Patient safety
Understanding check list challenges
Nigel Roberts, head theatre practitioner, at Birmingham Women’s and Children’s NHS Hospital Trust, provides an insight into a Delphi Study (round one), which has sought to understand current practice around the use of the WHO Surgical Safety Checklist and some of the challenges around implementation.
This article addresses information raised as part of a Delphi study of NHS hospital operating theatres in England. Through a combination of closed and open-ended questions, the aim of the first Delphi study round was to solicit specific information and views on how the World Health Organization’s Surgical Safety Checklist (SSC) is currently being used in the perioperative setting, as part of a strategy to reduce surgical ‘never events’. Operating theatre managers, matrons and clinical educators (that work on the frontline of surgical care and deliver the surgical safety checklist daily), were canvassed for their views and insights, as operating theatre experts. Participants were from the seven regions identified by NHS England. The study revealed that the majority of Trusts do not receive formal training on how to deliver the SSC, checklist champions are not always identified, feedback following a ‘never event’ is usually given and that the de-brief is the most common step missed. While the intention is not to establish whether the lack of training, cyclical learning and missing steps has led to the increased presence of never events, it has facilitated a broader engagement in the literature, as well as highlighting some possible reasons why compliance has not yet been universally achieved. Furthermore, the Delphi study is intended to be an exploratory approach to inform a more in-depth doctoral research study intended to improve patient safety in the operating theatre, inform policy making and quality improvement.
Introduction and background context Barrett and Heale (2020)1
disagreement on an issue”. The Delphi technique is an iterative multistage
process, designed to transform opinion into group consensus. If used systematically and rigorously, it can contribute significantly to broadening knowledge with the healthcare profession. The research gathered data to seek expert opinions of users of the WHO surgical safety checklist and to gain a consensus of opinion based on the end user’s knowledge and expertise. The data collected helped to identify trends and patterns to make logical sense of this research topic. The technique developed an approach which promoted anonymity and avoided direct confrontation among experts.
state that the Delphi
technique was first developed in the 1950s in an attempt to gain reliable expert consensus. Jones and Hunter (1995), cited in Vogal et al (2019),2
further explain that “this technique seeks
the opinion of a group of experts in order to assess the extent of agreement and to resolve
Literature review In summary, NHS operating theatres, as well as operating theatres across the globe, encounter daily time pressures, high workloads, and there is a potential for catastrophic results if errors occur. The checklists that are used across the
world today are based upon three principles: simplicity, widespread applicability, and measurability (WHO, 2008).3 Recognition of theatres being a hazardous
environment was made by Thomas et al (2000) (cited in Patel et al, 2014),4
when it was estimated
that nearly half of the adverse events that occur are preventable. The ethos of a checklist is to help identify mistakes before any harm is caused to patients. Helmreich (2000)5
reported
that checklists are commonly used as a method of both error and safety management to reduce risk. Haynes et al (2009)6
demonstrated that the
use of a simple checklist can reduce the risk of morbidity, mortality and surgical site infection associated with surgery. Checklists not only reinforce communication (McConnell et al, 2012)7 but also improve communication among all of the multidisciplinary team (Gillespie et al, 2010 and Low et al, 2012)8,9 In 2009, the World Health Organization (WHO)
launched guidelines for safe surgery saves lives (WHO, 2009)10
in six languages (Haynes et al, February 2023 I
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