Patient safety
Trusts from the audit by twenty-one was due to the following reasons: a) Nine Trusts were not yet in existence between April 2015 – March 2020 at the point that LocSSIPs where first introduced.
b) Six Trusts were excluded as a result of only appearing to have one operating theatre, therefore meaningful data was difficult to ascertain.
c) Two of the Trusts are non-NHS. d) We removed the data from a further Trust because of a possible conflict of interest. e) Three Trusts did not provide any contact details.
Table three details the number of participants by NHS England region. The Delphi study was sent to all participants on the 27 October 2022; all responses were recived back on the 11 November 2022. In total, 23 NHS England Trusts participated. This study was undertaken by Qualtrics to ensure anonymity. This equates to 18% of NHS England Trusts that have operating theatres, as part of their routine or emergency patient services. This
Delphi Study round one participants Region
London
Southwest Southeast Midlands East
Northwest
Northeast & Yorkshire Total
Table 3.
study took a representative sample. It was a random selection and the sample
of staff was determined by the participants volunteering from across NHS England. However, it can be argued that it is possible to generalise the results for the entire research population – i.e. NHS England. There was a range of
Team brief 3.85% Sign in 3.85% Sign out 3.85% De-brief 69.23% Check, Stop, Block 19.23%
hierarchical agenda-for-change bands, age and professional qualification held, i.e., RGN or ODP.
Results For any system or process to work, training should occur. However, worryingly, 73% of responses stated that training on how to deliver the checklist was not offered by their organisation. The literature supports the development and alteration of checklists to suit the specialty. Verdaasdonk et al (2009)46
found
that if the WHO checklist is modified, it may influence its efficiency, but if the WHO checklist is too long or difficult, it may have a negative effect or no effect at all. Raman et al ’s (2016)21 study suggested that checklists need to be tailored to the specific task being performed. 64% of respondent stated that their Trust has both generic and specialty checklists, and 32% stated that only a generic SSC is available. Previous literature by Taylor, Slater and Reznick (2010), cited in Treadwell et al (2014)27 Barimani et al (2020),33
evidenced the myth of Figure 2: Which of the five steps (six if ‘prep, stop, block’ is included) are commonly missed.
Time 17.24% Staff attitude 27.59% Culture 18.97% Lack of leadership 15.52% Communication 15.52% Other 5.17%
‘time consuming’, by reporting the WHO checklist took only about two minutes on average. The results from the Delphi study found that time was a perceived barrier for the delivery of the checklist, as only 59% of respondents felt that there was enough time to undertake the SSC. Interestingly, only 32% of Trusts had
checklist champions. Treadwell et al (2014)27 also concluded that enlisting leaders as local champions is a positive strategy for successful implementation. To ensure that cyclical learning and continual education occurs, feedback is critical, but only 59% of respondents stated that they always feedback if a never event occurs. Regarding whether all five steps are
Figure 3: Perceived barriers as to why the SSC does not get completed. 28
www.clinicalservicesjournal.com I February 2023
completed, figure two shows which steps are missed. As the literature supports, there could be many reasons or perceived barriers as to why the surgical safety checklist is not always completed. Mahajan (2011)25
found
3 1
5 4 2 3 5
23/136
Participants Percentage of invited regions participating
13% 5%
23% 16% 11% 12% 23%
18%
and
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