WHO Surgical Safety Checklist Research Articles

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

Objectives: To assess the quality of the meta-analyses that review the WHO surgical safety checklist. Methods: 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. Results: 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. Conclusions: 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.

Unlocking Insights: Exploring Knowledge and Attitudes on the WHO Surgical Safety Checklist among Operating Room Personnel in Police and Services Hospital, Peshawar, Pakistan

Background: The World Health Organization's Surgical Safety Checklist (SSC) has been identified as a pivotal tool for enhancing patient safety in operating rooms globally. Despite its proven efficacy, varying levels of knowledge and attitudes towards the SSC among healthcare professionals can influence its successful implementation. Objective: This study aimed to evaluate the knowledge and attitudes of operating room personnel towards the SSC at the Police and Services Hospital (P&SH) in Peshawar, Pakistan, identifying gaps and areas for improvement to facilitate better adoption and utilization of the SSC. Methods: A cross-sectional survey was conducted from November 2023 to January 2024 among 30 permanent staff members in the operating theaters at P&SH, including surgeons, nurses, anesthetists, and technicians. Participants were selected using convenience sampling. The survey comprised demographic questions, knowledge-based questions regarding the SSC, and items assessing attitudes towards the checklist. Data were analyzed using descriptive statistics to summarize demographic information, knowledge levels, and attitudes. Results: The study found that 93.3% of participants had heard of the SSC, with 93.3% demonstrating good knowledge and a positive attitude towards its implementation. However, 3.3% of the participants displayed poor knowledge, and a small fraction exhibited neutral or negative attitudes (6.7%). A significant majority (93.3%) expressed strong support for using the SSC in all surgical procedures, while concerns were raised about its potential to waste time and impact operating efficiency negatively. Conclusion: The high level of awareness and positive attitudes among operating room personnel at P&SH towards the SSC is encouraging. Nevertheless, the presence of knowledge gaps and efficiency concerns highlights the need for targeted educational interventions and strategies to address misconceptions and operational challenges. Enhancing the understanding and efficient use of the SSC can further solidify its role as a cornerstone of patient safety in surgical settings.

Perceptions of the perioperative team regarding the use of the WHO Surgical Safety Checklist

Perceptions of the perioperative team regarding the use of the WHO Surgical Safety Checklist

Does the WHO Surgical Safety Checklist Need Modification for Orthopaedic Surgery Practices? A Cross-Sectional Survey Among Indian Orthopaedic Surgeons.

It is well known that the implementation of the WHO surgical safety checklist (SSC) leads to improved operating room team coordination and reduced perioperative complication and mortality rates. Although it is proven to be beneficial worldwide, its awareness and usage need to be evaluated in a diverse country like India. As orthopaedic surgeries involve implants and tourniquet usage, it is important to evaluate the applicability of WHO SSC specifically to orthopaedic surgeries, and whether any modifications are needed. A web-based cross-sectional survey was conducted among Indian Orthopaedic Surgeons with a pre-defined questionnaire regarding awareness, usage and suggestions to modify the existing WHO SSC (2009) for orthopaedic surgeries. 513 responses were included for final analysis. 90.3% of surgeons were aware of the surgical safety checklist; however, only 55.8% used it routinely in their practice. The awareness of SSC availability was 1.85 times more among younger surgeons (< 20years of experience) than among those with > 20years of experience. 17% of surgeons thought the usage of SSC was time-consuming and 52.4% of participants felt a need to modify the existing WHO SSC (2009) for orthopaedic surgeries. 34.5% recommended the inclusion of the patient blood group in the "Sign-in" section, 62.77% proposed the inclusion of details about the tourniquet, whereas only 6.63% suggested adding about surgical implant readiness in the "Time-out" section and 72.7% suggested including a check to make sure the tourniquet was deflated, removed and also recording of the total usage time during the "Sign-out" section. Despite high (90%) awareness among Indian Orthopaedic surgeons, they have limited usage of the WHO SSC in their practice. Identifying barriers and considering modifications for orthopaedic surgeries, like details about tourniquet usage during the "Time-out" section and a check to ensure it was removed during the "Sign-out" section, will improve patient safety and outcomes. The online version contains supplementary material available at 10.1007/s43465-024-01096-5.

