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Figure: WHO surgical safety checklist.
Source publication
To evaluate the current practices regarding formal or informal implementation of individual elements of the World Health Organisation's Surgical Safety Checklist in tertiary care hospitals of Karachi and to establish a pre-checklist baseline to suggest a plan for implementation of the checklist.
The qualitative knowledge-attitude-practice (KAP) sur...
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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...
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
... Results that came out were terrifying, site for surgery was not marked in 10.7% cases, during timeout in 88.3% cases staff did not introduce themselves to the patient, during sign-out name of procedure performed was not recorded in 33% cases, instruments were not counted in 20.4% cases, specimens taken were marked with patients' identity in only 9.7% cases. 6 Another common factor is to fill out the checklist form without involving the patient and is mostly done by juniors on call. Surgeons don't even bother to confirm all the marked information. ...
Mistakes happen. We all make mistakes that makes us human. But when a surgeon makes mistake, it costs lives. Being surgeon, a little negligence might make catastrophic incidents happen. An unintentionally retained needle in the abdominal cavity or surgery of a normal limb instead of faulty gall bladder can have serious consequences not only for the patient and the patient-physician relation but also for the healthcare system. Such negligence events have become common in Pakistan. In Faisalabad, it was reported that a patient with gall stones was mixed up with a patient of limb surgery having the same name that led to inappropriate surgical procedures performed on both.[1] In Abbottabad, an incident was reported where the patient had to undergo an arm surgery but an eye surgery was performed in a private hospital. [2] Everyone blamed the surgeon and the health care system but no one dared to dig into the cause. Why are such childish mistakes happening? And if happened once how is this being repeated? How could a surgeon, a practically learned man make such non-sense? The answer to all these questions lies in the WHO Surgical Safety Checklist. “Safe Surgery Save Lives” was initiated by the World Health Organization (WHO) in 2007 in order to alleviate the number of such unwanted events encountered in the surgical procedures. For the purpose of improving patient safety with least of the resource utilization, WHO came on board with safety checklist in 2008.[3] The WHO 19-item checklist is based on advocating safety checks and a good communication among surgery team members during perioperative periods. It also contains a time-out procedure. In Pakistan, in spite of the great effectiveness, the time-out is either not practiced or is done by some junior, and not by the operating surgeon at the preoperative time. A time-out is a short interval before incision during which it is confirmed that the patient on the surgery bed is the correct one, the procedure to be performed on it is exact and at the required part of body either marked or unmarked.[4] The surgeon should be present at the time-out and all members should guarantee the correct patient, procedure and site. Patient participation in the time-out process is also advised. Majority of the patients show great compliance and satisfaction for participating in the time-out procedure. ---Continue
... This was consistent with a study conducted in Karachi. 9 The current study showed complication rate of 16.9% which was almost similar to a cohort study. 1 This may be due to the fact that the current study included only elective surgeries in which complication rates are usually lower. ...
Objective:
To determine the incidence of complications in elective surgeries and to grade them according to the Clavien-Dindo Classification System.
Methods:
The cross-sectional study was conducted in the General Surgery Operation Theatre of Holy Family Hospital, Rawalpindi, Pakistan, from February to April 2018, and comprised patients undergoing elective surgeries. Age, gender, region of surgery, type and grade of complications, were recorded using Clavien-Dindo Classification proforma. Data was analysed using SPSS 23.
Results:
Of the total 212 patients, 36(16.9%) had some complication. There were significantly more complications in people aged 40 years or above compared to those <40 years (p<0.05). Of the total surgeries, 126(59.43%) were in the abdomino-pelvic region.
Conclusions:
Peri-operative complications were found to be significantly related with age of the patient and the type of surgery.
... The same study also reports that no formal count of sponges, needles and instruments were done in 21% of the observed surgeries. 14 A similar survey on WHO Surgical Safety Checklist implementation in hospitals in Ethiopia also reported that 75% of the respondents felt that there was a need to improve surgical safety in their ORs before the implementation of the Checklist. The same survey also points out that the respondents found the 'time-out' section of the Checklist hardest to fill. ...
Objective
The objectives of this study are to determine the knowledge and attitude towards surgical safety among the health care professionals including surgeons, anesthetist, hospital administrators, and operation room personnel and raise awareness towards the importance of safe surgery.
Method
A pilot cross- sectional study of 543 healthcare providers working in the operating rooms and the surgical intensive care units was conducted in two tertiary care hospitals, within a study period of one month. A structured questionnaire was constructed and an informed verbal consent was taken. The questionnaire was then distributed.
Results
A total of 543 respondents participated in the study out of which there were 375 (69%) men and 168 (31%) women. The ages ranged between 23–58 years, mean40.5±24.74. There were110 (20.25%) surgeons, 58 (10.68%) anesthetist, 132 (24.30%) trainees, 125 (23.02%) technicians, and were 118 (21.73%) nurses. The question regarding briefing operation room personnel is important for patient safety was agreed by 532 (98%) respondents. Amongst the respondents, 239 (44%) did not feel safe to be operated in their own setup. Team communication improvement through the check list implementation was agreed by 483 (89%) respondents. 514 (94.7%) opted for the checklist to be used while they are being operated. That operation room personnel frequently disregard established protocols was agreed by 374 (69%) respondents. 193 (35.54%) of the respondents stated that it is difficult for them to speak up in the OR if they perceive a problem with patient care.
