Surgical Safety Checklist Research Articles

Using OR Black Box Technology to Determine Quality Improvement Outcomes for In-situ Timeout and Debrief Simulation.

The purpose of this study was to determine quality improvement outcomes following the pilot implementation of an in-situ simulation designed to enhance surgical safety checklist performance. OR Black Box (ORBB) technology allows near real-time assessment for surgical safety checklist performance. Before our study, timeout quality was 73.3%, compliance was 99.9%, and engagement was 89.7% (n=1993 cases); Debrief Quality was 76.0%, compliance was 66.9%, and engagement was 66.7% (n=1842 cases). This IRB-approved study used prospective convergent multi-methods. During 2 months, a 15-minute in-situ simulation, incorporating rapid cycle deliberate practice, was implemented for OR teams. ORBB analytics generated Timeout and Debrief scores for actual operations performed by surgeons who participated in simulation (Sim-group) versus those who did not (No-sim group) over 6 months, including 2 months pre-intervention, during-intervention, and post-intervention. Inductive content analysis was performed based on simulation discussions to determine team member perspectives. Thirty simulations with 163 interprofessional participants were conducted. ORBB data from 1570 cases were analyzed. Scores were significantly better for the Sim-group compared with the No-sim group for debrief quality (84% vs. 79% P<0.001, during-intervention), compliance (73% vs. 66%, P<0.001, post-intervention), and engagement (80% vs. 73%, P=0.012, during-intervention). There were no between-group differences for Timeout scores. Thematic analysis identified 2 primary categories: "culture of safety" and "policy." This simulation-based QI intervention created a psychologically safe training environment for OR teams. The novel use of ORBB technology facilitated outcome analysis and showed significantly better Debrief scores for simulation-trained surgeons compared with nontrained surgeons.

Why the checklist works: the interplay of non-technical skills and the WHO surgical safety checklist in variable resource healthcare settings

Why the checklist works: the interplay of non-technical skills and the WHO surgical safety checklist in variable resource healthcare settings

109 Compliance Rates of the WHO’s Surgical Safety Checklist, Within a District General Hospital’s ENT Department

109 Compliance Rates of the WHO’s Surgical Safety Checklist, Within a District General Hospital’s ENT Department

Impact of educational intervention among nurses on implementation of surgical safety checklist at a tertiary care teaching institute

Impact of educational intervention among nurses on implementation of surgical safety checklist at a tertiary care teaching institute

FACTORS RELATING TO NURSES' COMPLIANCE IN IMPLEMENTING THE SURGICAL SAFETY CHECKLIST : A SCOPING REVIEW

Backround: One component of Safe procedure Saves Lives is a surgical safety checklist (SSC), which serves as a tool for the surgical team to utilize in the operating room to ensure that the procedure is both safe and of high quality, SSC compliance cannot be separated from the factors that influence it, therefore we need to know these factors to overcome SSC problems SSC compliance cannot be separated from the factors that influence it, therefore we need to know these factors to overcome SSC problems. This article aims to obtain a comprehensive picture of the factors related to nurse compliance in implementing the Surgical Safety Checklist. Design: This study uses the Arksey and O'Malley model to conduct the analysis. Data Source: The analyzed literature consisted of Scholar, Science Direct, and Pubmed from January 2016 to June 2023. Identification and selection of literature used Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Moher 2009. Result: The results were 15 articles that were analyzed, consisting of 12 quantitative articles, two descriptive articles, and one literature review article. This article summarizes findings regarding compliance in implementing the Surgical Safety Checklist, including attitudes, perceptions, motivation, knowledge, time for operations, age, length of work, education, teamwork, and nurse compliance. Conclusion: There is a relationship between 10 factor include attitudes, perceptions, motivation, knowledge, time for operations, age, length of work, education, teamwork, and nurse compliance. in the implementation of SSC.

How we WHO: why are we not more engaged with the WHO Surgical Safety Checklist?

How we <scp>WHO</scp>: why are we not more engaged with the <scp>WHO</scp> Surgical Safety Checklist?

Attitudes towards surgical safety checklists among American College of Veterinary Surgeons diplomates.

