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A surgical safety checklist (SSC) was implemented and routinely evaluated within our hospital. The purpose of this study was to analyze compliance, knowledge of and satisfaction with the SSC to determine further improvements.
The implementation of the SSC was observed in a pilot unit. After roll-out into each operating theater, compliance with the...
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Background: Surgery is an essential part of health care. Adverse events can occur in surgical care but more than half of these are avoidable. A number of checklists have been developed to reduce these adverse events; the WHO surgical safety checklist has shown better outcome improvements than previous checklists. This study was designed to apply WH...
Citations
... Menurut Adriana (2016), komplikasi bedah setelah menggunakan SSC secara keseluruhan menurun dari 19,9% menjadi 11,5% dan angka kematian menurun dari 1,9% menjadi 0,2%. Saat ini, lebih dari 4.000 rumah sakit di seluruh dunia telah menerapkan SSC dan WHO mengungkapkan bahwa daftar periksa ini dapat dimodifikasi tergantung pada kondisi ruang operasi setempat (Sendlhofer et al., 2015). Penelitian yang dilakukan oleh Weiser et al. (2020) Pengetahuan perawat tentang keselamatan pasien merupakan hal yang penting karena jika pengetahuan perawat tentang keselamatan pasien kurang jelas akan mempengaruhi kinerja perawat itu sendiri dalam melaksanakan SSC di ruang operasi (Notoatmodjo, 2016). ...
Surgical Safety Cheklist (SSC) bertujuan untuk meningkatkan keamanan operasi dan mengurangi kesalahan dalam prosedur pembedahan. Rendahnya tingkat kepatuhan pengisian SSC berpotensi menimbulkan masalah terkait keselamatan pasien. Berbagai faktor menentukan kepatuhan, namun pengetahuan menjadi salah satu faktor utama. Tujuan dari penelitian ini adalah untuk menganalisis hubungan tingkat pengetahuan perawat bedah dengan kepatuhan Surgical Safety Checklist (SSC) Di Ruang Operasi Rumkital Dr. Midiyato Suratani Tanjungpinang Tahun 2024. Desain penelitian ini adalah kuantitatif korelasional dengan pendekatan cross sectional dan metode analitik observasional. Sampel perawat bedah di ruang kamar operasi yang berjumlah 30 responden dengan teknik sampel yaitu total sampling. Penelitian dilaksanakan pada tanggal 15 Februari-15 Maret 2024. Instrumen yang digunakan berupa kuesioner pengetahuan yang terdiri dari 18 pernyataan dan kuesioner kepatuhan SSC yang terdiri dari 22 pertanyaan terkait Sign in (9 pertanyaan), Time out (6 pertanyaan), Sign out (7 pertanyaan). Uji statistik yang digunakan dalam penelitian ini adalah Chi Square dengan taraf signifikansi α 5%. Hasil penelitian menunjukkan bahwa tingkat pengetahuan perawat sebagian besar berada pada kategori Baik yaitu sebesar 16 orang (53,3%) dengan melaksanakan penerapan SSC secara patuh yaitu sebanyak 15 orang (50%). Hasil uji statistik Chi-Square menunjukkan nilai p value = 0,00 < α (0,05). Berdasarkan hasil penelitian disimpulkan bahwa terdapat hubungan yang signifikan antara tingkat pengetahuan dengan kepatuhan penerapan SSC perawat bedah Di Rumkital Dr. Midiyato Suratani Tanjungpinang. Penelitian ini merekomendasikan adanya penyegaran pengetahuan pada perawat bedah terkait SSC untuk meningkatkan kepatuhan perawat.
... ; https://doi.org/10.1101/2024.12.06.24318304 doi: medRxiv preprint teamwork (6,7). The absence of positive role models, unenthusiastic team members, hierarchical obstacles, limited knowledge of proper usage, and inadequate implementation procedures have also been reported as barriers to effective SSC adoption (8). ...
... Formal training was essential, as the initial informal approach proved ineffective in improving WHO Surgical Safety Checklist (SSC) adherence. This finding aligns with various studies that highlight the importance of structured education in driving compliance with clinical protocols (8,(11)(12)(13)(14). The formal training not only increased staff understanding but also reinforced the consistent use of the SSC, contributing to the overall success of the QI project. ...
