WHO Safety Checklist Research Articles

Exploring attitudes toward safety climate: a cross-sectional study among interventional radiology team members using the Safety Attitudes Questionnaire (SAQ)

BackgroundInterventional radiology (IR) has evolved into a well-established medical discipline known for its minimally invasive procedures. Establishing a culture of safety in IR settings is crucial to improve patient safety and quality of care. This study describes and compares attitudes about patient safety among professionals working with IR in Sweden. In addition, this study evaluates whether the WHO Safety Checklist for IR is routinely used for radiological interventions.MethodsThis cross-sectional survey uses an electronic questionnaire to collect data from 25 IR units. The attitudes of IR team members (radiographers, physicians, nurses, and assistant nurses) were assessed using the Swedish Safety Attitudes Questionnaire (SAQ), which was adapted for this context.ResultsThe two highest factor scores/percentages of positive responses from the IR team were found for job satisfaction (90/94%) and teamwork climate (85/92%), and stress recognition had the lowest values (54/25%). The attitudes were relatively consistent, with few significant differences between the professions (Factor scores: P = 0.039 for job satisfaction, and P = 0.050 for working conditions. Percentage of positive responses: P = 0.027 for perceptions of management). The radiographers tended to have slightly lower values compared to the other professions among these factors (P < 0.05). The WHO safety checklist for IR was not being used on a regular basis, but the respondents recognized its importance for patient safety.ConclusionsThis study shows high factor scores for the different safety climate factors, with job satisfaction having the highest values. Areas that need improvement are perceptions of management and stress recognition. Attitudes were consistent across professions in the IR team, but radiographers had slightly lower values in some aspects.

307 Intraluminal Migration of Gossypiboma and rectal expulsion an unusual Case- Case Report

Abstract Background Gossypiboma refers to foreign body retained in the body at the end of operation and can be in the form of gauze, sponge or any form of textile resulting in grave consequences for both the patient and the surgeon. Case Summary A 23-year-old female presented with complain of generalized abdominal pain along with non-bilious vomiting since 10 days. She also had relative constipation since four days. Her past surgical history was unremarkable except for three elective lower segment caesarean sections at another hospital. Upon abdominal examination, she had a scar of pfannenstiel incision along with 3x4 cm swelling in umbilical region with positive cough impulse. Her bowel sounds were exaggerated. DRE was unyielding. Clinical diagnosis of subacute intestinal obstruction was made and she was managed conservatively. Ultrasound abdomen showed dilated gut loops with hyperperistalsis. It also revealed a defect measuring 8.5 cm in the supraumbilical region of anterior abdominal wall through which fat content was seen protruding. She was advised contrast enhanced CT abdomen, developed diarrhoea and later on expelled the surgical sponge per rectally. After passage of surgical sponge, condition of patient improved and symptoms resolved. Discussion Diligent efforts are required to prevent this human error by ensuring meticulous sponge count, use of radio-opaque sponges, adjunctive use of WHO safety checklist and introduction of new advancements like tagging system in our healthcare system. Conclusion Gossypiboma is under-reported due to reluctance of institutions to report it to governing body. Reporting of such dreadful complications of surgery and analysis of their root cause should be done to prevent such events from happening.

Comparing compliance with the WHO surgical safety checklist and complication rates in gynecologic surgery between day and night shifts

PurposeAt least half of surgical complications can be avoided by using surgical checklists. However, universal implementation and compliance have been reported as being variable. Patients undergoing urgent surgical intervention are at increased risk for complications. The aim of this study was to evaluate the checklist compliance together with the complication rate during day and night shifts in a European University hospital.Methods51 and 52 consecutive patients who had surgery during day and night shifts were included. The primary outcome measures were compliance and completeness of the WHO safety checklist. The occurrence of postoperative complications was investigated.ResultsThe analysis included 103 surgical procedures. The mean compliance rate of use was 93% and the mean completeness rate was 22%. After operations were broken down by day or night shift, we found that checklists were less often available in night shifts compared to day shifts. The completeness of the checklist and the occurrence of postoperative complications did not differ between day and night shifts.ConclusionThis study reports worse checklists availability in night shifts when compared to day shifts, but complication rates did not increase. Further studies are warranted to investigate postoperative complication rates together with checklist compliance in day versus night shifts.

The importance of a safety checklist and strategic rest breaks in gynaecological laparoscopy

This study focuses on the importance of a safety checklist for gynaecological laparoscopic surgeries. Although several general safety checklists are used in practice (e.g.: The WHO Safety Checklist), there is no dedicated safety checklist for gynaecological laparoscopic surgeries. Our aim is to introduce a safety checklist dedicated to gynaecological laparoscopy. It is based on our experience in performing various gynaecological laparoscopic surgeries in a tertiary care center with a substantially high workload. It has been compiled after studying the complications occurring in areas covered by the aforementioned checklist. We present data from 776 cases performed over 4 years at the Professorial Unit in Obstetrics and Gynaecology affiliated to the University of Sri Jayewardenepura, at Colombo South Teaching Hospital, Kalubowila, Sri Lanka. The mean surgical time and complications associated with patient positioning have been assessed. Complications associated with the areas assessed were found to be of low incidence. However, we believe that these can be reduced further by the introduction of a checklist specifically tailored for gynaecological laparoscopy.

