Implementation Of Surgical Safety Checklist Research Articles

Implementation of Surgical Safety Checklist : Literature Review

Background: Health services provided to patients must not only be of high quality but also appropriate and prioritize patient safety, including patients undergoing surgery in hospitals. WHO in 2007 has provided recommendations for using a surgical safety checklist (SSC) to improve patient outcomes. However, its application in the operating room is influenced by many factors and is still a challenge for surgeons, anesthesiologists and for nurses in filling out the SSC. Therefore, it is very important to conduct a literature study to be able to find and describe previous studies that have been published, so that the results of this literature review can contribute to the implementation of SSC filling for the better. Methods: This literature study used 2 databases and from other sources. The search results found that there were 123 articles from Pubmed data based, 94 articles from Science Direct and there were 15 articles from other sources. However, only 12 articles were eligible for further review (included). Results: the literature study found that the compliance of SSC filling was around 67% to almost 100%. Some of the barriers in implementing SSC filling are: lack of initiative, lack of support from senior surgeons and weak teamwork. Conclusion: educational intervention is very effective in improving SSC completion compliance.Keywords: Surgical safety checklist , Hospital

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.

Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi

BackgroundThe WHO introduced the Surgical Safety Checklist (SSC) in 2008, which has been proven to enhance collaboration and patient safety before, during and after surgical procedures. However, the impact of...

Implementation of the Surgical Safety Checklist in Central Surgical Unit of Santo Antonius Hospital Pontianak

Surgical Safety Checklist (SSC) is a patient safety procedure in the form of a checklist created by WHO as the basis for actions carried out by the surgical team. The aim is to find out an overview of the Implementation of the Surgical Safety Checklist. This research is quantitative descriptive observational. Checklist sheet instrument. Sample of 69 surgical patients using accidental sampling technique. The results of more than half of the implementation of SSC, namely 41 operations (59.4%) were in the poor category because the surgical team was less consistent in carrying out SSC in each phase, namely more than half of the implementation of sign-in, 39 operations (56.5%) were insufficient, the implementation of time out was 35 surgery (50.7%) was lacking and the implementation of sign out was 45 operations (65.5%) lacking. Conclusion: The implementation of the Surgical Safety Checklist in the Central Surgical Unit at Santo Antonius Hospital Pontianak is in the poor category.

CheckPOINT: a simple tool to measure Surgical Safety Checklist implementation fidelity

IntroductionThe WHO Surgical Safety Checklist (SSC) is a communication tool that improves teamwork and patient outcomes. SSC effectiveness is dependent on implementation fidelity. Administrative audits fail to capture most aspects...

Perceptions of Patient Safety Among Middle Managers at an Operating Suite

In 2008, the World Health Organization launched the Surgical Safety Checklist (SSC) to reduce the number of adverse events occurring at operating suites. The objective of this study was to explore middle managers’ experiences of patient safety culture, the meanings they attach to this culture, and their perceptions of one of its best-known strategies, the SSC. This study used a qualitative design involving structured interviews with the head of department, quality managers, and nursing supervisors at an operating suite. Eleven middle managers acknowledged that the SSC supports memory and instils accountability. Work overload was highlighted as the main barrier in SSC implementation, while feedback was identified as the main facilitator. We found significant differences in levels of understanding of patient safety culture among different types of middle managers and professions. Key aspects for promoting an effective, long-lasting patient safety culture were also identified.

Compliance With and Barriers to Implementing the Surgical Safety Checklist: A Mixed-Methods Study.

This mixed-methods study aimed to determine nurses' views on the use of the Turkish version of the World Health Organization's Surgical Safety Checklist (SSC). Phase 1 of the study consisted of a survey of perioperative and surgical nursing unit nurses' perceptions on the use of the SSC. The results showed that personnel believed that every step of the checklist was not always applied and that an increased workload and the lack of team cooperation negatively affected the use of the checklist. Phase 2 of the study involved RN circulator interviews and focused on their experiences using the SSC, the obstacles to SSC implementation, and ways to increase compliance. We interviewed 126 nurses during phase 1 and 20 nurses during phase 2. We analyzed the interviews and identified three themes: the importance of using the SSC, barriers to using the checklist, and compliance with the checklist and applicability.

