Evaluation of a patient safety programme on Surgical Safety Checklist Compliance: a prospective longitudinal study

Abstract

BackgroundSurgical Safety Checklists (SSC) have been implemented widely across 132 countries since 2008. Yet, despite associated reductions in postoperative complications and death rates, implementation of checklists in surgery remains a challenge. The aim of this study was to assess the impact of a patient safety programme over time on SSC use and incidence of clinical errors.DesignA prospective longitudinal design over three time points and a retrospective secondary analysis of clinical incident data was undertaken.MethodsWe implemented a patient safety programme over 4 weeks to improve surgical teams’ use of the SSC. We undertook structured observations to assess surgical teams’ checklist use before and after programme implementation and conducted a retrospective audit of clinical incident data 12 months before and 12 months following implementation of the programme.ResultsThere were significant improvements in the observed use of the SSC across all phases, particularly in sign-out where completion rates ranged from 79.3% to 94.5% (p<0.0001) following programme implementation. Across clinical incident audit periods, 33 019 surgical procedures were performed. Based on a subsample of 64 cases, clinical incidents occurred in 22/16 264 (0.13%) before implementation and 42/16 755 (0.25%) cases after implementation. The most predominant incident after programme implementation was inadequate tissue specimen labelling (23/42, 54.8%). Clinical incidents resulted in minimal or no harm to the patient.ConclusionsThe benefit in using a surgical checklist lies in the potential to enhance team communications and the promotion of a team culture in which safety is the priority.

Newly trained operating room nurses’ experiences of nursing care in the operating room

“…As reported in 2010, the World Health Organization's recommended surgical timeout before surgery was an opportunity to identify and resolve potential problems (27). Further studies also confirm the benefits of enhanced team communications, which in turn can lead to a team culture in which patient safety is prioritised (28). The ORNs said that lack of time is by far the greatest threat to good nursing care in an OR.…”

The impact of improved surgical safety checklist participation on OR efficiencies: A pretest-posttest analysis

“…The benefit of the checklist on patient outcomes, safety related practices and clinical processes are well researched [20][21][22][23] . There were no significant differences in clinical efficiencies despite observed improvements in checklist items coverage and participation post-implementation of PTB (acknowledging that the SCC was not fully utilised) 24 . Clearly, improvements in using the checklist do not translate into increased efficiencies.…”

“…Saving time (as a measure of efficiency) in the OR does not necessarily lead to increased efficiency 28 . PTB was implemented as a driver to enable change in practice and process when executing the checklist 14,24 . Yet strategies that target changes in practice (i.e.…”

“…Implementation of PTB aimed to simplify the checking process through addressing behavioural and contextual factors that contributed to limited use of the SSC 14,24 . Yet to achieve sustainable improvements in efficiencies, structural interventions such as parallel processing, physical layout of the OR and additional staffing should be considered.…”

Perioperative nurses’ engagement with the surgical safety checklist: A focused ethnography

“…There have been numerous studies undertaken of the WHO safety checklist since its worldwide introduction in 2009. Research conducted in the Australian setting indicates compliance and participation in the SSC varies, and barriers to nurse involvement in the process include work pressures, workplace culture and time restraints [7][8][9] . There is limited information on how Australian nurses engage in the nurse-specific section of the SSC, and further research is needed to understand this area of operating room nursing practice.…”