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

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

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

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

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

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

Knowledge, attitudes, beliefs and practices of the WHO surgical checklist in neurosurgery at a quaternary referral hospital, Durban, South Africa

BackgroundDespite an established WHO surgical safety checklist (SSCL) at the referral hospital in Durban, ‘‘Never Events’’ still occur. Observations suggest that many surgical team members are unaware of SSCL existence, those who knew about it are not convinced that it prevents errors, reduces morbidity and mortality and tend not to use it. ObjectivesThe study aimed to establish the knowledge, attitudes, beliefs and practices regarding the SSCL and its use among the neurosurgical staff at a quaternary referral hospital in Durban, South Africa. MethodsQuestionnaires were distributed to neurosurgical theatre staff at the referral hospital in Durban. Data collected included their awareness, beliefs, attitude and practices regarding the SSCL. Data collected were analysed using R Statistical computing software of the R core Team, 2020. ResultsOf the participants that responded, 97% had knowledge of SSCL, 84% knew where it is, 86% believed that it was easily accessible, 96% knew why and 90% knew when to use it. All agreed that the SSCL is a crucial safety tool. Majority believed that SSCL prevents perioperative adverse events, is not time consuming, is not a useless tool, does not increase the workload and does not make patients anxious. ConclusionResults show that most surgical teams know of WHO SSCL. The negative attitude of staff towards SSCL is a significant factor in most of the studies in deterring effective implementation and use. The majority of the study participants believe the SSCL is an essential surgical safety tool useful in preventing errors, morbidity and mortality.

6.G. Workshop: Quality assessment in perioperative care: Challenges and lessons learned from the SAFEST project

Abstract Approximately 313 million surgical procedures are performed worldwide annually, with millions of patients experiencing health benefits while many suffer perioperative complications and harm. World Bank estimations show over 7 million people suffering surgical complications annually, with 4.2 million deaths occurring within 30 days of surgery, placing perioperative mortality as the third most common cause of death. Beyond the ethical issues of patients suffering personal harm while undergoing care, the burden on the health system due to prolonged length of stay and treatment is critical. Perioperative morbidity and mortality have thus become a high-priority public health problem for health systems. Attempts to set targets for improvement adopted well-known conceptual frameworks to categorise areas of evaluation (e.g., Donabedian model) and acknowledged the multifactorial root of perioperative harm and the various patient-condition and system-level factors have been fundamental in perioperative safety. International collaboration is active in seeking to address the challenges of measurement and reporting (COMPAC-StEP), while various tools have been utilised for that purpose (e.g., WHO surgical safety checklist). Several indicators, agreed among experts based on empirical research, have been adopted to assess quality at pre- intra- and postoperative care, but seen as blunt to accurately describe system performance and indicate areas of improvement. This has resulted in poorly defined measures of uncertain value, lacking validity, reliability, and lawfulness, and raising doubts about their true impact on patient safety. On the other hand, patient-centeredness and meaningfulness for patients remain unclear, while traditional clinical measures are increasingly found inadequate to capture all aspects of patient care and recovery. Overall, evidence is still conflicting regarding the most appropriate markers of quality, while long-term and patient-centred outcomes are gaining more scientific attention, despite the various implementation challenges. Greater involvement of patients in the development and selection process of quality indicators is seen as fundamental to better reflect patient values in quality targets in healthcare. A main goal of the workshop is to discuss the challenges and the latest developments in quality assessment in perioperative care and turn the attention towards “evidence-based indicators” for improving quality of care and safety in the perioperative period. The SAFEST project and its approach to developing recommendations and core indicators for patient safety in perioperative care will be presented. The special contribution of patient representatives in the SAFEST stakeholder consensus will be identified. Attributes of ideal quality indicators will be highlighted with reference to evidence-based, important reliable, and actionable indicators and those most prominent in measuring patient-related outcomes of care. Key messages • Translating perioperative safety clinical guidelines recommendations into measurable standards and assess a core of indicators will enhance the implementation of patient safety best practices.

FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery.

FIGO is actively contributing to the global effort to reduce maternal morbidity, mortality, and disability worldwide. Cesarean delivery rates are increasing globally, without signs of slowing down. Bleeding associated with cesarean delivery has become an important cause of hemorrhage-related maternal deaths in many low- and middle-income countries. Correct surgical techniques to improve safety and reduce complications of cesarean delivery is of the utmost importance. This article presents FIGO's good practice recommendations for effective surgical techniques to reduce cesarean complications. Evidence-based information is included where data are available. An expanded WHO Surgical Safety Checklist for maternity cases is suggested. Different incision techniques through the layers of the abdominal wall with appropriate indications are discussed. Hysterotomy through a transverse incision is described, as are indications for low vertical and classical incisions. Important precautions when extracting the fetus are explained. Uterine closure includes a safe method ensuring adequate reapproximation of the upper segment if a vertical incision is made. The paper concludes with the management of two common bleeding problems following delivery of the placenta.

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...

