Operating theatres
A deeper dive into safe surgery barriers
Nigel Roberts provides an insight into a second Delphi study investigating the views of operating theatre teams on the surgical safety checklist and Local Safety Standards for Invasive Procedures. The findings suggest there is still much work needed to ensure that the checklist is fully accepted and used in operating theatres.
This paper aims to highlight the findings of a second Delphi study, which sought the views of theatre managers, matrons and clinical educators on the surgical safety checklist and Local Safety Standards for Invasive Procedures (LocSSIPs). The Delphi technique is an iterative multistage process, designed to transform opinion into group consensus. If used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the healthcare profession. The second round of the Delphi study revisited several questions from round one, to further understand the responses received. (The results of the first round were published in the February edition of CSJ.)1 The initial findings showed that the reasons for the debrief not being undertaken were due to all team members not being present, staff wanting to go home, current culture, and list over runs. Participants felt that training on the checklist should be mandated and annual; learning from other organisations was seen as key; and the NHS needs to revise how the checklist is currently being delivered by being more proactive and by providing the foundations of an electronic checklist to all NHS Trusts. Participants felt that a lack of direction from senior NHS leaders and multidisciplinary team working may impact on why the checklist is not always completed. Regarding LocSSIPs and their introduction, participants either strongly agreed or agreed that NHS Trusts must be held accountable for ensuring they are implemented. Surgical fires (non-airway) should be classed as a never event and cyclical learning must occur, by providing the details of every never event to all NHS Trusts. The second round facilitated a broader engagement in the literature, as well as highlighting a number of reasons why full compliance has not yet been universally achieved. Furthermore, the Delphi study is intended to be an exploratory approach to
Figure 1.
inform a more in-depth doctoral research study with the aim of improving patient safety in the operating theatre, informing policy making and ensuring quality improvement.
Literature review The checklists that are used across the world today are based upon three principles: simplicity, widespread applicability, and measurability (WHO, 2008).2
Recognition of theatres being a
hazardous environment was made by Thomas et al (2000), cited in Patel et al (2014),3
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. Haynes et al (2009)4
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)5 but also improve communication (Gillespie et al, 2010, & Low et al, 2012)6,7 multidisciplinary team.
among all of the In 2009, the World Health Organization (WHO)
launched guidelines for Safe Surgery Saves Lives (WHO, 2009)2 2009)4
in six languages (Haynes et al, , across 132 countries (Gillespie et al, 2018)8
with the aim of preventing unnecessary death and improving outcomes for surgical patients (Viswanath et al, 2017).9
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).10 In January 2009 (Braham et al, 2014)11
, the
National Health Service (NHS) authorised the use of the checklist, and the National Patient Safety Agency (NPSA) (2008)12
stated that all NHS
Trusts must adopt this very simple and effective intervention. From February 2010, the NPSA checklist became a mandatory requirement for all operations in NHS England (NPSA, 2010).13
It
was mandated by the NHS Commissioning Board Special Health Authority (Braham et al, 2014).11 Leadership for the successful implementation
March 2023 I
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