Pot beta-blocantele să reducă necesarul intraoperator de agenţi anestezici? Romanian Journal of Anaesthesia and Intensive Care 2015 Vol 22 No 2, 81-82
EDITORIAL IV
Implementing the WHO Surgical Safety Checklist
The introduction of the WHO Safe Surgery Saves Lives Checklist is probably one of the most significant events to take place in perioperative care. History will eventually judge it but it may well rank with the introduction of antiseptic techniques in surgery. The team at Brasov Children’s Hospital are to be congratulated for introducing the WHO Checklist and investigating their own use of it [1]. The results of this study are very similar to the initial steps in the majority of hospitals when they first start using the checklist. It is only by further knowledge, training, and understanding of the benefits of WHO Checklist that compliance begins to increase. Similar studies have asked the question “Has your use of the checklist ever identified something that had been missed?” e.g. forgotten to give the antibiotics. Once the theatre team has noticed that this happens and then have realised that the WHO Checklist can remind them of these things, they begin to appreciate its value and use it more thoroughly. A number of hospitals in the United Kingdom improved compliance with the WHO checklist dramatically, after such incidents where unfortunately the wrong leg of a patient had been operated on or even the wrong operation had been performed. One orthopaedic surgeon who actually had experienced this problem and had previously spoken out against the checklist because he thought it was a waste of time, immediately became the greatest advocate of the checklist in the hospital and started to insist on everyone else doing it correctly. As well as formally checking a number of essential items the process of performing the WHO Checklist improves multidisciplinary communication between the various nursing, surgical and anaesthetic team members in the operating theatre. It also establishes and demonstrates the culture that everyone is committed Adress for correspondence:
Dr David Whitaker Department of Anaesthesia Manchester Royal Infirmary Oxford Rd, Manchester M13 9WL United Kingdom E-mail: [email protected]
to making the patient’s care as safe and efficient as possible and reminds all members of the team about the recommended steps that are necessary to help the whole theatre team achieve this. Formal introductions in small hospitals where everyone has worked together for years can seem a little bit anomalous but if everyone understands the Human Factors [2] and psychological principles involved e.g. that if everyone, including the most junior nurse, has spoken to the group once in the morning they are much more likely to speak up later on in the day when something has or is about to go wrong, an instrument being touched and unsterilised or a tube is about to fall out! Also introductions are essential if there is a new member of staff, a medical student or a visitor. It also shows everyone is being serious about the checklist, committed and joining into the process. There were some comments in the study that there is a perceived lack of time to do the checklist but this is not borne out in reality. Any time spent in preparation is a good investment and with familiarity it can become very quick. It can save a lot of time making sure all the instruments, x-rays etc. are present at the start of the procedure and certainly if something were to go wrong it can save days filling out all the paperwork, doing the necessary reports and also all the personal consequences. The suggestion of giving registrars responsibility for completion of the checklist is a good idea but the consultant should also be present because after all they take the ultimate responsibility for the patients overall care. Checklist presentations and leaflets are excellent suggestions and there are some useful videos on the WHO website and YouTube that people could look at [3]. Hospitals that have been using the checklist for many years also find refresher training and updating is required for existing staff and as new staff join teams. Neily et al. showed how this repeat training and repetition can further improve the results [4].
82
Whitaker
In conclusion, the Brasov Children’s Hospital study is an excellent initial piece of work which should help promote the checklist and improve patient care. Other hospitals should be encouraged to look at their own checklist process using the same model and help gather momentum for widespread implementation. Trainees doing similar audits in their hospitals on the use of the checklist can also be helpful in this regard. In the United Kingdom now if something serious has gone wrong during an operation the lawyers want to know if the WHO Checklist was correctly performed [5]. The hospital management also have a duty to support the necessary culture and any resources that are required for the theatre staff to carry out the work.