Background: Despite evidence demonstrating the benefits of the World Health Organization (WHO) Surgical Safety Checklist (SSC), its utilization is less frequent in countries with a lower Human Development Index (HDI). This quality improvement project aimed to enhance SSC utilization in a rural primary hospital to address critical issues, including inconsistent administration of prophylactic antibiotics, frequent instances of lost or mislabeled surgical specimens, and inadequate preparedness for essential surgical instruments and blood products.
Methods: This quality improvement project was conducted at a Primary Hospital, a rural facility in Ethiopia, to address suboptimal utilization of the WHO Surgical Safety Checklist (SSC). The surgical team included 2 specialists, 2 anesthetists, and 5 nurses, with an average SSC utilization rate of 50% and a completion rate of 80% over the prior 18 months. A Plan-Do-Study-Act (PDSA) approach was employed to enhance adherence. Key interventions included translating the SSC into Amharic, conducting a two-day training session, introducing pre- and post-operative briefings, and requiring surgeons to remain in the operating room until checklist completion. Bi-weekly audits and regular supervision were conducted to monitor progress, with feedback loops established to guide adjustments. The effectiveness of the intervention was assessed through quantitative and qualitative methods. Key performance indicators included SSC utilization and completion rates, with secondary metrics such as prophylactic antibiotic administration and surgical site infection rates. Trend analysis using run charts and Interrupted Time Series (ITS) analysis evaluated changes over time, while staff interviews provided insights into behavioral and attitudinal shifts. Sustained improvements were reinforced through ongoing training, monthly supervision, and staff recognition initiatives.
Results: The quality improvement project demonstrated a significant and sustained improvement in the utilization and completion rates of the WHO Surgical Safety Checklist (SSC). Baseline measurements in October 2023 showed a utilization rate of 53% and a completion rate of 65%. Following targeted interventions, both metrics steadily improved, reaching 100% by June 2024 and maintaining this level through September 2024.
Conclusion: The QI project demonstrated that achieving 100% utilization and completion of the WHO Surgical Safety Checklist (SSC) is feasible even in rural hospitals of low- and middle-income countries (LMICs). Formal training proved crucial for improving adherence, addressing gaps seen with informal approaches, and fostering better team communication and culture. Challenges such as incomplete Sign-out sections and language barriers were mitigated by adapting the SSC to local contexts, including translation. These findings highlight the importance of structured interventions and localized solutions in enhancing surgical safety practices and inspire broader implementation in similar resource-limited settings
... Several researchers have used this instrument in their studies, given its good psychometric qualities. [33][34][35][36][37] An observation grid, which was the most suitable means of objectively assessing the practices of OR professionals concerning CL, and of measuring the degree and quality of CL application in the OR, which is why several researchers used this grid. [38][39][40] By using both a self-administered questionnaire and an observational grid, our study would be able to provide a comprehensive assessment of OR professionals' practices and perceptions of CL, which could be used to develop interventions to promote its safe use. ...
Introduction: Patient safety remains a major concern in the operating room (OR). The surgical checklist (CL) is presented as a solution for reducing postoperative complications by ensuring better patient safety, but the adoption and use of this tool remain modest in our ORs. So, we aimed to describe CL use practices and perceptions among OR professionals at the University Hospital Center (UHC) of Sahloul, Sousse in 2023. Methods: This was a cross-sectional study among OR professionals at UHC of Sahloul. Data were collected using a questionnaire and an observation grid. Results: The average age of respondents was 38.05 (±8 years) with a female predominance. Our results revealed positive perceptions (98.7%) regarding the usefulness of the surgical CL. Some difficulties were raised by participants, notably the difficulty of accepting verbalization aloud (59.4%), the anxiety generated by multiple checks for the patient (58.8%) and the difficulty of implementing CL during emergency interventions (49.4%). The observation grid revealed the rate of CL use in the OR (70.8%) and inadequate practices in the quality of CL item completion: Variation in the quality of CL item completion from one stage to the next; Items mostly ticked without verification, with only the patient identification (69.1%), procedure site (64.7%), known allergy (47.1%) and antibiotic prophylaxis (61.8%) items being checked aloud. Conclusion: CLs in the operating room are essential to guarantee safe, quality care. It is therefore essential that healthcare professionals, healthcare establishments and decision-makers not only recognize its importance, but also implement the necessary measures for its adoption and systematic use.
... In another Swedish study, only 43% of participants had received training in using the WHO checklist. Other similar studies have explained that inadequate implementation may be due to insufficient knowledge among participants about how to use the checklist, highlighting the need for well-structured training [22][23][24]. ...
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 checklist but 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.