Conclusion
Operation room personnel were not aware of several important areas related to briefing, communication, safety attitude, following standard protocols and use of WHO Surgical Safety check list. A pre-post intervention study should be conducted after formal introduction of the Checklist. Successful implementation will require taking all stake holders on board and rigorous training workshops, reinforcing and revisiting.
... The same study also reports that no formal count of sponges, needles and instruments were done in 21% of the observed surgeries. 14 A similar survey on WHO Surgical Safety Checklist implementation in hospitals in Ethiopia also reported that 75% of the respondents felt that there was a need to improve surgical safety in their ORs before the implementation of the Checklist. The same survey also points out that the respondents found the 'time-out' section of the Checklist hardest to fill. ...
Background:
The objectives of this study are to determine the knowledge and attitude towards surgical safety among the health care professionals including surgeons, anaesthetist, hospital administrators, and operation room personnel and raise awareness towards the importance of safe surgery.
Methods:
A pilot cross- sectional study of 543 healthcare providers working in the operating rooms and the surgical intensive care units was conducted in two tertiary care hospitals, within a study period of one month. A structured questionnaire was constructed and an informed verbal consent was taken. The questionnaire was then distributed; data collected and analysed on SPSS 20.0..
Results:
A total of 543 respondents participated in the study out of which there were 375 (69%) men and 168 (31%) women. The ages ranged between 23-58 years, mean 40.5±24.74. There were110 (20.25%) surgeons, 58 (10.68%) anaesthetist, 132 (24.30%) trainees, 125 (23.02%) technicians, and were 118 (21.73%) nurses. The question regarding briefing operation room personnel is important for patient safety was agreed by 532 (98%) respondents. Amongst the respondents, 239 (44%) did not feel safe to be operated in their own setup. Team communication improvement through the check list implementation was agreed by 483 (89%) respondents. 514 (94.7%) opted for the checklist to be used while they are being operated. That operation room personnel frequently disregard established protocols was agreed by 374 (69%) respondents. 193 (35.54%) of the respondents stated that it is difficult for them to speak up in the OR if they perceive a problem with patient care.
Conclusions:
Operation room personnel were not aware of several important areas related to briefing, communication, safety attitude, following standard protocols and use of WHO Surgical Safety check list. A pre-post intervention study should be conducted after formal introduction of the Checklist. Successful implementation will require taking all stake holders on board and rigorous training workshops, reinforcing and revisiting.
... Medical community may not want them to speak in view of the risk of litigation, and also to remain quiet and defend other doctors who make mistakes. 15 The majority of students attributed the causes of error to the 'person approach' and was not aware of the importance of 'systems approach' and of reporting systems. For example, a common misconception, especially among UGs, was that only physicians can determine the causes of medical error. ...
Objective:
To assess medical students' perceptions about patient safety issues before the teaching of "patient safety" can be recommended.
Methods:
The cross-sectional survey was undertaken at the Dow Medical College and Civil Hospital, Karachi, in September, 2013. Data collection tool was a structured questionnaire administered to medical students. The main outcome measures were students' perceptions about patient safety issues and their attitude towards teaching of patient safety curriculum.
Results:
There were 229 medical students in the study with a response rate of 100%. Overall, 129(57%) students agreed that medical errors were inevitable, but 106 (46.9) thought competent physicians do not make errors. While 167(74%) students said medical errors should be reported, 204(90%) thought reporting systems do not reduce future errors. Besides, 90(40%) students thought only physicians can determine the causes of error and nearly 177(78%)% said physicians should not tolerate uncertainty in patient care. Overall, 217(96%) agreed that patient safety is an important topic; 210(93%) agreed that it should be part of medical curriculum; 197(87%) said they would like to learn how to disclose medical errors to patients and 203(90%) to faculty members.
Conclusions:
A significant knowledge gap existed among medical students regarding patient safety issues. The teaching of 'patient safety' was highly supported by students and needs to be included in medical curriculum on an urgent basis.
... 439 Despite such obvious benefits, operationalisation of the WHOSSC may be poor. 70,190,[562][563][564] Failures to follow the checklist include not identifying the patient; undertaking a wrong-site surgery or procedure; 565 and failing to identify staff members. 123,566 In addition, pressure of time may lead to surgical procedures being started before the checklist is completed. ...
... In contrast, maladaptive decoupling was apparent in the local implementation of the focal intervention RSC, centred on the WHOSSC. Given the Welsh health-care policy commitment to this practice, as well as its world-wide professional advocacy, 439,565,727 it is worth considering the means through which such maladaptive decoupling manifested, that is, the simple and common failure to identify the members of the theatre team in the checklist. This practice reduced the possibility of individuals being blamed for any failures, undermining belief in the WHOSSC as a meaningful practice. ...
