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WHO safe surgery checklists are not being followed by NHS trusts


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


Readers' comments (4)

  • This is a great procedure as it makes everyone involved aware of what is done what should be done.however, i do have my objections to this as it seems time consuming. I believe that the sign out should be done after the surgery is complete and everyone is out of scrubs and the baby is back on the approprate ward. This would give every one on the team enough time to do analysis after and could possible note done and pass onto the relevent person

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  • This is not a time consuming procedure! It takes less than 2 minutes to complete and even if it took longer, it saves lives and it a must! What's the point in completing the 'SIGN OUT' if the patient is back on the ward? It must be completed in theatre. This procedure is not just for patients it's for staff also. These mistakes should not be happening!

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  • The video does make the checklist seem a bit time consuming, but I think that says more about training videos than the checklist!
    The whole of the checklist should be completed in theatres. There is no time like the present to reflect on practice, and if any matters are worthy of note after the procedure, they should be discussed there and then. When the team has dispersed, things will be forgotten and the potential to correct or improve practice may have been lost. Benefits to team morale should also be considered as all will feel heard and therefore valued.
    What I don't understand is why there should be any delay in implementing this checklist. The statistics are indeed shocking and if staff feel too pressured to complete it, when so much benefit to patients is evident, it is a sad endictment of NHS targets. We are all potential surgical patients, and I know I, for one, would wish to know that I am the right patient, that the right procedure is going to be carried out on me, and that nothing will be left inside.

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  • The checklist is a great idea. It should draw the surgical team together, it ay seem time consuming now but with time will will adapt to the changes.
    We work in theatres where the patient is anaesthetised in theatre this will make the new checking procedures easier as everyone is already together. We already review the list with the consultant at the star and we announce the patient into the theatre whilst still awake so the patient comfirms the checks also.
    Well done to the video makers!

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