To examine attitudes towards surgical safety checklists (SSCs) among American College of Veterinary Surgeons (ACVS) diplomates and to identify barriers to implementation. Qualitative online research survey. A total of 1282 current ACVS diplomates. An anonymous online survey was distributed to current ACVS diplomates via email. ACVS diplomates were identified using publicly available data through the ACVS website. A total of 1282 surveys were electronically distributed, and respondents were given 4 weeks to respond. The survey consisted of 34 questions examining (1) demographic information, (2) current use of SSCs, (3) knowledge and attitudes towards SSCs, (4) perceived advantages and disadvantages to use of SSCs, (5) implementation strategies, and (6) potential reasons for noncompletion of SSCs. Survey response rate was 20% (257/1282). A total of 169 of 249 (67.9%) respondents indicated using SSCs. Respondents generally agreed that SSCs were proven to reduce surgical complications (196/249 [78.7%]) and did not perceive any disadvantages to use (100/138 [75.2%]). Respondents not using SSCs were more likely to perceive them as a waste of time (p < .001). The most common reasons for noncompletion of SSCs were forgetfulness (21/52 [39.6%]) and time constraints (19/52 [36.5%]). Improved training (72/138 [52.2%]) and modifying the SSC based on staff feedback (69/138 [50%]) were suggested as methods to improve SSC uptake. Respondents currently using SSCs were generally satisfied. Time constraints and memory related issues were common causes for noncompletion of SSCs. Efforts to expand the implementation of SSCs in veterinary surgery should focus on improved engagement of relevant stakeholders and modification of the SSC to suit local conditions.

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.

Perioperative patient safety indicators-A Delphi study.

To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context. A modified Delphi method. A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study. The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment. Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety. This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement. The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care. The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'. No patient or public contribution.

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.

Refining Successful Implementation Strategies for the Surgical Safety Checklist in High-Income Contexts: Results of an International Mixed Methods Study

Refining Successful Implementation Strategies for the Surgical Safety Checklist in High-Income Contexts: Results of an International Mixed Methods Study

THE MODERATION ROLE OF SAFETY LEADERSHIP IN INFLUENCING A CULTURE OF PATIENT SAFETY

Background This research is motivated by several problems related to patient safety in central surgical installations from 2020 to 2022. The aim of this research is to empirically reveal the influence of interprofessional collaboration and the implementation of the surgical safety checklist on patient safety culture with safety leadership as a moderating variable. Methods This research is motivated by several problems related to patient safety in central surgical installations from 2020 to 2022. The aim of this research is to empirically reveal the influence of interprofessional collaboration and the implementation of the surgical safety checklist on patient safety culture with safety leadership as a moderating variable. Results The results of the three-box method analysis concluded that interprofessional collaboration, implementation of the surgical safety checklist and patient safety culture were at the medium index, and safety leadership was at the high index. Hypothesis testing proves that simultaneously interprofessional collaboration, implementation of the surgical safety checklist and safety leadership have an effect on patient safety culture with a p value of 0.000. Partially, interprofessional collaboration has an effect on patient safety culture with a t-value of 4.900, implementation of the surgical safety checklist with a t-value of 4.444, safety leadership with a t-value of 4.740. Conclusion The moderation test concluded that safety leadership did not moderate the influence of interprofessional collaboration on patient safety culture with a t-value of 1.175, but moderated the influence of the implementation of the surgical safety checklist on patient safety culture with a t-value of 2.739.

Factors Related to the Completeness of Electronic Surgical Safety Checklist Documentation in Banyumas Public Hospital

Background: Patient safety in surgery is a program established by the WHO and is a standard for accreditation by KARS, implementing the electronic surgical safety checklist. This has been proven to reduce patient safety incidents in the surgical room. Method: This quantitative research used a descriptive correlation design with a cross-sectional approach. A total sampling technique was employed, involving 34 surgical nurses in the Central Surgical Installation of RSUD Banyumas, who met the inclusion and exclusion criteria. The research instrument utilized an observation sheet based on the surgical safety checklist Standard Operating Procedure (SPO) at RSUD Banyumas. Data analysis was conducted using the chi-square test. Results: The results of the study revealed that the majority of nurses were male (70.6%), aged between 31-40 years (41.2%), and above 40 years (41.2%), with a DIII level of education (70.6%), and work experience of 1-5 years (44.1%), and they completed the electronic surgical safety checklist documentation (67.6%). Age, education level, and work experience correlate with the completeness of electronic surgical safety checklist documentation at RSUD Banyumas (p-value ? ?). Conclusion: Age, education level, and work experience related to the completeness of electronic surgical safety checklist documentation at RSUD Banyumas.

