Patient safety


2009)11 2018)12


, across 132 countries (Gillespie et al, with the aim of preventing unnecessary


death and improving outcomes for surgical patients (Viswanath et al, 2017).13


Consequently,


nineteen items were compiled into the three steps, for the original WHO safer surgery checklist (SSC). However, later in December 2010, following feedback from the initial implementation, a further two steps were added. These were the ‘team brief’ and ‘debrief’ (Shah, 2011).14


From February 2010, the checklist became


a mandatory requirement for all operations in NHS England (NPSA, 2010).15 When the checklist was introduced in 2009, the WHO indicated that the checklist is not intended to be comprehensive; additions and modifications were encouraged (WHO, 2009).10 This was supported by Harden (2013)16


had previously Midlands


East of England


South West


London South East


, as it was


suggested that checklists are not ‘one-size-fits- all’; they must be customised to fit local practice. Verdassdonk et al (2009)17


suggested that, if the checklist is modified, it may influence its efficiency but, if it is too long or difficult, it may have a negative effect or no effect at all. McConnell et al (2012)18


found


similar findings as they suggested the checklist should remain succinct and concise, otherwise ‘checklist fatigue’ may occur. Thimbleby (2013), cited in Westman et al, 2020),19


stated that


checklists need to be tailored for different procedures. However, Pugel et al (2015)20


suggested


that adopting a checklist to fit local practice may promote ownership and could improve compliance. Raman et al (2016)21


suggested


that checklists need to be tailored to the specific task being performed. The use of stock questions decreases the likelihood of ensuring all theatre personnel are attentive. This was supported by both Raman et al. (2016)21


and Barbanti-Brodano et al (2020)22


Figure 1: NHS England by region. al (2014)27


North West


North East, Yorkshire and the Humber


reported that the perceived barriers


fell into four categories: confusion; pragmatic challenge; access to resources and individual beliefs and attitudes. A year later, in 2015, Treadwell et al (2014)27


still noted that there


were barriers but, in fact, identified five main categories: staff perception; workflow; design and content of the checklist; implementation and local context. Gillespie et al ’s (2018)12 Australian study stated that the most significant barriers to using the SSC were workflow, knowledge, contents, and clinical leadership. To successfully implement the safer surgical checklist, Collins et al (2014)28


suggested that


key stakeholders are identified. A change in culture and a shared vision for safety and active communication were all required. This theory was supported by both Bergs et al (2014)29 Gillespie et al (2018).12


and They suggested that there as


they suggested specialised checklists reduce adverse events. The answer to whether the barriers to SSC


are being reduced or removed was partly addressed by Fourcade et al (2012)23 etal (2012)24


and Levy , whose earlier research suggested al (2014),26


that, despite the awareness of the safer surgical checklist, most hospitals were struggling with effective implementation. Mahajan’s (2011)25 early research suggested that some barriers to implementation included: anxiety; timing; duplication; relevance and misuse. Hurtado et al ‘s study (2012), cited in Patel et concluded that knowledge of when


to use the checklist was a definitive barrier to effective implementation. Levy et al ’s (2012)24 American study also concluded that there was a lack of understanding and familiarity of the checklist among staff. Later in 2014, Treadwell et


26 www.clinicalservicesjournal.com I February 2023


is evidence identifying both contextual and organisational challenges in relation to checklist adoption. To lead the change and to implement the SSC, Vats et al (2010)30


suggested that the use of


local champions will help in achieving complete adoption of the checklist. This theory was previously supported by Reinertsen et al (2007)31 Paull et al (2009)32 Collins et al (2014),28


and


Patel et al (2014).26 Mahajan (2011)25


found that, for successful


implementation, three essential elements were required. They included: developing local champions, organisational leadership, and training. Conley et al (2011), cited in Barimani et al (2020),33


,


and Sewell et al (2013), cited in Treadwell et al (2014),27


the SSC was used. Oppikofer and Schwappach (2017)35


suggested that hospital leadership


is essential, as acceptance comes from the participation of the users. Other challenges associated with the use of the SSC, while undertaking this literature review, was one of time. An early study in France by Fourcade et al (2102)23


concluded the SSC was


considered ‘a waste of time’ as it took staff too long to complete, when their workload was already busy. There was also a perception of no actual added patient benefit. A study in Canada, by Urbach et al (2014),36


found that the SSC


added steps that caused unnecessary delays in an already busy operating theatres schedule. Treadwell et al (2014)27


staff felt the checklist decreased efficiency in the operating room. Tian et al ’s (2016)37


study


reported that the WHO checklist was still relevant and important, but concluded that adequate time must be provided for checklist completion – as this will lead to both ‘buy in’ from staff and ultimately improve patient safety. Barimani et al (2020)33


similarly reported that


concluded that a


major barrier to adoption of the SSC was the lack of a streamlined and cohesive approach in implementation. In the current climate, where the NHS and


stated that a local champion can lead


implementation by educating and supporting team members, as this will also help reduce the perceived barriers, as previously mentioned. O’Connor et al ’s (2013)34


study, in Ireland, found


that by having a designated local champion, it helped to remove any barriers and ensured


other healthcare organisations from around the world are faced with high demands on an already stretched service, we must consider the staff and potentially how fatigued they are all feeling, following COVID-19, and the pressures placed on NHS Trusts by the Government to tackle a growing backlog of patients that require not only surgical intervention, but also other NHS services (O’Dowd, 2021).38 The next question to ask is: why are never


events still occurring, if the SSC is in daily use? The literature would suggest that there are still areas that require further research, education, and training. NHS England (2021)39


defines


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68