The WHO Surgical Safety Checklist in Belgian hospitals: Changes in use, knowledge, opinions and perception of pressure among operating room professionals between 2016 and 2021

Background: Implementing a Surgical Safety Checklist (SSC) poses several challenges. Operating room (OR) professionals’ opinions on SSC determine whether it is used. Additionally, OR professionals often complain of pressure for execution and presence of inappropriate components in the SSC. Objectives: This study aimed to investigate whether the use of and opinions on SSC improved, and whether feelings of pressure and opinions on the appropriateness of the items changed. Design: Repeated cross-sectional study. Setting: An online survey was sent to all Belgian OR professionals (nurses, surgeons, and anesthesiologists) in 2016 and 2021. Methods: Respondent characteristics were summarized using the proportions of discrete variables. Other data were analyzed using Pearson’s chi-squared test or Fisher’s exact test. A p-value (0.01) was considered statistically significant. Results: In 2021, participation increased from 1419 to 2166 OR professionals. More participants stated that they used SSC, and that its use was more systematic. Opinions about SSC revealed a significant change in patients’ appreciation of SSC use (more positive) and signs of a lack of knowledge of the patient file (less negative). More negative feelings were observed when the SSC was not used. The OR staff experienced less time pressure to complete the SSC. Surgeons, anesthesiologists, and colleagues exerted more pressure on SSC use. The pressure for not using the SSC was low. Seven of the 22 SSC components were judged more appropriate by 2021. ‘Time Out’ improved more than ‘Sign In’ or ‘Sign Out’. Team member introduction remained the least-supported component. Conclusion: SSC was used more often in 2021. Most of the opinions were positive. There was more pressure to use SSC. Most components were considered appropriate, except for team introduction. Local adjustments can align needs with the staff’s opinions. However, crucial components must be maintained.

146 WHO Surgical Checklist Compliance and Attention Rates Among Different Specialties and Years

Abstract Aim This study aims to evaluate the compliance of surgical staff to the WHO surgical safety checklist, excluding sign-out. The quality of surgical marks and inattentive rates of surgical staff during me-out were also investigated. Method Data was collected over 3 weeks using a fixed criteria in September 2022 within 3 hospitals consisting of 5 sites. A total of 105 procedures were observed. Mean and confidence intervals were calculated using SPSS. Results The mean compliance rate of the checklist was 97%. Sign-in (97%), Time-Out (96%), and Surgical mark rates (98%) all scored similarly. Among specialties observed, interventional cardiology scored the highest compliance rates, at 100%, while cardiothoracic surgery scored the lowest at 91%. In 38% of procedures observed, surgical staff were found to be inattentive during me-out. Among the inattentive surgical staff, 73% of surgical staff had mild inattentiveness (e.g. filling up drug charts), 18% had moderate inattentiveness (e.g. talking to other staff), 9.1% of them had severe inattentiveness (e.g. scrubbing in). Among the audit cycles from 2014 to 2022, there was an increase in sign-in rates from the previous cycle held in 2019 to 2022 from 82% to 97%. Inattentive rates increased from 33% in 2019 cycle to 38% in 2022 cycle. Conclusions This study reports high compliance rates and improvement with the checklist among all specialties, but also high inattentive rates by surgical staff. Improvements such as fostering a good culture among surgical staff on the WHO checklist and paying attention are key in never reducing events.

Preventing well leg compartment syndrome among patients in the lithotomy position-Operating room nurses' perspectives: A qualitative study.

To describe operating room nurses' experiences of well leg compartment syndrome and how they work perioperative to prevent it during the lithotomy position. The study had a qualitative design. Focus group interviews were performed with 10 operating room (OR) nurses. The interviews were semi-structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge. The severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome. No patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme.

Addressing knowledge gaps in Surgical Safety Checklist use: statistical process control analysis of a surgical quality improvement programme in Ethiopia.

The WHO Surgical Safety Checklist reduces morbidity and mortality after surgery, but uptake remains challenging. In particular, low-income countries have been found to have lower rates of checklist use compared with high-income countries. The aim of this study was to determine the impact of educational workshops on Surgical Safety Checklist use implemented as part of a quality improvement initiative in five hospitals in Ethiopia that had variable experience with the Surgical Safety Checklist. From April 2019 to September 2020, each hospital implemented a 6-month surgical quality improvement programme, which included a Surgical Safety Checklist workshop. Statistical process control methodology was used to understand the variation in Surgical Safety Checklist compliance before and after workshops and a time-series analysis was performed using population-averaged generalized estimating equation Poisson regression. Checklist compliance was defined as correctly completing a sign in, timeout, and sign out. Incidence rate ratios of correct checklist use pre- and post-intervention were calculated and the change in mean weekly compliance was predicted. Checklist compliance data were obtained from 2767 operations (1940 (70 per cent) pre-intervention and 827 (30 per cent) post-intervention). Mean weekly checklist compliance improved from 27.3 to 41.2 per cent (mean difference 13.9 per cent, P = 0.001; incidence rate ratio 1.51, P = 0.001). Hospitals with higher checklist compliance at baseline had the greatest overall improvements in compliance, more than 50 per cent over pre-intervention, while low-performing hospitals showed no improvement. Surgical Safety Checklist workshops improved checklist compliance in hospitals with some experience with its use. Workshops had little effect in hospitals unfamiliar with the Surgical Safety Checklist, emphasizing the importance of multifactorial interventions and culture-change approaches. In receptive facilities, short workshops can accelerate behaviour change.

