WHO Safety Surgical Checklist implementation evaluation in public hospitals in the Brazilian Federal District

Abstract

The World Health Organization (WHO) created the WHO Surgical Safety Checklist to prevent adverse events in operating rooms. The aim of this study was to analyze WHO checklist implementation in three operating rooms of public hospitals in the Brazilian Federal District. A prospective cross-sectional study was performed with pre- (Period I) and post (Period II)-checklist intervention evaluations. A total of 1141 patients and 1052 patients were studied in Periods I and II for a total of 2193 patients. Period I took place from December 2012 to March 2013, and Period II took place from April 2013 to August 2014. Regarding the pre-operatory items, most surgeries were classified as clean-contaminated in both phases, and team attire improved from 19.2% to 71.0% in Period II. Regarding checklist adherence in Period II, "Patient identification" significantly improved in the stage "Before induction of anesthesia". "Allergy verification", "Airway obstruction verification", and "Risk of blood loss assessment" had low adherence in all three hospitals. The items in the stage "Before surgical incision" showed greater than 90.0% adherence with the exception of "Anticipated critical events: Anesthesia team review" (86.7%) and "Essential imaging display" (80.0%). Low adherence was noted in "Instrument counts" and "Equipment problems" in the stage "Before patient leaves operating room". Complications and deaths were low in both periods. Despite the variability in checklist item compliance in the surveyed hospitals, WHO checklist implementation as an intervention tool showed good adherence to the majority of the items on the list. Nevertheless, motivation to use the instrument by the surgical team with the intent of improving surgical patient safety continues to be crucial.

Execução da lista de verificação de segurança cirúrgica em operações pediátricas: avaliação da conformidade

“…Although studies show that the use of checklist makes the communicative process more effective in OR, the practice of nonverbal verification refers to the insufficiency in the interdisciplinary communication in OR (3,6) . The team discussions ensure greater patient safety, since professionals explain relevant topics about the client and the surgical planning.…”

“…In addition, it was concerned with reducing the Hawthorne, effect which gives greater reliability to the results obtained. In other studies of compliance in the checklist application, the team knew that it was being observed and changes in behavior may influence the assessment (3,7) .…”

“…The benefits of the WHO Surgical Safety Checklist are demonstrably associated with reduced mortality and surgical complications (2)(3)(4) . Systematic review and meta-analysis of six studies that evaluated the effect of the tool in postoperative complications, revealed a strong correlation between the reduction of these AEs and the use of the checklist.…”

“…Satisfactory repercussions of the surgical safety procedure may be related to the conformity of the checklist application in health services, the completeness of its completion and the way of implementation (5)(6) . The introduction of the checklist in the OR routine is only an advent for surgical safety, since studies that analyzed its execution point to unsatisfactory levels of adhesion to the instrument (3,(7)(8)(9)(10)(11) . A review study on the checking of the checklist items in Brazilian hospitals identified that the practice is inadequate in the country, with a mean of measuring most safety items less than 80% (10) .…”

Índice Autorreferido Pela Equipe De Cirurgia Ortopédica Sobre O Protocolo E Checklist De Cirurgia Segura

“…Muitas vezes, a equipe não adere ao protocolo devido à falta de percepção da importância do checklist na prática cirúrgica. Nesse sentido, o conhecimento da equipe de cirurgia é fundamental para que o protocolo seja implementado de forma adequada e homogênea, sobretudo que seja efetivamente utilizado, o que nem sempre é observado na prática, seja pelo desconhecimento ou pela falta de divulgação quanto à sua importância (11)(12)(13) . É importante ressaltar que o cumprimento desse protocolo tem como princípio fundamental a melhoria da comunicação entre os membros da equipe cirúrgica, atentando ao fato de que os eventos adversos são na maioria das vezes evitáveis.…”