The World Health Organization (WHO) developed the Surgical Safety Checklist (SSC) to help healthcare professionals minimise the most common and avoidable risks endangering the lives and well-being of surgical patients. We have asked some of our speakers participating in the 5th Annual Operating Theatre Management conference what has been their most significant step toward successfully implementing and applying the SSC.
Jodie Hulm, Clinical Nurse Specialist, Theatre, Princess Margaret Hospital for Children WA
Kirstie Johnson, Clinical Development Nurse, Theatre, Princess Margaret Hospital for Children WA
Our most significant step toward successfully implementing and applying the WHO SSC involved the development of a site specific document which addressed the needs of the paediatric patient. Key stakeholders were engaged from the outset to refine the WHO SSC and the recommendations of the WA Health SSC Guidelines. An extensive trial of the draft documentation was commenced together with theatre staff education and training. The entire trial exercise was audited to measure a baseline compliance rate and also to identify any issues as they arose. The draft document was revised 6 times and continued to be trialled until the final draft was published and the endorsed SSC was printed and put out into circulation.
The SSC continues to be a valuable shared tool to minimise risk to the paediatric patient and has also been adapted to include an additional IV flush check in the sign out phase at the request of anaesthetic staff. A legal disclaimer to protect nurse accountability for this particular check was added to verify that it is a verbal check only.
Rigorous compliance auditing has been conducted annually using two different tools to firstly observe the SSC being performed by theatre staff and monitor how well it is being performed. Secondly a document audit is also performed to examine if the SSC forms in the patient’s medical records have been completed and signed according to the SSC requirements. All results are reported to governance and executive committees as well as to theatre staff in conjunction with scheduled education and inservice sessions.
Charmayne Thompson, Operations Manager Perioperative Services, The Womens, VIC
The most significant step is stakeholder engagement and leadership during the implementation phases. It is essential that medical, nursing and ancillary staff are provided with evidence and reasoning before introducing any change. Regular evaluation and feedback is also part of implementing any new changes to process.
Sharon Cassidy,CNE, Central Australian Hospital Network, Department of Health NT
The most significant step in our implementation process of the SSC is acceptance by the entire interdisciplinary team, active promotion by interdisciplinary team leaders and a streamlined integration strategy that we are currently adapting. This concept has been crucial to achieving acceptance. It does require patience, commitment and follow-through by all stakeholders. It requires that the workflow is not impeded upon and that consistency is maintained.
In order further implementation to be successful, it does require committed champions who believe in the process and benefits on promoting a gold standard of client centred care in the perioperative environment. Within Alice Springs Hospital, there are a number of such champions who have taken it upon themselves to ensure that we are operating in a client centred environment that is dedicated to teamwork and effective interdisciplinary communication. The team has facilitated the implementation through regular in-services on the concepts behind the checklist and its many researched benefits, shown YouTube simulations on ‘how to’ and ‘how not to do’. They have utilised the Trial checklist and provided feedback and suggestions on how to improve the checklist efficacy for the specific needs of our somewhat unique environment.
We are currently still ongoing with our trial in line with other NT hospitals and plan to embark upon auditing our process in the near future.
Phyllis Davis, Nursing Director, Randwick Campus Operating Suite, The Prince of Wales Hospital, The Sydney Children’s Hospital, The Royal Hospital for Women
Buy in from the surgical team and the support of executive is absolutely crucial.
NSW is lagging behind most other states and our international colleagues in the implementation of the complete WHO Checklist (3 phase) most jurisdictions continue to do “time out” which is part 2 of the complete check list. The Ministry of Health has asked the Clinical Excellence Commission to develop and implement this activity – the meetings have been going on for 2 years! No end ……..yet