Using i-PARIHS to assess implementation of the Surgical Safety Checklist: an international qualitative study

BackgroundStrategies selected to implement the WHO’s Surgical Safety Checklist (SSC) are key factors in its ability to improve patient safety. Underutilization of implementation frameworks for informing implementation processes hinders our understanding of the checklists’ varying effectiveness in different contexts. This study explored the extent to which SSC implementation practices could be assessed through the i-PARIHS framework and examined how it could support development of targeted recommendations to improve SSC implementation in high-income settings.MethodsThis qualitative study utilized interviews with surgical team members and health administrators from five high-income countries to understand the key elements necessary for successful implementation of the SSC. Using thematic analysis, we identified within and across-case themes that were mapped to the i-PARIHS framework constructs. Gaps in current implementation strategies were identified, and the utility of i-PARIHS to guide future efforts was assessed.ResultsFifty-one multi-disciplinary clinicians and health administrators completed interviews. We identified themes that impacted SSC implementation in each of the four i-PARIHS constructs and several that spanned multiple constructs. Within innovation, a disconnect between the clinical outcomes-focused evidence in the literature and interviewees’ patient-safety focus on observable results reduced the SSC’s perceived relevance. Within recipients, existing surgical team hierarchies impacted checklist engagement, but this could be addressed through a shared leadership model. Within context, organizational priorities resulting in time pressures on surgical teams were at odds with SSC patient safety goals and reduced fidelity. At a health system level, employing surgical team members through the state or health region resulted in significant challenges in enforcing checklist use in private vs public hospitals. Within its facilitation construct, i-PARIHS includes limited definitions of facilitation processes. We identified using multiple interdisciplinary champions; establishing checklist performance feedback mechanisms; and modifying checklist processes, such as implementing a full-team huddle, as facilitators of successful SSC implementation.ConclusionThe i-PARIHS framework enabled a comprehensive assessment of current implementation strategies, identifying key gaps and allowed for recommending targeted improvements. i-PARIHS could serve as a guide for planning future SSC implementation efforts, however, further clarification of facilitation processes would improve the framework’s utility.Trial registrationNo health care intervention was performed.

235 A Closed Loop Clinical Audit on the Implementation of WHO Surgical Safety Checklist at a Tertiary Hospital in India

Abstract Aim To complete an audit on the level of compliance to the WHO surgical safety checklist in surgical operating theatres at a tertiary hospital in India. Method A total of 40 surgical operations were observed at the operating theatres at a tertiary hospital to confirm the practice of the WHO surgical safety checklist which formed the prospective part of our study. The study was conducted for a period of 2 months starting from July to August 2021. The results were then compared with standard guidelines and analyzed. Interventions were carried out by a series of rigorous meetings and discussions with the medical and the nursing staff. Results were re-audited after 2 weeks. Results Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80% and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%. Conclusion Compliance is seen to be greater in major surgeries than in minor surgeries. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for successful implementation of the Surgical safety checklist.

WE3.12 A Closed Loop Clinical Audit on The Implementation of WHO Surgical Safety Checklist at a Tertiary Level Hospital in India: Where do we stand?

Abstract Aim To complete an audit on the level of compliance to the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India. Method A total of 40 general surgeries were observed at the operating theatres at a tertiary level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for a period of 2 months starting from July to August 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out by a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted after 2 weeks. Results Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80% and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%. Conclusion Though in the first cycle of our audit the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle after rigorous awareness programs and training sessions. Compliance was seen to be greater in major surgeries than in minor surgeries. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for successful implementation of the Surgical safety checklist.

How to WHO: lessons from aviation in checklists and debriefs.

The World Health Organization (WHO) surgical safety checklist (SSC) has had an overall positive impact; however, it has not completely prevented adverse events and compliance with the checklist varies. The aviation industry is considered to have better engagement with their safety checklists, reporting not only safety improvements, but also a cultural shift in their checklist philosophy over recent years. We explored the personal attitudes of pilots working in the aviation industry to identify principles of an effective checklist philosophy that could be transposed to the healthcare setting to empower more effective, consistent and ultimately successful implementation of the WHO SSC. A questionnaire was developed by the authors. Three airline pilots were interviewed via telephone, and asked questions regarding the logistics of and attitudes to checklists in the aviation industry. Several key factors for successful checklist implementation were identified. These include regular training and education on human factors and the checklist's purpose, and institution of an atmosphere that is receptive, engaged and welcoming. Much can be learned from the aviation industry, where not only has the incidence of adverse events decreased, but the attitudes of people working in the industry have also transformed. The WHO SSC is an invaluable tool used in healthcare settings worldwide. However, it is not a standalone commodity. To be effective, it necessitates steadfast engagement from the team members involved in its implementation. Human and checklist must work in partnership, using each other's strengths and fallibilities, to optimise outcomes and prevent risks to patient safety.