Assessing, grading, and reporting intraoperative adverse events during and after surgery.

Intraoperative adverse events (iAEs) are under-reported, have poorly standardized nomenclature, and are plagued by barriers to reporting and cultural acceptance. Not surprisingly, although surgeons are willing to report iAEs, they often under-report these events, especially those of lower severity, owing to perceived clinical insignificance1. Attempts to overcome reporting deficits with surgical black-box systems, otherwise known as medical data recorders, have continued to receive pushback despite the potential benefits for quality improvement2,3. Until these systems gain further traction, integration of iAE reporting into the sign-out portion of the WHO safety checklist might be a useful aide-memoire4,5. Barriers to reporting, such as institutional, emotional, and litigious concerns, remain challenging to overcome6. Further, the intransigent blame culture continues to detract from a universally shared goal of improved patient safety6. The, regrettably, common lack of institutional support for litigation concerns, and an absence of clear definitions of what should be reported and how to report, might be surmountable with improved awareness of available resources. There are several iAE classification systems available, including, but not limited to: Modified Satava, the iAE severity classification system (Massachusetts General Hospital), the European Association of Surgical Endoscopy classification7,8, intraoperative adverse incident classification (European Association of Urology)9, and the classification of intraoperative adverse events (ClassIntra®)10. These systems are universally available and can be used to clearly delineate what constitutes an iAE. However, with the exception of ClassIntra®, many of these systems have yet to be validated and are known to have high inter-rater variability10–13. In the absence of a single best system, a vital first step is to record and grade iAEs prospectively, regardless of which system is chosen, so that we can move on to understanding the real-world implications of iAEs. Although these classification systems are useful for grading iAEs, they stop short of providing guidelines for reporting in publications or daily practice.

From box ticking to the black box: the evolution of operating room safety.

Efforts to improve the safety of patients in the operating room have focused on mitigating harm through the standardization of system, team, and human level factors. This article highlights existing and future methods for enhancing safety in the perioperative setting, and the theory and principles that underpin them. Evidence surrounding the development and implementation of select surgical safety interventions is discussed. Work in human factors and engineering that has inspired safety interventions such as the WHO Safety Checklist, and more recently operating room recorders, represents a movement away from traditional, retrospective or reactive methods of studying surgical safety, to prospective and proactive ones. Future work will examine the effectiveness of these interventions for improving patient outcomes and minimizing iatrogenic harm.

Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology.

The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.

Exploring nurses' use of the WHO safety checklist in the perioperative setting

To explore nurses' use of the World Health Organization safety checklist in the perioperative setting. Promoting quality and safety in health care has received worldwide attention. The World Health Organization surgical safety checklist (2009) is promoted for reducing postoperative morbidity and mortality. The checklist has been introduced in Irish perioperative settings. A descriptive, qualitative approach was utilised. A purposeful sample of ten nurses participated in individual, semi-structured interviews. Participants were committed to promoting safety in navigating challenges in introducing, complying and accepting the value of the World Health Organization surgical safety checklist in concordance with best practice. Participants moved from task completion to embracing the checklist as an effective surgical safety checking tool. Challenges were identified around roles and responsibilities in overseeing the completion of the checklist. The management of processes is critical when implementing any safety initiative. This paper highlights the complexity and challenges in implementing the World Health Organization surgical safety checklist, contributing to global discussions around translating policy into practice. The effective implementation of a checklist requires a coordinated management approach in collaboration with team members. These approaches will support learning experiences contributing to a shared understanding of the change being implemented by all team members.

Evidenzbasierung von Instrumenten zur Verbesserung der Patientensicherheit in der Chirurgie

Errors occurring in surgical procedures often have serious consequences for the patients. For this reason various measures have been designed over the past few years to ensure a greater level of patient safety in surgery. One such measure is the implementation of the WHO safety checklist in German hospitals. The benefits of this checklist on postoperative complications have been substantiated by evidence from EbM level II studies and meta-analyses. The application of further tools such as the systematic rating of hospitals in terms of defined operative procedures would appear theoretically rational, but has not been demonstrated by studies with a higher level of evidence.

Leak in Surgical Safety Checklist?

Material and methods We report a case that has taken place in our department, supplemented by literature review. Modified WHO Safety Checklist has been used in our department since a couple of years ago. Although “Team Time Out” was performed standardly following unpleasant situation happened: after an elective arthroscopy, while the surgeon finished documentation, the responsible nurse informed him that the indicator strip for sterility did not show any discoloration. No one of the operating room personal knew whether the indicator strip was not checked or if it had been overlooked although a modified WHO Surgical Safety Checklist was performed carefully. Subsequently the question arose, what does it mean to the patient if surgical instruments were not sterilized but only cleaned by Washer-Disinfector.

