Health Organization Surgical Safety Checklist Research Articles

Role of Perioperative Surgical Safety Checklist in Reducing Morbidity and Mortality among Patients: An Observational Study.

Background:Safe Surgery Saves Lives. Patient safety is a fundamental of good quality health care, and complications due to the health-care system are well-documented and constitute an important public health problem. Implementation of the checklist in medicine and surgery can help to decrease the risk of adverse events thus can improve patient safety.Materials and Methods:After the Institutional Ethical Committee clearance, a total of 500 patients were enrolled and divided into two equal groups. In Group 1 (n = 250), patients underwent surgery before regular implementation of the World Health Organization (WHO) surgical safety checklist (SSC), whereas in Group 2 (n = 250), patients underwent surgery after the WHO SSC was regularly implemented. All the patients were followed up after the surgery, and patients were looked for and compared for the postoperative complications.Results:We found that 27 patients (10.8%) in Group 1 and 13 patients (5.2%) in Group 2 developed major wound disruption (P < 0.05). There were 73 patients (29.2%) in Group 1 and 34 patients (13.6%) in the Group 2 who developed an infection of the surgical site (P < 0.05). There were five patients (2%) in Group 1 while none of the patients in Group 2 developed sepsis during the study (P < 0.05).Conclusions:We found that implementation of the WHO SSC significantly reduces surgical site infections, major disruptions of the wound, and sepsis.

World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda's Referral Hospitals.

A pilot study on the World Health Organization (WHO) Surgical Safety Checklist (SSC) showed a reduction in both major complications and mortality of surgical patients. Compliance with this checklist varies around the world. We aimed to determine the extent of compliance with the WHO SSC and its association with surgical outcomes in 5 of Uganda's referral hospitals. A multicentre prospective cohort study was conducted in 5 referral hospitals in Uganda. Using a questionnaire based on the WHO SSC, patients undergoing surgical operations were systematically recruited into the study from April 2016 to July 2016. The patients were followed up daily for 30 days or until discharge for the purpose of documentation of complications. Logistic regression and linear regression were used to assess for association between compliance and perioperative surgical outcomes. We recruited 859 patients into the study. Overall compliance with the WHO SSC was 41.7% (95% confidence interval [CI], 39.7-43.8) ranging from 11.9% to 89.8% across the different hospitals. Overall compliance with "sign in" was 44.7% (95% CI, 43-45.6), with "time out" was 42.0% (95% CI, 39.4-44.6), and with "sign out" was 33.3% (95% CI, 30.7-35.9). There was no association between compliance and perioperative surgical outcomes: length of hospital stay, adverse events, and mortality. This study revealed low levels of compliance with the WHO SSC. There was a statistically significant association between this level of compliance and the incidence of pain and loss of consciousness postoperatively.

ADAPTAÇÃO E VALIDAÇÃO DE CHECKLIST DE SEGURANÇA CIRÚRGICA NA CESÁREA

RESUMO Objetivo: adaptar e validar um instrumento de segurança cirúrgica na cesárea, com base em revisão integrativa da literatura, e no protocolo e checklist de segurança cirúrgica da Organização Mundial da Saúde. Método: estudo metodológico, com triangulação de dados, envolvendo um total de 43 participantes, sendo oito juízes para a validação de conteúdo e aparente do instrumento, utilizando-se a técnica Delphi, e para a validação semântica outros 35 profissionais da equipe cirúrgica de um hospital público do Distrito Federal, Brasil. Foi aplicado o coeficiente de confiabilidade ao instrumento. Resultados: o instrumento alcançou índice de validade de conteúdo geral de 0,9 e concordância interavaliadores de 1. O coeficiente total do alfa de Cronbach foi de 0,86, e a média dos escores das dimensões obteve notas elevadas. Conclusão: o instrumento apresentou validade nos três critérios estudados e confiabilidade para ser aplicado em futuros estudos que avaliem a segurança cirúrgica na cesárea.

Implementation of the World Health Organization Surgical Safety Checklist Correlates with Reduced Surgical Mortality and Length of Hospital Admission in a High-Income Country.