... Điều dưỡng nữ chiếm 75,4% cao gấp 3 lần so với điều dưỡng nam là 24,6%. Do đặc thù của nghề điều dưỡng là chăm sóc đòi hỏi sự khéo léo và tỷ mỉ nên nữ điều dưỡng thường chiếm tỷ lệ cao trong các nghiên cứu của Nguyễn Văn Chinh và Nguyễn Vy Vân Thảo Ngân năm 2019 [9] là 65,8, tác giả Anna C Mascherek năm 2013 tại bệnh viện Thụy Sĩ [10] là 67,2%, tác giả Gerald Sendlhofer [11] tại bệnh viện Đại học Graz năm 2015 là 66,9%, nghiên cứu Suresk K Sharma [8] năm 2020 tại Uttarakhand (Ấn Độ) là 56%, nghiên cứu Juan J Delgado Hurtado [12] năm 2012 tại thành phố Guatemala là 85%. ...
Objective: To assess the knowledge and attitudes of operating room nurses at Nhan Dan Gia Dinh Hospital regarding the surgical safety checklist and related factors.
Subjects and Methods: A descriptive cross-sectional study was conducted involving 69 operating room nurses at Nhan Dan Gia Dinh Hospital from June 1, 2022, to July 30, 2022. Data were collected using a self-administered questionnaire.
Results: Of the participants, 68.1% demonstrated good knowledge, while 31.9% had moderate or limited knowledge about the surgical safety checklist. Regarding attitudes, 95.7% of nurses exhibited a positive attitude toward the checklist, whereas 4.3% showed a non-positive attitude.
Conclusion: Although the majority of operating room nurses showed good knowledge and positive attitudes towards the surgical safety checklist, a small proportion still exhibited non-positive attitudes. Continuous training and reinforcement of the importance of surgical safety protocols are essential to ensure consistent adherence and to promote patient safety.
... Leadership oversight and integration of SSC into existing perioperative risk assessment may increase likelihood of acceptance by surgical teams [9,25,26]. The evidence would inform Ethiopia's safe surgery strategy. ...
Background
Ministry of Health (MOH) of Ethiopia adopted World Health Organization’s evidence-proven surgical safety checklist (SSC) to reduce the occurrence of surgical complications, i.e., death, disability and prolong hospitalization. MOH commissioned this evaluation to learn about SSC completeness and compliance, and its effect on magnitude of surgical complications.
Methods
Health institution-based cross-sectional study with retrospective surgical chart audit was used to evaluate SSC utilization in 172 public and private health facilities in Ethiopia, December 2020–May 2021. A total of 1720 major emergency and elective surgeries in 172 (140 public and 32 private) facilities were recruited for chart review by an experienced team of surgical clinicians. A pre-tested tool was used to abstract data from patient charts and national database. Analyzed descriptive, univariable and bivariable data using Stata version-15 statistical software.
Results
In 172 public and private health facilities across Ethiopia, 1603 of 1720 (93.2%) patient charts were audited; representations of public and private facilities were 81.4% (n = 140) and 18.6% (n = 32), respectively. Of surgeries that utilized SSC (67.6%, 1083 of 1603), the proportion of SSC that were filled completely and correctly were 60.8% (659 of 1083). Surgeries compliant to SSC guide achieved a statistically significant reduction in perioperative mortality (P = 0.002) and anesthesia adverse events (P = 0.005), but not in Surgical Site Infection (P = 0.086). Non-compliant surgeries neither utilized SSC nor completed the SSC correctly, 58.9% (944 of 1603).
Conclusions
Surgeries that adhered to the SSC achieved a statistically significant reduction in perioperative complications, including mortality. Disappointingly, a significant number of surgeries (58.9%) failed to adhere to SSC, a missed opportunity for reducing complications.
... Twelve studies revealed that lack of proper training and education, which would be necessary for OR staff to understand need, importance, as well as practical SSC implementation and also address to their concerns regarding its use. 9,19,[22][23][24][25][26]29,35,37,39,40 Studies have estimated that approximately 90% of OR staff recommend that proper training is necessary for successful adoption and use of the SSC. ...
... Four studies considered this issue; however, opinions lie at both ends of a spectrum. 22,24,39,40 On one hand, some studies support involvement of patient in the SSC at least at sign-in; on the other hand, some studies show that involving patients in the SSC would add to patient anxiety and hinder staff discussing any deficiencies or concerns relevant to patient or procedure. ...
... Sendlhofer et al 39 (2015, Austria) ...
