Implementing the World Health Organization Surgical Safety Checklist: A Model for Future Perioperative Initiatives

Styer, Kristin Alt; Ashley, Stanley W.; Schmidt, Ilona; Zive, Elaine M.; Eappen, Sunil

doi:10.1016/j.aorn.2011.03.012

Cited by 22 publications

(24 citation statements)

References 8 publications

(10 reference statements)

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“…This generates internal challenge through which previously accepted standards of quality and safety -for example, the nature and frequency of adverse outcomes in theatre 169,191,406 or for central venous catheter-related bloodstream infections 407 -are viewed in a pejorative light. Practitioners, acting as institutional entrepreneurs, 41 now collectively adopt a new normative standard leading to practice-based change 181 and the rejection of old habits.…”

Section: Deinstitutionalisationmentioning

confidence: 99%

“…172 The strength and success of this promotion is reflected in the way that the MI-PDSA approach has been applied across a range of contexts, and to a variety of issues. Many of these themes are of direct relevance to this study, including (i) the role of local champions in leading change; [182][183][184] (ii) the education of health-care professionals in evidence-based practice change; [185][186][187][188] (iii) the implementation of the World Health Organization Surgical Safety Checklist (WHOSSC); 169,[189][190][191] (iv) the development and implementation of anti-infective prescribing policies, [192][193][194] including those for correct hand hygiene; 195 and (v) the large-scale transformation of health-care services through a heightened emphasis on patient safety. Transforming Maternity Services -Reducing mortality and harm by improving the recognition and response to the acutely deteriorating woman -Reducing mortality and harm from venous thromboembolism in pregnancy and the postnatal period -Reducing preventable still birth in Wales Improving Primary and Community Care -Reducing chronic heart failure -Improving care for patients with atrial fibrillation -The primary care trigger tool -Improving medicines management -Improving care for patients with learning disabilities (Learning disabilities annual health check) -Reducing harm in dental care -Reducing harm from falls in the community Mental Health -Identifying depression in hospital settings -Improving dementia care -Prescribing of psychotropics -Eating disorder -First episode psychosis http://www.1000livesplus.wales.nhs.uk/programme-areas FIGURE 1 1000 Lives + national patient safety programme areas.…”

Section: Lives + National Programme In Nhs Walesmentioning

confidence: 99%

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A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Deinstitutionalisationmentioning

confidence: 99%

Section: Lives + National Programme In Nhs Walesmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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“…As in other institutions, the time-out card has been converted from paper to an electronic format. 38 Since instituting the current version of the time-out, the neurosurgery department has been using an electronic format projected on digital screens in the operating theater. In the future, the surgeon might enter responses using a mobile tablet with screen touch technology that projects to screens.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…Leadership endorsement early in the implementation process and throughout its entire progress has been instrumental. 38 …”

mentioning

confidence: 99%

“…Numerous hospitals, both small and large scale, have implemented the WHO checklist and continue to observe its positive impact. 38,39,42,43 To date, few groups have reported their experience with a surgical checklist specifically for neurosurgery. 9,18,22,25 Implementing the First Surgical Safety Checklist at UCLA As of July 1, 2004, the UCLA Health System adopted the Universal Protocol created by The Joint Commission Board to address the continuing occurrence of wrongsite, wrong-procedure, and wrong-person surgery.…”

mentioning

confidence: 99%

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University of California, Los Angeles, surgical time-out process: evolution, challenges, and future perspective

McLaughlin

Winograd

Chung

et al. 2012

FOC

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Since the development of the WHO Safe Surgery Saves Lives initiative and Surgical Safety Checklist, numerous hospitals across the globe have adopted the use of a surgical checklist. The UCLA Health System developed its first extended Surgical Safety Checklist in 2008. Authors of the present paper describe how the time-out checklist used before skin incision was implemented and how it progressed to its current form. Compliance with the most recent version of the checklist has been closely monitored via documentation and observance audits. In addition, the surgical team's appreciation of the current time-out has been assessed. Cultural, practice, and human resource challenges are discussed, as are potential future avenues for innovations in the emerging field of the surgical checklist in neurosurgery.

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A Phenomenographic Study of Swedish Nurse Anesthetists’ and OR Nurses’ Work Experiences

Nordström¹,

Wihlborg²

2019

AORN Journal

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In the complex OR environment, perioperative team members need to practice communication and teamwork to ensure safe, high-quality care. A lack of collaboration among professionals in the OR during surgery results in inefficiency, increased tension, and suboptimal patient care. The purpose of this study was to determine how nurse anesthetists and OR nurses experienced their work in the OR. We used a qualitative design with a phenomenographic approach and conducted 12 interviews in two surgical departments in the southern part of Sweden. We identified four categories of description: team member approach, professional awareness, lifelong learning approach, and safety and the patient's interest. We found that the nurses' work experiences in the OR were multifaceted and correlated with concepts of teamwork, safety, and communication.T he OR is a highly technological and multiprofessional environment where team members must manage medical technology, time pressure, and productivity. In Sweden, the responsibilities of nurse anesthetists and OR nurses are to maintain a safe and secure environment of care for the patient during surgery. 1,2 The nurse anesthetist independently induces and maintains general anesthesia and extubates the patient with support from the anesthesiologist. 1 The OR nurse is responsible for aseptic technique, maintaining a sterile field, preparing supplies and instruments, counts, documentation, supporting the surgical team, and advocating for the patient. 2 Collaboration and communication among surgical team members help to ensure safe care during surgery. [3][4][5] Communication in the OR requires both verbal and nonverbal skills, the ability to listen actively, and basic interpersonal skills, such as being polite and speaking clearly. These skills help to achieve optimal communication among team members and a safe and effective OR environment. 6 Surgical team members who work together often can communicate and collaborate more effectively because working relationships need time to develop. 7,8 The absence of basic communication and respectful acknowledgment among OR staff members affect the ability to develop shared understandings, which is important in enhancing team performance. 8 STATEMENT OF PURPOSEThe purpose of this study was to describe the work experiences of nurse anesthetists and OR nurses in the OR. LITERATURE REVIEWBringing different professionals together does not always lead to optimal collaboration. Members of a team must trust each other to develop a common process, achieve professional collaboration, and develop high-quality care. 9 Four interactional factors are important for effective collaboration among health care teams: willingness to participate in collaborative practice, trust, communication, and mutual respect and understanding. 10 In the study by Lingard et al, 11 team members in the OR lacked insight into the professional roles and obligations of other team members, and when tension in the OR occurred, this often CONCLUSION Nurse anesthetists' and OR nurses' work expe...

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Implementing the World Health Organization Surgical Safety Checklist: A Model for Future Perioperative Initiatives

Cited by 22 publications

References 8 publications

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

University of California, Los Angeles, surgical time-out process: evolution, challenges, and future perspective

A Phenomenographic Study of Swedish Nurse Anesthetists’ and OR Nurses’ Work Experiences

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