Patient safety in the operating room at a governmental hospital

Patient safety is a fundamental principle of healthcare; it is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical errors that often lead to adverse healthcare events. The aim of this study is to aid any hospital in attaining better quality of patient care in the operating room (OR) by achieving patient safety according to the WHO safety guidelines. Specific objectives include the assessment of patient safety status in OR, the identification of hazards, and the assessment of risks that jeopardize this safety. This is a descriptive observational study carried out in three ORs of a governmental hospital. The study was carried out from December 2008 through April 2009. A total of 100 patients undergoing general surgical and urological surgical procedures were selected. The data collection tools included the WHO surgical safety checklist, nonstructured interviews, patient records, anesthesia checklist, and the risk assessment matrix. According to the WHO safety checklist, patients' safety was checked during three stages. During the 'sign in' stage, only 3% of all the patients had the operation site marked for surgery and an incident of a single wrong side surgery was recorded. There was a clear lack of communication between doctors and patients. During the 'time out' stage, 80% of surgeries lacked organized discussion among surgical team members for anticipated critical events. Prophylactic antibiotics were administered to 59% of patients undergoing surgeries. The 'sign out' stage was properly carried out in 100% of the procedures. Risk assessment in the 'sign in' stage showed six of 11 procedures leading to a major risk to patients. Also, in the 'time out' stage, three of eight procedures had a major risk. To reach an optimal level of patient safety in the OR, it is recommended that the checklist should be implemented as part of the daily surgical routine. Identification of the hazards to which patients could be exposed and assessment of risks must be the ultimate goal in any OR.

Accuracy of red dot in clinical practice

s / Clinical Radiology 67 (2012) S11–S20 S20 of red dot in clinical practice Authors: Sachin Yallappa, Dominic Clarke, Jill Elizabeth Minford Background to the audit: This study was performed to determine the accuracy of radiographer's red dot radiographs in a community hospital clinical practice with collaboration with Minor injury unit. Standard, indicator and target: standard is deprived from Accuracy of Radiographer's Red dot or triage of accident and emergency radiographs in clinical practice: a systematic review. Clinical Radiology (2006) 61, 604605. Indicator: sensitivity and specificity measurements compared with the standard. Target: Sensitivity-91%, Specificity-95% derived from standard. Methodology: Between August 2011 to November 2011, 499 consecutive patients had extremity radiographs in the context of acute trauma. Out of 499 radiographs 488 radiographs were assessed (11 patients excluded due to inconclusive reporting). Radiographs, with and without red dot as marked by the radiographers were compared with the consultants Radiologist report. Datawere collected retrospectively fromCRIS / PACS system. Results of 1st audit round: The current study had sensitivity and specificity of 0.95 and 0.94 with PPV of 87% and NPV of 98%. 1st action plan: Radiographic red dot marking in current study demonstrated radiographers excellent performance and compares favorably to nationally published data. There is a significant potential to reduce clinical errors in trauma extremity radiographs. Quantitative assessment could be followed by qualitative if narrative descriptors of fractures became routine practice. Potential for repeat audit to demonstrate persistence of high standards. WHO safety checklist audit Author: Gibran T. Yusuf Background to the audit: This audit assesses completion of the WHO safety checklist for interventional radiology in a tertiary centre. The WHO interventional radiology checklist is based on the recent surgical checklist. The principle is potential communication errors are eradicated reducing avoidable complications. The checklist is new to radiology and deemed mandatory. It is critical to ensure uptake to avoid potential complications and comply with national objectives. Standard, indicator and target: The WHO checklist is now a requirement and compliance should be 100% Methodology: 100 cases attending for interventional radiology were analysed. Sign in, sign out and the pre-attendance ward checklist were checked for completion. In cases where general anesthetic was used time out was also checked. Results of 1st audit round: 100 cases analysed were analysed at a tertiary centre. The majority of which were angiogram/angioplasty and chemoembolisation. The pre-intervention ward checklist was completed in 82%. Sign in was performed in 83%, however sign out was only performed in 65%. When general anaesthetic was used only 50% had time out read. 1st action plan: Findings have been presented at a joint meeting to raise awareness. Alteration of the checklist to create a user-friendly approach and place an onus on the interventionalist to become a named responsible individual. The new checklist is due to be introduced and will be reaudited when in circulation.

WHO safety checklist audit

Background to the audit: This audit assesses completion of the WHO safety checklist for interventional radiology in a tertiary centre. The WHO interventional radiology checklist is based on the recent surgical checklist. The principle is potential communication errors are eradicated reducing avoidable complications. The checklist is new to radiology and deemed mandatory. It is critical to ensure uptake to avoid potential complications and comply with national objectives.