The World Health Organization Surgical Safety Checklist (WHO SSC) has been widely implemented in an effort to decrease surgical adverse events. The effects of the checklist on postoperative outcomes have not previously been examined in Australia, and there is limited evidence on the effects of the checklist in the long term. A retrospective review was conducted using administrative databases to examine the effects of the implementation of the checklist on postoperative outcomes. Data from 21,306 surgical procedures, performed over a 5-year time period at a tertiary care centre in Australia where the WHO SSC was introduced in the middle of this period, were analysed using multivariate logistic regression. Postoperative mortality rates decreased from 1.2 to 0.92% [p = 0.038, OR 0.74 (0.56-0.98)], and length of admission decreased from 5.2 to 4.7days (p = 0.014). The reduction in mortality rates reached significance at the 2-3years post-implementation period [p = 0.017, OR 0.61 (0.41-0.92)]. The observed decrease in mortality rates was independent of the surgical procedure duration. Implementation of the WHO SSC was associated with a statistically significant reduction in mortality and length of admission over a 5-year time period. This is the first study demonstrating a reduction in postoperative mortality after the implementation of the checklist in an Australian setting. In this study, a relatively longer period examined, comparative to previous international studies, may have allowed factors like surgical culture change to take effect.

Abstract 259: Pre-Procedure Checklist and Morning Huddle as Part of Patient Evaluation for Cardiac Catheterisation

Background: World Health Organization (WHO) Surgical Safety Checklist had a significant impact on surgical outcomes(1). In 2009, The United Kingdom National Patient Safety Agency required the use of this checklist(2). A pre procedure checklist for central venous line placements was one of the first commonly used checklists, and since then, the concept has been expanded to include venous thromboembolism prophylaxis, patient discharge, and many more(3). In 2016, Society of Cardiovascular Angiography and Interventions (SCAI) published a best practices consensus statement Update, which included a pre-procedure checklist for cardiac catheterizations(4). Objectives: The goals of the project were two-fold. First, to formalize the pre-procedure evaluation of patients referred to the cardiac catheterization laboratory, and second, to introduce a ‘Morning Huddle’ for all team members. The huddle is directed by a physician and includes a brief patient history and procedural plan to ensure everyone has a clear understanding of the procedure indication, patient specific risks, and procedural equipment needed. It would also provide an opportunity for group questions or to raise concerns. Methods: Safety Attitudes Questionnaire (SAQ) was used with permission from University of Texas Health Science Center at Houston, to assess the attitudes towards safety of the staff working at the cardiac catheterization laboratory, as well as the general cardiology fellows. Cardiology fellows were provided with pre-catheterization checklist, adapted from the SCAI best practices consensus statement Update, as well as an outline for the format of the ‘Morning Huddle’. Results: The total number of responses obtained were 23. The survey revealed that the majority of the staff felt that the physicians and nurses worked in a well-coordinated team (95.7%, 22 of 23). Almost 26% (6 of 23) of the staff interviewed reported difficulty in speaking up when a problem was perceived. Communication breakdown was not noted to be a problem by the majority interviewed, although a small percentage did disagree (26%, 6 of 23). Conclusions: Although the survey was overwhelmingly positive at baseline, room for improvement was noted. It is anticipated that the intervention will allow the staff an opportunity to speak up when a problem is perceived, and improve communication, by empowering the team during the ‘Morning Huddle’. Our overarching goal is to improve the safety climate in the catheterization laboratory.

An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres.

The World Health Organization (WHO) has implemented the Surgical Safety Checklist (SSCL) as part of the Safe Surgery Saves Lives campaign. This is aimed at improving surgical safety worldwide. Despite many perceived benefits of the SSCL, compliance and acceptance in many areas remain poor. To investigate perceptions of theatre staff regarding the checklist and to identify reasons and barriers for poor compliance and implementation. Questionnaires were handed out to theatre teams across all surgical disciplines at two large hospitals in Durban, South Africa, over a 2-week period. Data collected included role in theatre, intention of the SSCL, training received, as well as questions regarding previously identified barriers and staff perceptions. Questionnaires were distributed to 225 practitioners, with a response rate of 81.7% from 51 nurses, 54 anaesthetists and 79 surgeons. Rank of medical staff included 52 seniors (consultants) and 81 juniors (registrars and medical officers). The majority (95%) of respondents perceived the SSCL as intended to improve safety, prevent errors or reduce morbidity and mortality. A total of 146 respondents (79.3%) received no SSCL training. No new barriers were identified, but previously identified barriers were confirmed. Our key factors were time-related issues and lack of buy-in from team members. Surgeons were perceived as being supportive by 45.1% of respondents, in contrast to nurses (62.5%), anaesthetists (70.1%) and management (68.5%). When compared with junior staff, senior staff were 5-fold more likely to feel that staff did not need to be trained and 8-fold more likely to indicate that the checklist did not improve patient safety. The WHO SSCL is an important tool in the operating room environment. The barriers in our setting are similar to those identified in other settings. There needs to be widespread training in the use of the SSCL, including adaptation of the checklist to make it fit for purpose in our setting. Improving use of the checklist will allow theatre staff to work together towards ensuring a safer theatre environment for both patients and staff.

