Review: Evidence Based Practice of Surgical Safety Checklists

In accordance with the World Health Organisation (WHO 2008) checklist and Local trust policies, a team briefing was held before the day’s list started. The checklist is part of a second Global Patient Safety Challenge initiative entitled ‘Safe Surgery Saves Lives’, aimed at reducing the number of surgical deaths worldwide and was launched in June 2008. This not

The Joint Commission focuses on certain goals each year. For patient safety and positive outcomes, hospitals are required to follow certain standards. National Patient Safety Goals were established in 2002 to help identify areas of concern with patient safety. This group is made up by a panel of experts including nurses, doctors, pharmacists and many other healthcare professionals. They advise the Joint Commission on how to address these different patient safety issues. Two goals to be discussed are improving the accuracy of patient identification and medication safety. To improve patient

The OR is naturally a high risk environment, surgery naturally exposes staff to patient blood and body fluids, involves the handling of sharp instruments, and the close interactions of the surgical team within a limited amount of space (Jagger et al., 2011). Operations involve the types of sharps; trocars, some surgical instruments, saws, drills, reamers, and some suture needles and scalpel blades that may not easily be replaced with Safety Engineered Devices (SED’s) (Guest, Kable, & McLeod, 2010). The majority of sharps injuries within the OR result from handling sharps, such as needles, blades and sharp instruments hand-to-hand (Jagger et al., 2011).

In 2003, as an outcome of all the sentinel events reported to the Joint commission lead to the creation of the “The Universal protocol for preventing wrong site, wrong procedures, and wrong person surgery” (Mulloy & Hughes 2008). So, one of the ways that could have potentially prevented the situation from happening at the first place was implementing the universal protocol procedure. According to the protocol the conduction of proper pre as well as post-operating procedures are extremely mandatory. Therefore, by enforcing a standardized routine pre-operating procedure such as verifying the patient as well as the correct site for the procedure, by having the medical staff or preferably the physician marking the operating site with his or her initials before the surgery will be an effective preventive measure (Mulloy & Hughes 2008).

The Safe Surgery Save Lives initiative undertaken by the World Health Organization (WHO) in 2008 focused on implementation of a surgical checklist. The safety checklist requires the surgical site be checked during the check in process as well as during the surgical time out.

Conversely, the How to Guide: Five Steps to Safer Surgery is an adjunct to the World Health Organization (WHO), Safe Surgery Saves Lives: The Second Global Patient Safety Challenge. In this, the primary goal is to confirm that surgical teams not only communicate, but follow safety standards in order to minimize common mistakes and insure the best outcome for surgical patients. The standards included in this literature emphasize, “improving anesthetic safety practices, ensuring surgery is undertaken on the correct part of the body, preventing surgical site infections, and improving communication and teamwork” (Beaumont & Russell, 2012). The actual checklist consists of the following 5-step process:

The Joint Commission Accreditation Body assesses health care organization’s compliance with National Patient Safety Goals. The goal of the Joint Commission Body is to focus on critical aspects and patient safety issues in health care organizations, which can vary according to the setting of the health care being performed (Chassin, 2008). Infections occurring in surgical sites of patients account for 15% of all infections that transpire in a hospital setting, and the risk of death doubles in patients who develop infections. The dangers of surgical site infections include superficial, deep, and organ or space infections. The different infections include cellulitis, gangrene, MRSA, and wound sinus, which can lead to amputation, organ

Lastly, in the surgery theatre, misidentification may happen due to the same factors formerly mention plus failure to mark site/side of surgery, failure to properly perform time-out, and multiple surgical teams (Chan et al., 2010). To analyze the risk for these errors, few factors will be analyzed including human factors (staffing, scheduling, supervision, and qualification), equipment and technology (scanners, computers, and software), Communication (between staff and patients, between staff, between staff and physician, between physician and patient, and between units), environmental factors (physical, safety, security, and preparedness), and procedures and policies (planning, staff education, patient education, protocols, patient identification, and patient observation) (Chan et al., 2010).

In 2008, it was estimated that “medical errors total more than $19.5 billion” (Andel, 2012, p. 12). It is important to address and solve this problem at this time because the National Quality Forums (NQF) “never events” considers such events. Never events are events that occur that should have never occurred in the first place. Reducing and eventually eliminating wrong site surgeries will help improve patient safety in the operating room and become a leading example in improving patient safety in all aspects of healthcare.

They are very easy to navigate and it only took minutes to locate the information I needed for this project. The Joint Commission and the World Health Organization (WHO) set the standards and recommendations that hospitals follow when making their policy and procedures for patient safety and patient care. These two websites clearly state the required time-out elements and expectations of a surgical time-out. This information was very helpful in helping me make sure that all required elements were included.

At least half a million deaths per year could be prevented with effective implementation of systemic improvements in operating rooms. Specifically, multiple studies have found implementing the use of the WHO Surgical Safety Checklist would significantly reduce surgical morbidity and mortality due to surgical errors.

Checklists are good to use to enhance safety. Errors within the clinical tasks which would consist of attentional behavior- for instance diagnostic or handoff errors- this would include solutions that are more geared towards additional training, supervision, and decision support instead of standardizing behavior. The achievement and effectiveness of checklists is avoiding central line infections and enhancing surgical safety “resulted from the strong evidence base supporting each of the individual items in the checklist, and therefore checklists may not be successful in areas where the "gold standard" safety practices have yet to be determined (Checklists,

* Hand washing is the most important method of preventing the spread of infection by contact (Ayliffe et al 1999). The Nottingham University Trust Policy on Hand Hygiene (2009) states that there are three types of hand hygiene, the first is ‘routine hand hygiene’ which involves the use of soap and water for 15 – 20 seconds or the application of alcohol hand rub until the hand are dry. The second is ‘hand disinfection’ which should be used prior to an aseptic procedure by washing with soap and water and applying alcohol hand rub afterwards. The third is ‘surgical hand washing’ which is the application of a microbial agent to the hands and wrists for two minutes. In addition to which a sterile, disposable brush may be used for the first surgical hand wash of the day although continued use will encourage colonisation of microbes. The third example is the most appropriate to any O.D.P undertaking the surgical role as it is the best way for the surgical team to eliminate transient flora and reduce resident skin flora (World Health Organization 2010). The first and second are important to any O.D.P undertaking any other role within the Operating Department as this is the best way to reduce the transient microbial flora without necessarily affecting the resident skin flora

Issues related to a lack of patient safety have been going on for a lot of years now. Throughout the first decade of the 21st century, there has been a national emphasis on cultivating patient safety. Patient safety is a global issue, that touches countries at all levels of expansion and is one of the nation's most determined health care tests. According to the Institute of Medicine (1999), they have measured that as many as 48,000 to 88,000 people are dying in U.S. hospitals each year as the result of lapses in patient safety. Estimates of the size of the problem on this are scarce particularly in developing countries; it is likely that millions of patients worldwide could suffer disabling injuries or death every year due to unsafe medical care. Risk and safety have always been uninterruptedly been significant concerns in the hospital industry. Patient safety is a very much important part of our health care system and it really

Those who incorporate the best practice standards can reduce the morbidity and mortality associated with surgical site infections.