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

Abstract

To gain greater insight into how nurses engage with the multidisciplinary team during the surgical safety checklist process. Participants and settingParticipants were a purposeful sample of eight operating room nurses. The study was conducted in the operating room department of a major tertiary teaching hospital in South Australia. MethodsPhase 1 employed participant observations while phase 2 employed semistructured interviews. FindingsParticipants supported the use of the surgical safety checklist and valued its role to enhance patient safety. Multidisciplinary team culture played a significant role in how the checklist was conducted and heavily influenced the level of nurse participation in the process. Observations indicated poor compliance with the nursing review section of the checklist. ConclusionsMultidisciplinary team engagement is important for effective communication during the process of utilising the surgical safety checklist to promote safe outcomes for patients. Nurses are more likely to actively participate in the checklist process if they feel their role is valued by other team members. The nurse-specific area of the checklist is an area for improvement as this tends to be overlooked and considered less important than other checklist items. Modifications in timing the checklist and nurse training may be beneficial to address non-compliance with the nurse area of the checklist.

Barriers and facilitators associated with the implementation of surgical safety checklists: A qualitative systematic review

“…Of the 1912 publications retrieved from the database searches, a total of 34 studies were included (Figure 1) (Page et al, 2021). The studies were conducted in a range of countries: Jordon 1 (Albsoul et al, 2022), Turkey 1 (Aydin Akbuga et al, 2023), Brazil 1 (De Oliveira Junior & De Magalhães, 2017), France 1 (Fourcade et al, 2012), Cyprus 1 (Georgiou et al, 2018), Thailand 1 (Kasatpibal et al, 2018), Sweden 3 (Krupic et al, 2020; Nordström & Wihlborg, 2019; Rönnberg & Nilsson, 2015), Saudi Arabia 1 (Manamela et al, 2022), Zambia 1 (Munthali et al, 2022), Spain 1 (Peñataro‐Pintado et al, 2021), Switzerland 1 (Schwendimann et al, 2019), New Zealand 1 (Weller et al, 2018) and Madagascar 1 (White et al, 2018), USA 2 (Alidina et al, 2017; Conley et al, 2011), multiple countries 2 (Aveling et al, 2013; Elam et al, 2022), Norway 3 (Haugen et al, 2015; Høyland et al, 2014; Wæhle et al, 2012), UK 3 (O'brien et al, 2017; Robertson‐Smith, 2016; Russ et al, 2015), Australia 4 (Braaf et al, 2013; Gillespie, Marshall, et al, 2016; Gillespie, Withers, et al, 2016; Rogers et al, 2020) and Canada 6 (Dharampal et al, 2016; Gagliardi et al, 2014; Mahmood et al, 2019; Mobilio et al, 2022; Spence et al, 2011; Ziman et al, 2018). The sample sizes ranged from 8 to 196 participants and represented the total number of all members of the perioperative MDT: surgeons, anaesthesiologists, operating room nurses, medical students, nurse anaesthetists, surgical trainees, theatre support workers, radiographers, nursing students, administrative staff, management and consumers (see Table 1).…”

“…TA B L E 3 (Continued) et al, 2013;Krupic et al, 2020;Robertson-Smith, 2016;Rogers et al, 2020;Schwendimann et al, 2019).…”

“…Specific surgical specialties were reported as barriers because the culture inherent within individual specialties impacted compliance rates and engagement in the MDT (Elam et al, 2022;Munthali et al, 2022;Peñataro-Pintado et al, 2021;Rogers et al, 2020;Schwendimann et al, 2019;Weller et al, 2018;Ziman et al, 2018). The culture of professional independence or disciplines working in 'professional silos' in operating theatres was a barrier to team communication and successful checklist processes (Alidina et al, 2017;Braaf et al, 2013;Fourcade et al, 2012;.…”

“…Many studies identified that additional perioperative clinical tasks negatively impacted timely and accurate completion of the checklist (Alidina et al, 2017; Braaf et al, 2013; Dharampal et al, 2016; Gillespie, Marshall, et al, 2016; Gillespie, Withers, et al, 2016; Krupic et al, 2020; Rogers et al, 2020; Russ et al, 2015; Weller et al, 2018; Ziman et al, 2018). Additional distractions and interruptions, such as irrelevant conversations, music, high mechanical noise, phones and other background noise, also created barriers to the completion of the checklist (Braaf et al, 2013; Krupic et al, 2020; Robertson‐Smith, 2016; Rogers et al, 2020; Schwendimann et al, 2019).…”

“…Specific surgical specialties were reported as barriers because the culture inherent within individual specialties impacted compliance rates and engagement in the MDT (Elam et al, 2022; Munthali et al, 2022; Peñataro‐Pintado et al, 2021; Rogers et al, 2020; Schwendimann et al, 2019; Weller et al, 2018; Ziman et al, 2018).…”