In his annual report on the NHS, published last week, chief medical officer for England Sir Liam Donaldson backed the use of the World Health Organization’s Surgical Safety Checklist, which was issued earlier this month (NT News, 1 July, p9).
This recommends a ‘time-out’ period before skin incision when all staff on a multidisciplinary team run through a safety checklist. All team members confirm their name and role, before the senior nurse, surgeon and anaesthetist confirm the patient, site and procedure.
Nursing teams should also provide a sterility report and highlight any potential concerns about equipment, the guidance states, while surgeons should provide details such as critical or unexpected steps, operation duration and blood loss.
After the operation and before the patient leaves the operating room, the nursing team are required to verbally confirm that the name of the procedure has been recorded, that instrument, sponge and needle counts are recorded, how the specimen is labelled – including patient name – and whether there are any equipment problems.
Surgeons, anaesthetists and nurses should then discuss any concerns about recovery and management of the patient, according to the checklist.
Jane Reid, president of the Association for Perioperative Practice, and former nurse adviser to the WHO Safer Surgery Saves Lives campaign, said: ‘The real issue is to do with briefing the team and the time-out and debriefing, which requires a congregation of the entire team and recognising their contribution.
‘With the challenges of staffing and the pressure of throughput, teams don’t tend to be consistent. When there are errors they are rarely to do with competence and often to do with communication,’ she said.
Mike Hayward, RCN acute and emergency care sector adviser, added:
‘It legitimises a lot of the practice that has gone on in the past where assertive nurses have been able to prevent potential medical mistakes from happening.’