Hospital 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.
Objectives
This 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.
Design
We 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.
Setting
Welsh Government and NHS Wales.
Participants
Interviews 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 measures
Identification of the contextual factors pertinent to the local implementation of the 1000 Lives
+
patient safety programme in Welsh NHS hospitals.
Results
An 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.
Conclusions
Heightened 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.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
... These results similar to that of Askarian et al. (2011) (26) who found that pulse oximeter functioning and risk of blood loss >500 ml were in total compliance for the surgeries performed (100%) after intervention; Bliss et al. (2012) (23) found that most individual checklist components were completed by >90%, and also Rosenberg et al. (2012) (29) reported that site and side marking increased from 69.9% prechecklist to 97.8% (p<0.0001) and anticipation of estimated blood loss increased from 0% to 82.1% (p<0 .0001); also Khorshidifar et al., (2012) (27) and Toor et al., (2013) (32) reported similar results. In a study carried out by Sayed et al. (2013) (33) ; reported that only 3% of all the patients had the operation site marked for surgery and an incident of a single wrong side surgery was recorded. ...
... (35) also reported that the knowledge of the names and roles among the team members improved. The anesthetists discussed possible critical events more often (P< 0.001); Bliss et al., (2012) (23) also found that site was marked and visible; relevant images properly labeled and displayed; any equipment concerns (100%); antibiotic prophylaxis within one hour before incision and sterilization indicators have been confirmed (95.9%) respectively after checklist implementation and also Toor et al., (2013) (32) reported that (11.7%) of team members introduced themselves by name and role; surgeons discussed critical steps in (58.3%) cases; anaesthetist reviewed specific patient concerns in (59.2%); nursing team reviewed sterilization in (71.8%) cases; and prophylaxis antibiotic was administered in (61.3%) cases within the final 60 minutes. ...
... meanwhile there were no statistical significant difference between them as regard recording the name of procedure and the specimen labeled which were low in both groups and correct count of instrument, sponge and needles which were high in both groups (p>0.05) ( Table 4). These results was similar to Askarian et al., (2011) (26) and Toor et al., (2013) (32) . ...
ackground: Surgical care is associated with a considerable risk of complications and death that represents a substantial burden of disease worthy of attention from the public health community worldwide. A surgical checklist is an inexpensive tool that will facilitate effective communication and teamwork to prevent patient harm. Aim & Objectives: This study aims to improve the safety of surgical care to decrease morbidity and mortality associated with surgery at Zagazig University Hospital through the following objectives: 1- To assess the performance of surgical team (surgeons, anesthetists and nurses) about surgical safety before and after intervention. 2- To assess the incidence of major post-operative complications before and after intervention. 3- To assess surgical team attitude about patient safety in operating rooms (OR) before and after intervention. 4-To increase the awareness for all surgical team about surgical safety to decrease post operative complications. Subjects & Methods: an interventional study was conducted in general surgery department of Zagazig University Hospital during the Academic year 2012-2014. Comparing 157 patients before and 157 patients after intervention who are 16 years of age or older undergoing inpatient major surgical operation were consecutively enrolled in the study and all surgical teams (surgeons, anesthetists and nurses) of the selected group were included during the period of the study. The study was carried out through 3 phases. Results: Results of this study showed that there was a high statistically significant reduction in 30 days major post-operative complications after implementation of WHO surgical safety checklist, the total number of complications decreased from 50.96% to 27.39% (p = 0.0001), in-hospital mortality decreased from 3.18% to 0% (p = 0.02). There was statistical significant improvement of surgical team attitude about OR surgical safety after intervention (p<0.05), there was high statistical significant negative correlation between physician and nurse coordination and occurrence of postoperative complications(r= -0.27) (p<0.05). The checklist was considered easy to use by 94.6% of physicians, 62% of nurses. Conclusion: In conclusion, this study revealed that a relatively simple education program for implementation of WHO surgical safety checklist was associated with reduction in major post-operative complications and mortality in a hospital with a high standard of care. It is recommended to use the Surgical Safety Checklist in all operative procedures.
Objective: to learn how postgraduate surgical and allied trainees at Arif Memorial Teaching Hospital (AMTH), Pakistan, feel about non-technical abilities in the operating room. Methodology: A cross-sectional survey was conducted at the AMTH theaters, thirty postgraduate trainees filled the Operating Room Management Attitudes Questionnaire (ORMAQ). Results: Except for procedural compliance and error disclosure, which point to differences in implementation and awareness, postgraduate trainees have good opinions about every aspect of the ORMAQ survey. Conclusion: The findings mostly match those of earlier ORMAQ surveys of surgical teams conducted in other nations. Due to shady systematic working practices and cultural norms, the disparities highlight the possible hazard to patient safety. The results validate the use of human factor training and team interventions to apply protocols and guidelines. This survey also aids in gathering information for a hospital's quality assurance program. Keywords: Non-technical skills, ORMAQ, patient safety, surgery, human factors
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.
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.