Dr David Whitaker, FRCA, FFPMRCA, FFICM, Hon FCARCSI Manchester Royal Infirmary, UK Conflict of interest Nothing to declare
References 1. McGinlay D, Moore D, Mironescu A. A prospective observational assessment of Surgical Safety Checklist use in Brasov Children’s Hospital, barriers to implementation and methods to improve compliance. Rom J Anaesth Int Care 2015; 22: 111-121 2. http://www.chfg.org/wp-ontent/uploads/2010/11/Human_ Factors_How_to_Guide_2009.pdf (accessed 20/9/2015) 3. World Health Organization. How to do the WHO Surgical Safety Checklist. https://www.youtube.com/watch?v=_jE5NgLkTo4 (accessed 20/9/2015) 4. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304: 1693-1700 5. http://www.telegraph.co.uk/news/health/news/10810077/Manundergoing-minor-surgery-given-vasectomy-by-mistake.html (accessed 20/9/2015)
Rom J Anaesth Int Care 2015; 22: 81-82
EDITORIAL IV
Implementing the WHO Surgical Safety Checklist
The introduction of the WHO Safe Surgery Saves Lives Checklist is probably one of the most significant events to take place in perioperative care. History will eventually judge it but it may well rank with the introduction of antiseptic techniques in surgery. The team at Brasov Children’s Hospital are to be congratulated for introducing the WHO Checklist and investigating their own use of it [1]. The results of this study are very similar to the initial steps in the majority of hospitals when they first start using the checklist. It is only by further knowledge, training, and understanding of the benefits of WHO Checklist that compliance begins to increase. Similar studies have asked the question “Has your use of the checklist ever identified something that had been missed?” e.g. forgotten to give the antibiotics. Once the theatre team has noticed that this happens and then have realised that the WHO Checklist can remind them of these things, they begin to appreciate its value and use it more thoroughly. A number of hospitals in the United Kingdom improved compliance with the WHO checklist dramatically, after such incidents where unfortunately the wrong leg of a patient had been operated on or even the wrong operation had been performed. One orthopaedic surgeon who actually had experienced this problem and had previously spoken out against the checklist because he thought it was a waste of time, immediately became the greatest advocate of the checklist in the hospital and started to insist on everyone else doing it correctly. As well as formally checking a number of essential items the process of performing the WHO Checklist improves multidisciplinary communication between the various nursing, surgical and anaesthetic team members in the operating theatre. It also establishes and demonstrates the culture that everyone is committed Adress for correspondence:
Dr David Whitaker Department of Anaesthesia Manchester Royal Infirmary Oxford Rd, Manchester M13 9WL United Kingdom E-mail: [email protected]
to making the patient’s care as safe and efficient as possible and reminds all members of the team about the recommended steps that are necessary to help the whole theatre team achieve this. Formal introductions in small hospitals where everyone has worked together for years can seem a little bit anomalous but if everyone understands the Human Factors [2] and psychological principles involved e.g. that if everyone, including the most junior nurse, has spoken to the group once in the morning they are much more likely to speak up later on in the day when something has or is about to go wrong, an instrument being touched and unsterilised or a tube is about to fall out! Also introductions are essential if there is a new member of staff, a medical student or a visitor. It also shows everyone is being serious about the checklist, committed and joining into the process. There were some comments in the study that there is a perceived lack of time to do the checklist but this is not borne out in reality. Any time spent in preparation is a good investment and with familiarity it can become very quick. It can save a lot of time making sure all the instruments, x-rays etc. are present at the start of the procedure and certainly if something were to go wrong it can save days filling out all the paperwork, doing the necessary reports and also all the personal consequences. The suggestion of giving registrars responsibility for completion of the checklist is a good idea but the consultant should also be present because after all they take the ultimate responsibility for the patients overall care. Checklist presentations and leaflets are excellent suggestions and there are some useful videos on the WHO website and YouTube that people could look at [3]. Hospitals that have been using the checklist for many years also find refresher training and updating is required for existing staff and as new staff join teams. Neily et al. showed how this repeat training and repetition can further improve the results [4].
82
Whitaker
In conclusion, the Brasov Children’s Hospital study is an excellent initial piece of work which should help promote the checklist and improve patient care. Other hospitals should be encouraged to look at their own checklist process using the same model and help gather momentum for widespread implementation. Trainees doing similar audits in their hospitals on the use of the checklist can also be helpful in this regard. In the United Kingdom now if something serious has gone wrong during an operation the lawyers want to know if the WHO Checklist was correctly performed [5]. The hospital management also have a duty to support the necessary culture and any resources that are required for the theatre staff to carry out the work.
Dr David Whitaker, FRCA, FFPMRCA, FFICM, Hon FCARCSI Manchester Royal Infirmary, UK Conflict of interest Nothing to declare
References 1. McGinlay D, Moore D, Mironescu A. A prospective observational assessment of Surgical Safety Checklist use in Brasov Children’s Hospital, barriers to implementation and methods to improve compliance. Rom J Anaesth Int Care 2015; 22: 111-121 2. http://www.chfg.org/wp-ontent/uploads/2010/11/Human_ Factors_How_to_Guide_2009.pdf (accessed 20/9/2015) 3. World Health Organization. How to do the WHO Surgical Safety Checklist. https://www.youtube.com/watch?v=_jE5NgLkTo4 (accessed 20/9/2015) 4. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304: 1693-1700 5. http://www.telegraph.co.uk/news/health/news/10810077/Manundergoing-minor-surgery-given-vasectomy-by-mistake.html (accessed 20/9/2015)
Rom J Anaesth Int Care 2015; 22: 81-82