Introduction:
This review was conducted to determine what factors might be responsible for prejudicing the outcomes after the implementation of a World Health Organization Surgical Safety Checklist (WHO SSC), grouping them appropriately and proposing strategies that enable the SSC a more helpful and productive tool in the operating room.
Methods:
It was a rapid scoping review conducted as per Preferred Reporting Items for Systematic Review and Meta-analyses extension guidelines for scoping reviews (PRISMA-Scr). Comprehensive search on MEDLINE and Embase was carried out, to include all relevant studies published during last 5 years. Twenty-seven studies were included in analysis. The barriers to SSC implementation were classified into 5 main groups, with further subdivisions in each.
Results:
The results of review revealed that there are 5 major barriers to SSC at the following levels: organizational, checklist, individual, technical, and implementation. Each of these major barriers, on further evaluation, was found to have more than one contributing factors. All these factors were analyzed individually.
Conclusions:
This rapid scoping review has consolidated data, which may pave the way for experts to further examine steps that might be taken locally or globally in order that the WHO SSC to successfully achieve all its desired goals.
... Ο Borchard και οι συνεργάτες του πραγματοποίησαν μία συστηματική ανασκόπηση από την οποία προέκυψε ότι η χρήση της Λίστας Ελέγχου χειρουργικής ασφάλειας κυμάνθηκε από 12% έως 100% (Borchard et al., 2012). Η μη βέλτιστη εφαρμογή της Λίστας Ελέγχου μπορεί να οδηγήσει σε μείωση της ποιότητας των αποτελεσμάτων των χειρουργικών επεμβάσεων και μπορεί στην πραγματικότητα να συμβάλλει στην πρόκληση σφάλματος ή βλάβης στους ασθενείς Morgan et al., 2015;Russ et al., 2015;Sendlhofer et al., 2015;Bergs et al., 2014;Gagliardi et al., 2014;Rydenfalt et al., 2014;Saturno et al., 2014;Braaf et al., 2013;Cullati et al., 2013;Hannam et al., 2013;Morgan et al. 2013;Sparks et al., 2013;Fourcade et al., 2012;Levy et al., 2012;Sheena et al., 2012;van Klei et al., 2012;Walker et al., 2012;Vogts et al., 2011;Bosk et al., 2009). Η επιτυχημένη εφαρμογή της Λίστας Ελέγχου απαιτεί προσοχή πέρα από αυτήν και εξέταση της κουλτούρας ασφάλειας του εκάστοτε χειρουργείου Vats et al., 2010). ...
Εισαγωγή: Η Λίστα Ελέγχου χειρουργικής ασφάλειας του Παγκόσμιου Οργανισμού Υγείας εφαρμόζεται σε χειρουργικές επεμβάσεις παγκοσμίως, σε μία προσπάθεια να μειωθούν οι ανεπιθύμητες μετεγχειρητικές επιπλοκές. Η εφαρμογή του συγκεκριμένου εργαλείου βελτιώνει το επίπεδο ασφάλειας και ποιότητας των υπηρεσιών που παρέχονται στο χειρουργείο. Ακόμα, ενισχύει την κουλτούρα ασφάλειας μεταξύ του προσωπικού κατά τη διάρκεια της χειρουργικής επέμβασης και μειώνει τη συχνότητα εμφάνισης μετεγχειρητικών επιπλοκών. Σκοπός: Ο γενικός στόχος της μελέτης ήταν να διερευνηθεί η συμβολή της Λίστας Ελέγχου ως προς την κουλτούρα ασφάλειας, τη μείωση των μετεγχειρητικών επιπλοκών και τη μετεγχειρητική πορεία των ασθενών. Υλικό και μέθοδος: Πρόκειται για μία μη πειραματική συγχρονική μελέτη που αφορά την εφαρμογή της Λίστας Ελέγχου χειρουργικής ασφάλειας την χρονική περίοδο πριν, κατά και μετά τη διάρκεια των χειρουργικών επεμβάσεων σε Ελληνικό δημόσιο νοσηλευτικό ίδρυμα, για να διαπιστωθεί αν συμβάλλει στη μείωση των μετεγχειρητικών επιπλοκών. Πραγματοποιήθηκαν 312 χειρουργικές επεμβάσεις και η Λίστα Ελέγχου εφαρμόστηκε σε 155 (49,7%). Χρησιμοποιήθηκαν περιγραφικά στατιστικά στοιχεία και σχεδιάστηκαν πίνακες συχνότητας για τα γενικά χαρακτηριστικά του δείγματος. Αποτελέσματα: Από τους 312 ασθενείς που συμμετείχαν στη μελέτη, οι 115 (36,9%) ήταν άντρες και οι 197 (63,1%) γυναίκες. Η πλειονότητα των συμμετεχόντων ανήκε στην ηλικιακή ομάδα 65-74 ετών και ακολουθούσε η ηλικιακή ομάδα 55-64 ετών. Το συνολικό ποσοστό των επιπλοκών που καταγράφηκε ήταν 7/312 (2,2%). Το ποσοστό των επιπλοκών για τις χειρουργικές επεμβάσεις που εφαρμόστηκε η Λίστα Ελέγχου ήταν 0/155 (0%), ενώ σε όσες δεν εφαρμόστηκε ήταν 7/157 (4,5%). Το συνολικό