Evaluation of a countrywide implementation of the world health organisation surgical safety checklist in Madagascar.

BackgroundThe 2009 World Health Organisation (WHO) surgical safety checklist significantly reduces surgical mortality and morbidity (up to 47%). Yet in 2016, only 25% of East African anesthetists regularly use the checklist. Nationwide implementation of the checklist is reported in high-income countries, but in low- and middle-income countries (LMICs) reports of successful implementations are sparse, limited to single institutions and require intensive support. Since checklist use leads to the biggest improvements in outcomes in LMICs, methods of wide-scale implementation are needed. We hypothesized that, using a three-day course, successful wide-scale implementation of the checklist could be achieved, as measured by at least 50% compliance with six basic safety processes at three to four months. We also aimed to determine predictors for checklist utilization.Materials and methodsUsing a blended educational implementation strategy based on prior pilot studies we designed a three-day dynamic educational course to facilitate widespread implementation of the WHO checklist. The course utilized lectures, film, small group breakouts, participant feedback and simulation to teach the knowledge, skills and behavior changes needed to implement the checklist. In collaboration with the Ministry of Health and local hospital leadership, the course was delivered to 427 multi-disciplinary staff at 21 hospitals located in 19 of 22 regions of Madagascar between September 2015 and March 2016. We evaluated implementation at three to four months using questionnaires (with a 5-point Likert scale) and focus groups. Multivariate linear regression was used to test predictors of checklist utilization.ResultsAt three to four months, 65% of respondents reported always using the checklist, with another 13% using it in part. Participant’s years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with counting instruments (p< 0.05), but not with verifying: patient identity, difficult intubation risk, risk of blood loss, prophylactic antibiotic administration, or counting needles and sponges.ConclusionUse of a multi-disciplinary three-day course for checklist implementation resulted in 78% of participants using the checklist, at three months; and an increase in counting surgical instruments. Successful checklist implementation was not predicted by participant length of medical service, hospital size or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.

An exploration of surgical team perceptions toward implementation of surgical safety checklists in a non-native English-speaking country

In-depth information on the success and failure of implementing the World Health Organization surgical safety checklist (SSC) has been questioned in non-native English-speaking countries. This study explored the experiences of SSC implementation and documented barriers and strategies to improve SSC implementation. A qualitative study was performed in 33 Thai hospitals. The information from focus group discussions with 39 nurses and face-to-face, in-depth interviews with 50 surgical personnel was analyzed using content analysis. Major barriers were an unclear policy, inadequate personnel, refusals and resistance from the surgical team, English/electronic SSC, and foreign patients. The key strategies to improve SSC implementation were found to be policy management, training using role-play and station-based deconstruction, adapting SSC implementation suitable for the hospital's context, building self-awareness, and patient involvement. The barriers of SSC were related to infrastructure and patients. Effective policy management, teamwork and individual improvement, and patient involvement may be the keys to successful SSC implementation.

Use of the World Health Organization Surgical Safety Checklist by Nigerian anesthetists.