The Effectiveness of Implementation of Surgical Safety Checklist in Different Countries: A Systematic Review

<p id="p00000"><strong>Background:</strong> The Surgical Safety Checklist (SSC) was created by the World Health Organization to improve patient safety and studies have shown that this checklist can significantly improve perioperative outcomes in surgical patients. However, some studies from developed areas have reached contradictory results. This review is intended to evaluate the different impacts of the SSC between countries with low human development index and countries with high human development index. <p id="p00005"><strong>Methods:</strong> A systematic review was performed to identify all studies on the effects of the SSC on postoperative complications, which were published from January 1, 2009 to November 30, 2018, with no language restrictions. Seven electronic databases PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), the Cochrane library, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI) were searched. <p id="p00010">Data extracted and synthesized by using standard forms, two authors independently identified studies on inclusion decisions and extracted study characteristics. If two authors had different opinions on a study, a third author was asked to adjudicate. <p id="p00015"><strong>Results:</strong> Eleven articles met the inclusion criteria. Five studies were from countries with low human development index; the other six were from countries with high human development index. Results indicated that the SSC led to reduced complications (RR, 0.48; 95% CI, 0.25-0.93; P = 0.03) in countries with low human development index. <p id="p00020"><strong>Conclusion:</strong> The SSC can more effectively reduce postoperative complications in countries with low human development index. It suggests that the implementation of the SSC can help make up for the deficiencies of the medical system and improve the safety of patients undergoing surgery.

HUBUNGAN TINGKAT STRES KERJA PERAWAT DENGAN PELAKSANAAN SURGICAL SAFETY CHECKLIST DI KAMAR OPERASI

Introduction: Nurse work stress is a condition where nurses are faced with work demands that can result in physiological, psychological &amp; behavioral disorders and can affect performance. The purpose of this study was to determine the relationship of nurses work stress levels with the implementation of Surgical Safety Checklist in the operating room. Methods: This research method uses correlational with cross-sectional approach and 18 respondents with a sampling technique using the entire population. The independent variable in this study is the level of work stress nurses with the dependent variable implementation of the Surgical Safety Checklist. The research instrument used a questionnaire on nurses' work stress levels and the Surgical Safety Checklist observation sheet. Scatterplot analysis results obtained negative direction which means that the increase in the variable level of work stress nurses will be followed by a decrease in the implementation of the Surgical Safety Checklist. Result: The results of the correlation coefficient 0.637 with strong interpretation and t count 3.24 more than the results of t table 1.76 means that there is a linear relationship of. Conclussion: There are relationship of nurses work stress levels with the implementation of Surgical Safety Checklist in the operating room. Discussion for the results of research where the increasing level of work stress nurses, the implementation of the Surgical Safety Checklist decrease. The recommendation for further research is to conduct research into work stress factors for nurses with the impact that can result from work stress with a higher number of respondents

PATIENT SAFETY CHECKLIST IN NEUROANAESTHESIA: AN IMPACT ON PROTOCOL AND OUTCOME.

BACKGROUND: Surgical safety checklists is a common tool to prevent human fallacies and may help in avoiding complications .Major surgeries like neurosurgery need a thorough preparation and a specic checklist tailored to neurosurgery which may serve the purpose .So we intend to follow the neurosurgical safety checklist to elude anticipated complications. Objectives 1. To identify the adherence to various elements of the Modied WHO SSC for neurosurgery. 2. To analyse how a mandatory speciality-specic checklist practice can help in early identication of those interventions that are specic to neurosurgery, which can otherwise be overlooked. METHODOLOGY: Ÿ Study Design: Observational study Ÿ Duration of study: From May 2021 to August 2021. Ÿ Sampling Method: Convenience sampling Ÿ Sampling Procedure: Systematic Random Sampling. RESULT: This study was carried out in 77 patients undergoing various neurosurgery procedures and was found that none of the patients had diagnosis, procedure written on the name tag in pre-op period and ICP monitoring tools were not available. It was found that the anaesthesiologist as a safety list coordinator can implement the checklist ensuring minimal complications related to the surgery and also active involvement of all the members. CONCLUSION: The implementation of surgical safety checklist for Neurosurgery, by a designated checklist co-ordinator, can rectify anaesthetic and surgical facets promptly, without increasing the time required for the operation and also reduces the risk for post-op recovery.