ποσοστό θνησιμότητας ήταν 1/312 (0,3%). Βρέθηκε στατιστικά σημαντική σχέση (P<0,05) κατά τη σύγκριση των μετεγχειρητικών επιπλοκών μεταξύ των δύο ομάδων, πριν και μετά την εφαρμογή της Λίστας Ελέγχου. Συμπεράσματα: Η εφαρμογή της Λίστας Ελέγχου σχετίζεται με τη μείωση των μετεγχειρητικών επιπλοκών και το φαινόμενο αυτό φαίνεται να είναι μεγαλύτερο στις αναπτυσσόμενες χώρες. Η χρήση της Λίστας Ελέγχου συμβάλλει σημαντικά στη βελτίωση της ποιότητας και της ασφάλειας των χειρουργικών επεμβάσεων, με αποτέλεσμα λιγότερες μετεγχειρητικές επιπλοκές. Ακόμα, παρατηρήθηκε βελτίωση όσον αφορά το εργασιακό κλίμα, την επικοινωνία και την αποτελεσματικότητα της ομάδας. Λέξεις Κλειδιά: Λίστα Ελέγχου χειρουργικής ασφάλειας, μετεγχειρητικές επιπλοκές, Παγκόσμιος Οργανισμός Υγείας
... Firstly, it is supervision to ensure compliance. Previous research indicated that despite implementation of the SSC is essential, continual supervision and leadership is needed to preserve compliance and precision in its administration (Sendlhofer et al., 2015). Secondly, it is regular conducting of audits and providing feedback on compliance with SSC use (Sendlhofer et al., 2016). ...
Purpose
The purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan.
Design/methodology/approach
This was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data.
Findings
Three main themes emerged from data analysis namely compliance with the surgical safety checklist, the impact of surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus to accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist, and help enhance awareness about its importance.
Originality/value
While steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges for consistent, complete and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.
... [13] In addition, other studies have shown that staff do not follow or use the checklist correctly, possibly because they have not been instructed sufficiently in its use, so more training is needed. [20,21] In another study, it was pointed out that there is a risk that the use of the WHOSSC will be deficient and implementation will fail unless staff are shown how to use it. It is also important to mention the importance of understanding why the WHOSSC is used and that an understanding of the checklist is achieved. ...
Introduction: In Sweden, during specialty training, the nurse anesthetist learns how to ensure patient safety in a health-care setting by implementing the surgical checklist measures during perioperative care. To date, there are still considerable shortcomings when it comes to implementing these patient safety measures in Swedish hospitals.
Aim: The purpose of this study is to describe the use of the WHO surgical safety checklist (WHOSSC) by surgical teams, with special emphasis on nurse anesthetists to increase patient safety.
Materials and methods: This descriptive questionnaire-based study was performed between September 2018 and March 2019 and included 196 health-care professionals who completed the questionnaire. The survey was carried out among all the health-care professionals at two surgical units at a university hospital during the data collection period.
Results: The results reveal that the majority of health-care staff in this study agree with the need to implement the WHOSSC during surgery and the necessity of doing so to ensure patient safety. However, it is not clear whether this checklist needs to be made a matter of routine at the clinics and whether this is possible in emergency situations.
Conclusion: The nurse anesthetists, as members of the surgical team, use the list all the time in emergency situations and conclude, like other members of the team, that the list improves patient safety. Clearer procedures are needed during surgery regarding the usage of the checklist in practice, and there should be a designated person in the surgical team responsible for implementing the checklist.
Keywords: Occupation; research; surgery; teamwork questionnaire; world health organization checklist.