Background:Surgery and anesthesia are essential parts of global healthcare. Surgical intervention has been largely beneficial but remains associated with significant morbidity and mortality. The increasing complexity of surgical interventions has made providers more prone to avoidable errors. The World Health Organization Surgical Safety Checklist (WHO SSC) was disseminated worldwide with the aim of reducing perioperative morbidity and mortality.Objective:There is a paucity of data to assess awareness and use of WHO SSC in low- and middle-income countries. The aim of this study is to evaluate the knowledge and use of WHO SSC by Nigerian anesthetists.Methodology:A structured self-reporting questionnaire was distributed to Nigerian physician anesthetists. One hundred and twenty-two questionnaires were distributed with 102 completed reflecting a response rate of 83.6%.Results:Awareness of the WHO SSC was reported by 93.1% of the respondents. Routine use of the checklist was reported by 62.7% of the respondents mostly in the teaching hospitals compared with the general hospitals and comprehensive health centers (86.2%, 23.3% and 14.3%, P = 0.0001). The respondents who had a perception that WHO SSC does not prevent errors were the least likely to use it (odds ratio: 0.08, P = 0.0117).Conclusion:This study identified a high level of awareness and use of the WHO SSC by physician anesthetists in Nigeria. However, its use is mostly use of The WHO SSC list by Nigerian anesthetists in teaching hospitals.

The World Health Organization Surgical Safety Checklist: An audit of quality of implementation at a tertiary care high volume cancer institution.

Background and Aims:In 2007, the World Health Organization (WHO) implemented the Surgical Safety Checklist (SSC), which has enhanced the communication between the surgical team members, improved outcomes, decreased complications, and improved patient safety. However, for the checklist to be effective, proper implementation and compliance with the checklist are imperative. The aim of this study was to evaluate the quality of implementation of the WHO SSC during elective surgery at a tertiary referral cancer hospital in India.Material and Methods:In this prospective observational study, a trained research nurse passively observed the implementation of selected items from the modified version of the WHO SSC during elective surgeries and evaluated the compliance with the checklist, percentage of items for which the use of the SSC prompted an action, and level of interaction between the key team players during the conduct of the checklist.Results:We studied 200 surgeries for each part of the SSC. Compliance was 200 (100%), 156 (78%), and 153 (76.5%) for the first, second, and third part of the SSC, respectively. All the three parts were mostly initiated by surgeons [197 (98.5%), 92 (59%), and 136 (88.9%), respectively]. Overall, 131/2200 (5.95%) items in the checklist were carried out only after being prompted during the conduct of the checklist. The interaction between all three representatives was found in only 265/509 (52%) cases.Conclusion:The quality of implementation of the SSC was found to be suboptimal, with a definite scope for improvement. Compliance with all items on the checklist and active participation by all team members are crucial for successful implementation of the checklist.

The World Health Organization Surgical Safety Checklist

The World Health Organization Surgical Safety Checklist

Compliance and outcome of implementing World Health Organization surgical safety check list in surgical practice in a teaching hospital

Background: Surgical complications represent a signifi cant cause of morbidity and mortality with the rate of major complications after inpatient surgery in industrialized countries. The purpose of this study was to summarize experience with surgical checklist use and efficacy for improving patient safety.Objective: To evaluate the compliance of implementation and outcome of World Health Organization Surgical checklist use in surgical practice at Kathmandu Medical College.Methods: This is a prospectively designed descriptive study including adult patients undergoing surgical procedure in Kathmandu Medical College Hospital from June 2013 till June 2014. Obtained data on compliance of World Health Organization safety checklist use by practitioner and its outcome in patient’s safety were assessed using SPSS version 15.The surgeries that underwent under local anesthesia were excluded from the study.Results: World Health Organization checklist was implemented in all 288 patients undergoing various surgical procedures with acceptable compliance by all 41 practitioners. Although it had no impact on correctable mortality and morbidity, frequent instrument malfunctions were offi cially recorded. Attitudes towards use of checklist was good as 100% of participants wanted use of checklist if they were having operation on themselves. However 22% of the participants complained of extra time needed to fi ll the checklist. Time taken to fi ll up sign in column of checklist was on average from 120 to 150 seconds (mean 135±5secs) and sign out was 80-100 seconds (mean 95±6secs). Only 69% of the participants were available for sign out. Scissor malfunction was detected in 4(1.38%) cases and operation theatre table related problem was found in one case (0.34%).Conclusion: Implementation of World Health Organization Surgical Safety Checklist can be done with acceptable compliance and instrumental malfunction was well documented.

