Operating theatres
complex and demanding. While in this regard clinical outcomes, quality of life and, indeed, life expectancy can be improved and extended, this is only the case if surgery takes place within optimum conditions. Taking all other factors into consideration, the number of never events continues to remain a constant yet stubborn patient safety concern. It was also found that the debrief is time
critical and therefore results in poor adherence to the checklist. In addition, mandatory annual training on how to deliver the checklist must occur. It is acknowledged that the author is not yet in a position to draw further conclusions, as the final Delphi study round will draw on the results from the first and second rounds, as well as asking further research questions. In acknowledging that the participant rate
was 16%, it cannot claim to know how other Trusts are utilising the SSC. Given the timing and context in which the Delphi study was carried out, it is appreciated that other priorities could have impacted on the ability and willingness to participate. Nevertheless, it was perhaps surprising
to discover that there is a lack of direction/ leadership, and the lack of multidisciplinary team engagement from staff is still an issue, over a decade after the initial launch. LocSSIPs 2 are now being launched, Training must occur but, most importantly, NHS England needs to hold Trusts to account for not introducing them. A long-standing debate around whether
surgical (non-airway) fires should be classified as a never event was asked to the theatre safety experts, with an over-whelming response agreeing that this type of event should be added to the reportable never event list. The study has also raised questions that will be answered in the third Delphi round.
Conclusion To conclude, there is still much work needed to ensure that the surgical safety checklist is fully accepted and used in the operating theatre. It is not possible to say from only two Delphi study rounds whether the lack of compliance leads to greater risk of never events occurring, certainly those that involve intra-operative never events. While statistical analysis is important, the study hints that a greater qualitative understanding is needed of the factors that impact upon the persistence of never events. Given the paucity of the current literature, examples from never events and the stubbornness of the data to improve have acted as catalysts for further investigation. The intention is not to single out Trusts for
criticism based on non-compliance and without greater appreciation of context. Murphy (2016)44
24
www.clinicalservicesjournal.com I March 2023
Strongly agree 27.27% Agree 36.36% Somewhat agree 18.18% Neither agree nor disagree 18.18% Somewhat disagre Disagree Strongly disagree
Figure 12 – Should non airway surgical fires be classed as a never event (NE)?
has pointed to poor communication and lack of leadership as being common factors in the causation of procedural mishaps. Rather than criticism, the focus needs to shift from simply understanding adverse events, to the introduction of measures that will prevent their occurrence. The application of LocSSIPs 2 must ensure that the clinical approach to safety is the same, irrespective of the location, time, and resources available and that Trusts are held to account. Similarly, Radcliffe (2016)45
Strongly agree 13.64% Agree 31.82% Somewhat agree 54.55% Neither agree nor disagree Somewhat disagree Disagree Strongly disagree
Figure 13 – Should there be a system to share learning from a NE across NHS England?
training, these measures must go some way to ensure that the triad – designed to standardise, educate and harmonise – is complete .
CSJ
*A report on the third round of the Delphi Study will be published in the next edition of CSJ.
References for this article are available upon request.
affirms
that such standards aim to minimise risks of variation in practice. Moreover, safety standards are aimed at embedding best practice by minimising the risk of variation, maximising consistency, and, therefore, ensuring harmonisation across organisations. Wali et al ’s (2020)46
paper concludes that
high quality training is integral to ensuring that checklists are not mistaken for, or treated as, a tick-box exercise. Collaborative and interdisciplinary approaches do not always feature in the literature and, to conclude, teamworking and team learning are essential to effective implementation. Finally, the third Delphi study round, that commenced on the 9 January 2023, will enhance and add to the current knowledge and literature and provide an over-arching view of the current practice and what needs to change in order for full compliance with the surgical safety checklist. It is realising, along with Radcliffe (2016),45
that these standards alone cannot
prevent never events from occurring but, when combined with the staff education, the promotion of teamwork, and human factors
About the author
Mr Nigel D Roberts, MSc, BA (Hons) is a PhD student, head theatre practitioner, at Birmingham Children’s hospital, and a visiting lecturer at Birmingham City University. This paper is part of a literature review undertaken by the lead author towards the award of Doctor of Philosophy (PhD). It takes 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.
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