Gillespie Brigid M, Marshall Andrea P, Gardiner Therese, Lavin Joanne, Withers Teresa K
NHMRC Centre for Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation (HPI), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia.
Gold Coast Hospital and Health Service, Gold Coast University Hospital, Southport, Queensland, Australia.
ANZ J Surg. 2016 Nov;86(11):864-867. doi: 10.1111/ans.13433. Epub 2016 Jan 7.
Regardless of the benefits associated of the Surgical Safety Checklist, adherence across its three phases remains inconsistent. The aim of this study was to systematically identify issues around workflow that impact on surgical teams' ability to use the Surgical Safety Checklist in a large tertiary facility in Queensland, Australia.
Observational audit of 10 surgical teams and 33 semi-structured interviews with 70 participants from nursing, medicine and the community were conducted. Data were collected during 2014-2015. Inductive and deductive approaches were used to analyse field observations and interview transcripts.
The domain, impact of workflow on checklist utilization, was identified. Within this domain, seven categories illustrated the causal conditions which determined the ways in which workflow influenced checklist use. These categories included: 'busy doing the task'; 'clashing task priorities'; 'being pressured, running out of time'; 'adapting processes to work patterns'; 'doubling up on work'; 'a domino effect, leading to delays' and 'reality of the workflow'.
One of the greatest systemic challenges to checklist use in surgery is workflow. Process changes in the way that surgical safety checklists are used need to incorporate the temporal demands of the workflow. Any changes made must ensure the process is reliable, is easily embedded into existing work routines and is not disruptive.
尽管手术安全核对表有诸多益处，但其三个阶段的执行情况仍不一致。本研究旨在系统地识别在澳大利亚昆士兰州一家大型三级医疗机构中，影响手术团队使用手术安全核对表能力的工作流程相关问题。
对10个手术团队进行观察性审计，并对来自护理、医疗和社区的70名参与者进行了33次半结构化访谈。数据收集于2014 - 2015年期间。采用归纳和演绎方法分析实地观察结果和访谈记录。
确定了“工作流程对核对表使用的影响”这一领域。在该领域内，七个类别阐述了决定工作流程影响核对表使用方式的因果条件。这些类别包括：“忙于执行任务”；“任务优先级冲突”；“面临压力，时间紧迫”；“使流程适应工作模式”；“工作重复”；“多米诺效应，导致延误”以及“工作流程的实际情况”。
手术中使用核对表面临的最大系统挑战之一是工作流程。手术安全核对表使用方式的流程变更需要纳入工作流程的时间要求。所做的任何变更都必须确保流程可靠，易于融入现有工作常规且不会造成干扰。