PENGISIAN SIGN IN DALAM MENINGKATKAN KEPATUHAN SAFE SURGERY DI RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA II

Background: Complications and deaths due to surgery become one of the global health problems. World Health Organization estimates that at least half a million deaths due to preventable surgical. An effort to improve the quality of surgical services including the Surgical Safety Checklist to use made by World Health Organization. Compliance to use this surgery checklist which is can increase the number of safe surgery,reduce the wrong site surgery and nearmiss.&#x0D; Method: This research is a qualitative action research design. The study population was all the doctors and nurse anesthetist. Number of samples 6 people. The data is collected by observation sheet Surgical Safety Checklist: Sign In RS PKU Muhammadiyah Yogyakarta Unit II for 3 cycles of observation.&#x0D; Result and Discussion: The results of observations on the first to the third cycle shows that all disobeying nurse anesthetist (100%) the Surgical Safety Checklist to fill: Sign In. The results of the response every cycle and a structured interview with the anesthesiologist showed that nurses are still confused how to use the checklist, the checklist has not been a necessity, the culture of patient safety is still minimal, lack quality of human resources, lack of supervision and lack of socialization mechanisms Surgical Safety Checklist noncompliance that influence nurses Sign In to to fill.&#x0D; Conclusion: Completing Sign In in the installation of surgery center in PKU Muhammadiyah Yogyakarta Unit II Hospital is noncompliance, because they still haven’t got the identity bracelet mounted on a patient who will be operating and marking the location of a rare surgery. Advice to hospital are to create a Standard Operating Procedure (SOP), SOP socialize regularly, make in-house training, increase the commitment of doctors and nurses, create a surveillance system, create a system of reward and punishment.

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

Surgical safety checklist compliance process as a moral hazard: An institutional ethnography.

Charting is an essential component of professional nursing practice and is arguably a key element of patient safety in surgery: without proper, objective, and timely documentation, both benign and tragical errors can occur. From surgery on wrong patients to wrong limbs, to the omission of antibiotics administration, many harms can happen in the operating room. Documentation has thus served as a safeguard for patient safety, professional responsibility, and professional accountability. In this context, we were puzzled by the practices we observed with respect to charting compliance with the surgical safety checklist (SSC) during a study of surgical teams in a large, urban teaching hospital in Canada (pseudonym 'C&C'). This article leverages institutional ethnography and a subset of data from a larger study to describe and explain the social organisation of the system that monitored surgical safety compliance at C&C from the standpoint of operating room nurses. This data included fieldnotes from observations of 51 surgical cases, on-the-spot interviews with nurses, formal interviews with individuals who were involved in the design and implementation of the SSC, and open-ended questions from two rounds of survey of OR teams. We found that the compliance form and not the SSC itself formed the basis for reporting. To meet hospital accuracy in charting goals and legislated compliance documentation reporting requirements nurses 'pre-charted' compliance with the surgical checklist. The adoption of this workaround technically violated nursing charting principles and put them in ethically untenable positions. Documenting compliance of the SSC constituted a moral hazard, constrained nurses' autonomy and moral agency, and obscured poor checklist adherence. The findings highlight how local and extra local texts, technologies and relations create ethical issues, raise questions about the effectiveness of resulting data for decision-making and contribute to ongoing conversations about nursing workarounds.

The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway

BackgroundIn spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams’ perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department.MethodsThis qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke’s method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes.ResultsThe analysis process resulted in three themes describing the participants’ perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning.ConclusionsThis study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals’ competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.

Antibiotics Prophylaxis Practice in Arthroplasty Surgeries.

Background Infection in orthopedic surgery is one of the most dreaded complications. It is associated with prolonged morbidity, disability, and increased mortality. One of the cornerstones of the prevention of infections is antibioticprophylaxis. This study assessed the practice of antibiotic prophylaxis in arthroplasty surgeries in our local hospital. Methods One hundred and seventy-one elective joint replacement patients were retrospectively analyzed for documentation of antibiotic plan in postoperative instruction, choice of antibiotic, dose, anddosage. Compliance with the dosage (duration and frequency) of antibiotic prophylaxis was compared among patients who underwent different operations, among patients whose operation notes had antibiotics plans, and among those patients whose operation notes lacked this information. Results Ninety-six females and 75 males with a mean age of 71.4±9.8 years who underwent hip replacement, knee replacement, or shoulder replacement were included in this study. Preoperative and postoperative antibiotics were received by 100% and 94.7% of patients, respectively. In 19.3%, there was no instruction about postoperative antibiotics while 4% missed at least one postoperative dose. The dosage of postoperative prophylactic antibiotics was variable as 26.3% of the patients experienced delayed administration of doses. Not having intravenous access, failure to prescribe antibiotics, and prescribing antibiotics in the "once only" rather than "regular medication" section of the medication chart were the reasons for improper timing of antibiotic doses. Observing surgical safety checklist was effective in ensuring preoperative antibiotic administration, whereasfailing to document antibiotic plan in operation note was associated with poor compliance with postoperative dosage. Interprofessional participation is crucial to compliance with antibioticprophylaxis practice. Conclusion This study identified key areas for improvement in our antibiotics prophylaxis practice. It resulted in implementing strategies to improve staff's awareness about the importance of timely administration of prophylactic antibiotics and proper documentation by all team members.

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.