Interval follow up of a 4-day pilot program to implement the WHO surgical safety checklist at a Congolese hospital

BackgroundThe World Health Organisation Surgical Safety Checklist (SSC) improves surgical outcomes and the research question is no longer ‘does the SSC work?’ but, ‘how to make the SSC work?’ Evidence for implementation strategies in low-income countries is sparse and existing strategies are heavily based on long-term external support. Short but effective implementation programs are required if widespread scale up is to be achieved. We designed and delivered a four-day pilot SSC training course at a single hospital centre in the Republic of Congo, and evaluated the implementation after one year. We hypothesised that participants would still be using the checklist over 50% of the time.MethodWe taught the four-day SSC training course at Dolisie hospital in February 2014, and undertook a mixed methods impact evaluation based on the Kirkpatrick model in May 2015. SSC implementation was evaluated using self-reported questionnaire with a 3 point Likert scale to assess six key process measures. Learning, behaviour, organisational change and facilitators and inhibitors to change were evaluated with questionnaires, interviews and focus group discussion.ResultsSeventeen individuals participated in the training and seven (40%) were available for impact evaluation at 15 months. No participant had used the SSC prior to training. Over half the participants were following the six processes measures always or most of the time: confirmation of patient identity and the surgical procedure (57%), assessment of difficult intubation risk (72%), assessment of the risk of major blood loss (86%), antibiotic prophylaxis given before skin incision (86%), use of a pulse oximeter (86%), and counting sponges and instruments (71%). All participants reported positive improvements in teamwork, organisation and safe anesthesia. Most participants reported they worked in helpful, supportive and respectful atmosphere; and could speak up if they saw something that might harm a patient. However, less than half felt able to challenge those in authority.ConclusionOur study demonstrates that a 4-day pilot course for SSC implementation resulted in over 50% of participants using the SSC at 15 months, positive changes in learning, behaviour and organisational change, but less impact on hierarchical culture. The next step is to test our novel implementation strategy in a larger hospital setting.

Introductions During Time-outs: Do Surgical Team Members Know One Another's Names?

Introductions are the first item of the time-out in the World Health Organization Surgical Safety Checklist (SSC). It has yet to be established that surgical teams use colleagues' names or consider the use of names important. A study was conducted to determine if using the SSC has a measurable impact on name retention and to assess if operating room (OR) personnel believe it is important to know the names of their colleagues or for their colleagues to know theirs. All OR personnel were individually interviewed at the end of 25 surgical cases in which the SSC was used. They were asked (1) to name each OR participant, and (2) if they believed it is important to know the names of their team members and (3) for their team members to know their name. Of the 150 OR personnel interviewed, 147 (98%) named the surgery attending correctly. The surgery attending named only 44% of other OR staff (p <0.001). Only 62% of the OR staff correctly named the anesthesiology attending. The anesthesiology resident was the least well known but was able to name 82% of the others. The anesthesiology attending named his or her resident 100% of the time; the surgery attending correctly named his or her resident only 68% of the time (p = 0.002). This study suggests that OR personnel may consider introductions to be another bureaucratic hurdle instead of the safety check they were designed to be. It appears that this first step of the time-out is often being performed perfunctorily.

Effects of Implementation of W.H.O Surgical Safety Check List: Our Institutional Analysis

To err is human. Human errors and flaws in the system and quality of health care persist despite patient safety initiatives and identification of new strategies of improvement. A significant focus in surgery is to identify strategies and improve patient safety, prevent postoperative complications and any adverse events. The World Health Organization (WHO) surgical safety checklist has been shown to decrease mortality and complications and has been adopted worldwide. A retrospective pre-intervention study was done from September 2014 to August 2015, data analysed, necessary training, changes and awareness was implemented over 1 month and then, a prospective study was done post-intervention using WHO safety check list from October 2015 to September 2016 both at Rajarajeswari Medical College and Hospital, Bangalore, India by implementing the safety check list and by corrections of errors present during the pre-intervention phase. A total of 216 patients were recorded during the pre-intervention phase, and a total of 248 patients were included in the post-intervention analysis after implementing the WHO safety check list. Our study showed a reduction of intraoperative surgical complications from 5.1 to 2.41% and from 6.48 to 4.44% in postoperative surgical complications after the implementation of safety check list. There were significant reductions in anaesthesia complications, during and after surgery post implementation (intraoperative from 2.78 to 1.61%, postoperative from 1.4 to 0.8%). We also observed a significant change in the death rates post-implementation. Intraoperative death reduced from 1.4 to 0.4% and postoperative deaths reduced from 12.04 to 8%. Surgical safety check list improves the quality of patient care and improves perceptions on patient safety. It significantly reduces the morbidity and mortality by reducing the complications and improving the quality of treatment and health care. It is easy to understand and implement the surgical safety check list after training, proper guidance, and education. It is a must to implement the surgical safety check list in all institutions to improve the patient safety and to reduce the errors in patient care.

