书写在墙上：改进世界卫生组织手术安全检查表。

Writing's on the wall: improving the WHO Surgical Safety Checklist.

机构信息

Anaesthesia, Royal United Hospital Bath NHS Trust, Bath, UK

Anaesthesia, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK

出版信息

BMJ Open Qual. 2021 Jan;10(1). doi: 10.1136/bmjoq-2020-001086.

DOI:10.1136/bmjoq-2020-001086

PMID:33452183

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7813408/

Abstract

BACKGROUND AND PROBLEM

The WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved.

AIM

The aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019.

METHODS

In April 2018, a prospective observational audit and online survey took place. The results showed compliance for the 'Sign In' section of the checklist was 55% and for the 'Time Out' section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of 'Time Out' to ensure it was done immediately prior to knife-to-skin.

RESULTS

Following its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for 'Sign In' and to 94% for 'Time Out'. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with 'Sign In' and to 100% with 'Time Out'. Engagement was maintained at 100%.

CONCLUSIONS

The aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.

摘要

背景与问题

世界卫生组织手术安全检查表已被证明可提高患者安全性，并改善手术室的团队合作和沟通。2009 年，它被规定为英格兰和威尔士所有国民保健制度医院的强制性要求。该检查表旨在根据当地情况进行调整，并针对格洛斯特郡医院 NHS 基金会信托进行了修改。2018 年，决定审查使用改编后的世界卫生组织检查表，并确定是否可以提高合规性和参与度。

目的

目标是在 2019 年 4 月之前实现 90%的世界卫生组织手术安全检查表的合规性和参与度。

方法

2018 年 4 月，进行了前瞻性观察性审核和在线调查。结果显示，检查表“签到”部分的合规率为 55%，“停表”部分的合规率为 91%。整个手术团队的参与度为 58%。提议从纸质检查表改为壁挂式检查表，审查和精简检查表中的项目，并更改“停表”的时间，以确保在手术刀触及皮肤之前立即进行。

结果

2018 年 9 月引入新的壁挂式检查表后，对其进行了重新审核。“签到”的合规性提高到 91%，“停表”的合规性提高到 94%。整个手术团队的参与度达到 100%。收集了反馈意见，进行了调整，并在所有手术室分阶段推出了新的检查表。2018 年 12 月的重新审核显示，“签到”的合规性进一步提高到 99%，“停表”的合规性提高到 100%。参与度保持在 100%。