Patient safety


that leadership was required for successful implementation of the surgical safety checklist. Zuckerman et al (2012)47


also found that a


shared vision of active communication was also required. Sewell et al ’s orthopaedic study (2011), in the


UK, showed the importance of education and training in changing staff perceptions (cited in Collins et al, 2014)28 and Patel et al (2014)26


, Treadwell et al (2014)27 . Treadwell et al (2014)27


,


found that barriers included surgeon resistance to changing habits, awkwardness of self- introductions and steep interpersonal hierarchy. Ultimately, Gillespie et al ’s (2018)12


Australian


study stated that the most significant barriers to using the SSC were: workflow, limited knowledge about timing, content of checks, a lack of clinical leadership and dissonant attitudes. The study highlighted this, as the feedback was spread across several headings. Figure three details the perceived barriers. National Safety Standards for Invasive


Procedures (NatSSIPs) were published on the 7 September 2015. The intention was that the mandatory introduction of the WHO (2013) surgical safety checklist and the refinement of the three surgical ‘never events’; wrong site surgery; wrong implant or prosthesis and retained foreign object post procedure, would lead to a significant reduction in the incidence of ‘never events’ in the NHS in England. Despite these initiatives, the data would suggest that this has not been the case, and a marked decrease in ‘never events’ has not materialised. The Delphi study results, shown in figure four, highlight that much needed education is needed following the launch of ‘NatSSIPs two’ in 2023. Finally, several respondents suggested possible improvements to ensure the surgical checklist is delivered. The responses are shown in table four.


Discussion It was found that, of the Trusts that responded, the prevalence of no formal training and a small number of champions may actually result in poor adherence to the checklist. It is acknowledged that we are not yet in a position to draw further conclusions, as the proceeding Delphi study round is looking at the effectiveness of the theatre checklist and local safety standards for invasive procedures (LocSSIPs). In acknowledging that the participant rate


was 18%, it cannot claim to know how other Trusts are utilising the SSC; that said, given the timing and context in which the Delphi study was carried out, it is appreciated that other priorities could have an impact on ability


February 2023 I www.clinicalservicesjournal.com 29 Suggested improvements


1 Create different checklists for different specialties 2 Every organisation has devised their own version of this and I’m sure our’s could be improved by learning from others and their changes to the documentation over time etc.


3 More medical engagement; although it is better than many years ago, it still feels like it is seen as a nursing/ODP paper exercise by some surgeons.


4 Making it an automated process within the theatre computer system, so that it stops progress onto the next.


5 There needs to be buy in from consultants to ensure this process happens. Some are excellent, others have a ‘don’t care’ attitude and rely on the senior nurse and the registrar.


6 Sharing of information between Trusts on what/how audits are completed; moving to digital WHO Team debrief is difficult at the end of a busy, long list; getting teams together; updated NatSSIPs/ LocSSIPs by CPOC could be helpful once distributed.


7 Improving clinical engagement at all levels, particularly in higher leaders - i.e consultants etc. 8 Carrying out weekly audits to embed compliance within the teams.


Table 4: NHS England participants responses to improve the delivery of the checklist.


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