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial.

In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation.

The Surgical Safety Checklist: Results of Implementation in Otorhinolaryngology

To assess the impact of implementing the surgical safety checklist (SSCL) on the outcome of patient safety in otorhinolaryngology (ENT) surgical procedures in two hospitals in Saudi Arabia: Aseer Central and Abha Private Hospitals. This retrospective study conducted over seven years (1 July 2008 to 30 June 2015) followed a staff educational and training program for the implementation of the World Health Organization Surgical Safety Checklist (WHO SSCL). The program included the use of audiovisual aids and practical demonstrations. Incidents of non-compliance were treated as sentinel events and were audited by the process of root cause analysis. There were 5 144 elective ENT surgical cases in both hospitals in which the SSCL was utilized over the seven-year study period. The average compliance rate was 96.5%. Reasons for non-compliance included staff shortage, fast staff turnover, excessive workload, communication problems, and presence of existing processes. The implementation of the SSCL was a substantial leap in efforts towards ensuring surgical patients' safety. It is compulsory in the healthcare system in many countries. Such progress in healthcare improvement can be accomplished with the commitment of the operating suite staff by spending few moments checking facts and establishing an environment of teamwork for the benefit of the surgical patient.

Avaliação da segurança do paciente em cirurgia cardíaca de um hospital público

Objetivo: Avaliar itens de segurança na cirurgia cardíaca em pacientes de um hospital público. Método: Estudo descritivo e transversal. A coletade dados, desenvolvida em 2012, foi realizada em uma instituição hospitalar pública estadual, onde foram observadas 30 cirurgias cardíacas por meio deum roteiro embasado nas 3 fases do checklist de cirurgia segura da Organização Mundial da Saúde (OMS), com alternativas descritas como “em conformidade”e “em não conformidade”. Resultados: Os resultados de não conformidade corresponderam a 56% dos casos antes da indução anestésica,57% antes do procedimento e 75% na saída da sala de cirurgia. Conclusão: O checklist da OMS se faz necessário, porém, o treinamento profissional e aeducação permanente constituem a linha mestra para a formação de uma equipe de saúde crítica e consciente do seu papel na segurança dos pacientes.

Objective Assessment of Checklist Fidelity Using Digital Audio Recording and a Standardized Scoring System Audit.

ObjectivesThe use of the World Health Organization Surgical Safety Checklist (SSC) has been reported to significantly reduce operative morbidity and mortality rates. Recent findings have cast doubt on the efficacy of such checklists in improving patient safety. The effectiveness of surgical safety checklists cannot be fully measured or understood without an accurate assessment of implementation fidelity, most effectively through direct observations of the checklist process. Here, we describe the use of a secure audio recording protocol in conjunction with a novel standardized scoring system to assess checklist compliance rates.MethodsWe used a black box digital audio recording protocol to observe the execution of SSCs in real time. A novel checklist scoring system was used to quantify the implementation fidelity of a modified version of the SSC. Physician and staff perception of patient safety was also surveyed before and after implementation.ResultsAudio-recorded audits revealed a precisely executed checklist 73.6% of the time compared with a previously reported compliance rate of 97.6%. Implementation fidelity was highest during preanesthesia and preincision checklist sections, whereas postprocedure checklist compliance and fidelity was consistently the lowest. Positive attitudes on patient safety by surgical staff increased by 11% from baseline.ConclusionsThe use of a secure digital audio recording protocol is a simple yet effective tool for observing checklist performance. Moreover, the implementation of a standardized scoring system allows for the objective evaluation of checklist fidelity. Together, they provide a powerful auditing tool for identifying improvement.