A quarter of NHS acute trusts have not introduced a new set of pre-operative checks that give greater responsibility to theatre nurses and operating assistants six months after they were launched, a Nursing Times investigation has revealed. (Scroll down for a Surgical Safety Checklist video used at Great Ormond Street Hospital)
Nursing Times conducted a Freedom of Information request of all trusts in England to find out whether they observed new one-page, safety checklist published in June 2008 by the World Health Organization.
The checklist calls for a ‘time out’ immediately before incision, confirming the patients’ identity and the procedure to be performed. This should be accompanied by pre-anaesthesia ‘sign in’ checks and post-procedure ‘sign-out’ checks.
The accompanying WHO guidance on using the checklist suggests that its completion should be co-ordinated by a nurse. The checklist particularly recognises the contribution of each member of the surgical team, calling for more junior members of staff such as nurses and operating department practitioners to question surgeons’ decisions if necessary.
An international report on hospitals where the checklist has been piloted, published last month in the New England Journal of Medicine, found the guidelines reduced complications by 36% and mortality by 46%.
But according to the Freedom of Information investigation results, 24% of trusts in England are failing to observe any part of the checklist. A further 51% have partially introduced some of the checklist, and 24% are fully compliant.
Last month the National Patient Safety Agency, which is leading the introduction of the checklist in the NHS in England and Wales, ‘demanded’ all trusts implement an NHS-adapted version of the WHO guidelines by February 2010.
Theatre staff representatives have advocated the greater responsibility being given to nurses but warned that to see the benefits suggested by the pilot study, more than nine out of ten NHS hospitals would have to become compliant with the checklist.
Jane Reid, perioperative care intervention lead for the Patient Safety First campaign, said: ‘It is only when we achieve more than 95% compliance across all “elements” of the checklist, that we are likely to see the big gains in reducing harm as demonstrated in the global pilot studies.’
‘Nurses, doctors, anyone should be able to question, act as advocates for the patient, questioning anything that is untoward,’ she added. ‘We need that momentary pause immediately before knife to skin.’
Diane Gilmour, president of the Association for Perioperative Practice, said: ‘Safe surgery is about teams and how they work together. It allows people to stand up and be recognised.
Scroll down for a Surgical Safety Checklist video used at Great Ormond Street Hospital
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