Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia.
BMJ Open Qual. 2021 Nov;10(4). doi: 10.1136/bmjoq-2021-001593.
Despite good quality evidence for benefits with its use, challenges have been encountered in the correct and consistent implementation of the surgical safety checklist (SSC). Previous studies of the SSC have reported a discrepancy between what is documented and what is observed in real time. A baseline observational audit at our institution demonstrated compliance of only 3.5% despite a documented compliance of 100%. This project used quality improvement principles of identifying the problem and designing strategies to improve staff compliance with the SSC. These included changing the SSC from paper-based to a reusable laminated form, a broad multidisciplinary education and marketing campaign, targeted coaching and modifying the implementation in response to ongoing staff feedback. Five direct observational audits were undertaken over four Plan-Do-Study-Act cycles to capture real-time information on staff compliance. Two staff surveys were also undertaken. Compliance with the SSC improved from 3.5% to 63% during this study. Staff reported they felt the new process improved patient safety and that the new SSC was easily incorporated into their workflow. Improving compliance with the SSC requires deep engagement with and cooperation of surgical, anaesthesia and nursing teams and understanding of their work practices and culture. The prospective observational audit highlighted an initial 3.5% compliance rate compared with 100% based on an audit of the patient notes. Relying solely on a retrospective paper-based model can lead to hospitals being unaware of significant safety and quality issues. While in-person prospective observations are more time-consuming and resource-consuming than retrospective audits, this study highlights their potential utility to gain a clear picture of actual events. The significant variation between documented and observed data may have considerable implications for other retrospective studies which rely on human-entered data for their results.
尽管使用手术安全检查表（SSC）有良好的证据表明其有益，但在正确和一致地实施方面仍存在挑战。先前对 SSC 的研究报告称，在实时记录和实际观察之间存在差异。我们机构的基线观察性审核显示，尽管记录的合规率为 100%，但合规率仅为 3.5%。该项目使用质量改进原则来确定问题，并设计策略来提高员工对 SSC 的遵守程度。这些策略包括将 SSC 从基于纸张改为可重复使用的层压表格，广泛的多学科教育和营销活动，有针对性的辅导以及根据员工的持续反馈修改实施方式。在四个计划-执行-研究-行动周期中进行了五次直接观察性审核，以实时获取员工遵守情况的信息。还进行了两次员工调查。在这项研究中，SSC 的合规性从 3.5%提高到了 63%。员工报告说，他们认为新流程提高了患者安全性，并且新的 SSC 很容易融入他们的工作流程。提高 SSC 的合规性需要深入参与和外科、麻醉和护理团队的合作，并了解他们的工作实践和文化。前瞻性观察性审核突出了最初的 3.5%合规率，而基于患者记录的审核则为 100%。仅仅依靠回顾性的基于纸张的模型可能导致医院不知道存在重大的安全和质量问题。虽然现场前瞻性观察比回顾性审核更耗时和资源密集，但这项研究强调了它们在获得实际事件清晰画面方面的潜在效用。记录数据和观察数据之间的显著差异可能对其他依赖于人工输入数据的回顾性研究产生重大影响。
