-service training, mentoring, evaluation and awarding merits for the good adherence to patient safety. Furthermore, these findings can be used to develop strategies to promote perioperative surgical team adherence to WHO SSC and can be used for further research.