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

BackgroundImplementation 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.MethodsWe 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.ResultsThe 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.ConclusionFactors 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.

Evaluation of Implementation the Principles of Surgical Safety Checklist in Operating Rooms of the Selected Hospital of Kermanshah University of Medical Sciences in 2018

Background: Although surgery is done for improving the patient’s condition, it can put every individual that undergoes surgery at risk of irreparable postoperative complications. One way to decrease the post-surgery complications is apply of surgical safety checklist. Objectives: This study aimed to evaluate the implementation of surgical safety checklist in operating rooms of the selected hospital of Kermanshah University of Medical Sciences in 2018. Methods: This cross sectional descriptive study was done by a checklist designed based on the surgical safety checklist on randomly selected 150 operations, in the selected hospital of Kermanshah University of Medical Sciences between January and May 2018. Results: According to the findings, 77.1% of the safe surgery standards are observed in the operating rooms of the selected hospital. 77.48% of the safe surgery standards are observed before anesthesia, 74.8% of the standards are observed after anesthesia and before incision, and 79.33% of the standards are observed after suturing the wound until getting the patient out of the operating room. The results of t-test showed that there is a significant difference between different operating rooms in terms of the implementation of surgical safety checklist (P &lt; 0.05). Conclusions: The findings show that implementation level of safe surgery standards was low. So, it's necessary to take specific measures for explain the importance of the items of this checklist and developing educational programs to explain the importance of the patients’ safety in operating rooms for the surgical staff.

A Scoping Review of Strategies Used to Implement the Surgical Safety Checklist.

In 2007, the World Health Organization initiated the Surgical Safety Checklist (SSC) as part of an initiative to improve patient outcomes. After publication of the SSC, perioperative nurses identified challenges with implementing it and questioned its effectiveness. We desired to summarize the state of the science on the effectiveness of strategies that perioperative personnel have used to implement and assess the SSC; therefore, we conducted a scoping review. We searched several databases and identified 28 articles that described the three key stages of SSC implementation (ie, before, during, and after). Half of the identified articles addressed intervention strategies and most articles provided strategies for SSC implementation. The literature also indicated that effective implementation occurred when there was adequate planning. Perioperative leaders should work with nurses when implementing the SSC and monitor its use after implementation to verify compliance and help prevent negative patient outcomes.

Use of a surgical safety checklist after implementation in an academic veterinary hospital.

To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. Voluntary online survey and retrospective study. All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.

Impact of the Norwegian National Patient Safety Program on implementation of the WHO Surgical Safety Checklist and on perioperative safety culture

ObjectivesOur primary objective was to study the impact of the Norwegian National Patient Safety Campaign and Program on Surgical Safety Checklist (SSC) implementation and on safety culture. Secondary objective was...

Implementation Strategies and the Uptake of the World Health Organization Surgical Safety Checklist in Low and Middle Income Countries: A Systematic Review and Meta-analysis.

To identify the implementation strategies used in World Health Organization Surgical Safety Checklist (SSC) uptake in low- and middle-income countries (LMICs); examine any association of implementation strategies with implementation effectiveness; and to assess the clinical impact. The SSC is associated with improved surgical outcomes but effective implementation strategies are poorly understood. We searched the Cochrane library, MEDLINE, EMBASE and PsycINFO from June 2008 to February 2019 and included primary studies on SSC use in LMICs. Coprimary objectives were identification of implementation strategies used and evaluation of associations between strategies and implementation effectiveness. To assess the clinical impact of the SSC, we estimated overall pooled relative risks for mortality and morbidity. The study was registered on PROSPERO (CRD42018100034). We screened 1562 citations and included 47 papers. Median number of discrete implementation strategies used per study was 4 (IQR: 1-14, range 0-28). No strategies were identified in 12 studies. SSC implementation occurred with high penetration (81%, SD 20%) and fidelity (85%, SD 13%), but we did not detect an association between implementation strategies and implementation outcomes. SSC use was associated with a reduction in mortality (RR 0.77; 95% CI 0.67-0.89), all complications (RR 0.56; 95% CI 0.45-0.71) and infectious complications (RR 0.44; 95% CI 0.37-0.52). The SSC is used with high fidelity and penetration is associated with improved clinical outcomes in LMICs. Implementation appears well supported by a small number of tailored strategies. Further application of implementation science methodology is required among the global surgical community.