Bashford Tom, Reshamwalla Sophie, McAuley Jacqueline, Allen Nikole H, McNatt Zahirah, Gebremedhen Yohannes D
Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK.
Lifebox Foundation, London, UK.
Patient Saf Surg. 2014 Mar 28;8:16. doi: 10.1186/1754-9493-8-16. eCollection 2014.
The WHO Surgical Safety Checklist has a growing evidence base to support its role in improving perioperative safety, although its impact is likely to be directly related to the effectiveness of its implementation. There remains a paucity of documented experience from low-resource settings on Checklist implementation approaches. We report an implementation strategy in a public referral hospital in Addis Ababa, Ethiopia, based on consultation, local leadership, formal introduction, and supported supervision with subsequent audit and feedback.
Planning, implementation and assessment took place from December 2011 to December 2012. The planning phase, from December 2011 until April 2012, involved a multidisciplinary consultative approach using local leaders, volunteer clinicians, and staff from non-governmental organisations, to draw up a locally agreed and appropriate Checklist. Implementation in April 2012 involved formal teaching and discussion, simulation sessions and role play, with supportive supervision following implementation. Assessment was performed using completed Checklist analysis and staff satisfaction questionnaires at one month and further Checklist analysis combined with semi-structured interviews in December 2012.
Checklist compliance rates were 83% for general anaesthetics at one month after implementation, with an overall compliance rate of 65% at eight months. There was a decrease in Checklist compliance over the period of the study to less than 20% by the end of the study period. The 'Sign out' section was reported as being the most difficult section of the Checklist to complete, and was missed completely in 21% of cases. The most commonly missed single item was the team introduction at the start of each case. However, we report high staff satisfaction with the Checklist and enthusiasm for its continued use.
We report a detailed implementation strategy for introducing the WHO Surgical Safety Checklist to a low-resource setting. We show that this approach can lead to high completion rates and high staff satisfaction, albeit with a drop in completion rates over time. We argue that maximal benefit of the Surgical Safety Checklist is likely to be when it engenders a conversation around patient safety within a department, and when there is local ownership of this process.
世界卫生组织手术安全核对表在改善围手术期安全方面的证据基础日益增多，尽管其影响可能与实施的有效性直接相关。资源匮乏地区在核对表实施方法方面的文献记载经验仍然很少。我们报告了埃塞俄比亚亚的斯亚贝巴一家公立转诊医院的一项实施策略，该策略基于咨询、当地领导、正式引入以及随后进行审核和反馈的支持性监督。
规划、实施和评估于2011年12月至2012年12月进行。规划阶段从2011年12月至2012年4月，采用多学科协商方法，召集当地领导、志愿临床医生和非政府组织工作人员，制定一份当地认可且合适的核对表。2012年4月的实施包括正式教学与讨论、模拟演练和角色扮演，并在实施后进行支持性监督。评估通过实施一个月后完成的核对表分析和工作人员满意度调查问卷进行，2012年12月则通过进一步的核对表分析结合半结构化访谈进行。
实施一个月后，全身麻醉的核对表合规率为83%，八个月时的总体合规率为65%。在研究期间，核对表合规率有所下降，到研究期结束时降至20%以下。据报告，“手术结束核查”部分是核对表中最难完成的部分，21%的病例完全遗漏了该部分。最常被遗漏的单个项目是每个病例开始时的团队介绍。然而，我们报告工作人员对核对表的满意度很高，并对继续使用核对表充满热情。
我们报告了将世界卫生组织手术安全核对表引入资源匮乏地区的详细实施策略。我们表明，这种方法可导致高完成率和工作人员高满意度，尽管随着时间推移完成率会有所下降。我们认为，手术安全核对表的最大益处可能在于它能在科室内部引发围绕患者安全的讨论，以及该过程有当地的自主权。