Implementation of World Health Organization behaviorally anchored rating scale and checklist utilization: promising results for LMICs.

Operating teams can decrease the likelihood of patient risk by using the WHO Surgical Safety Checklist. To ascertain the impact of demographic factors on behaviorally anchored ratings and investigate operating room (OR) staff attitudes toward checklist administration, we set out to better understand how OR personnel use the checklist in a tertiary care hospital in Pakistan. A monocentric sequential mixed-methods study employing a quantitative approach of using World Health Organization Behaviorally Anchored Rating Scale (WHOBARS) assessments of surgical cases by OR personnel and two independent observers, who were certified surgeons having extensive experience in the rating of the WHOBARS scale for more than 1 year, followed by a qualitative approach of staff interviews were carried out in a tertiary care setting. In June and July 2022, over the period of 8 weeks, an intervention (training delivery) was implemented and evaluated. The information, skills, and behavior adjustments required to apply the checklist were taught in the course using lectures, videos, small group breakouts, participant feedback, and simulations. After the introduction of WHOBARS, 50.81% of respondents reported always using the checklist, with another 30.81% using it in part. Participants' years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with always counting instruments (51.08%), patient identity (67.83%), difficult intubation risk (39.72%), the risk of blood loss (51.08%), prophylactic administration of an antibiotic (52.43%), and the use of pulse oximeter (46.75%). Interviewees felt that the checklist could promote teamwork and a safe culture, particularly enabling speaking up. Senior staff were of key importance in setting the appropriate tone. The use of a multi-disciplinary course for checklist implementation resulted in 50.81% of participants always using the checklist and an increase in counting surgical instruments. Successful checklist implementation was not predicted by the participant's length of medical service, hospital size, or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.

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

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

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

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

Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality-Informed Policymaking Process to Serve Diverse Women, Children, and Families.

Health and economic inequities among U.S. racial/ethnic minority women and children are staggering. These inequities underscore a dire need for intersectionality-informed, social-justice-oriented maternal and child (MCH) policies and programs for U.S. women and children. In response, we developed the "Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality Informed Policymaking Process to Serve Diverse Women, Children and Families" to assist U.S. policymakers/aides, practitioners, and other stakeholders in developing more equitable MCH policies/programs. This article describes the Toolkit development process and initial assessments of acceptability and feasibility for use in MCH policymaking. Between 2018 and 2021, we utilized the process that the World Health Organization (WHO) used to develop its WHO Surgical Safety Checklist to develop the content (e.g., case studies) and format (i.e., structure), make strategic decisions (e.g., core items, primary audiences, timing of utilization), test concepts, and receive feedback. We convened a 2-day planning meeting with experts (n = 8) in intersectionality, policymaking, and MCH to draft the Toolkit. Next, we convened half-day workshops with policymaking and program leadership and staff in Washington, DC, New Orleans, LA, and Santa Fe, NM, to refine the Toolkit (n = 37). Then we conducted an initial assessment of the Toolkits' acceptability and feasibility using surveys (n = 21), followed by focus groups (n = 7). The resulting Toolkit distills Critical Race Theory's and intersectionality's most critical elements into a user-friendly modality to promote and enhance equitable MCH policies and programs for diverse U.S. women and families.

IMPACT OF IMPLEMENTING A SURGICAL SAFETY CHECKLIST IN HOSPITAL: LITERATURE REVIEW

ABSTRACT Background: The Surgical Safety Checklist is part of WHO's efforts to reduce the number of deaths worldwide. Purpose: To analyze the impact of implementing the WHO Surgical Safety Checklist in hospitals. Methods: Article search was carried out through PubMed and ScienceDirect databases using keywords ("impact") OR ("effect") AND ("implementation") AND ("surgical safety checklist") AND ("hospital") . The total number of articles found was 195, but only six articles met the inclusion criteria. Results: A comprehensive study in 7 hospitals located in 4 countries found the impact of implementing the Surgical Safety Checklist in hospitals could improve the quality of care, reduce the length of hospitalization, reduce mortality and complications that cause morbidity, reduce treatment costs, improve surgical team communication, increase trust in the safety culture in the operating room, improve teamwork climate, safety climate, surgical outcomes, and improve patient safety. Conclusion: Surgical Safety Checklist can reduce mortality and morbidity, improve quality of care, reduce treatment costs, and affect the attitudes &amp; perceptions of team members and patient safety.