Transforming Evidence: WHO Surgical Safety Checklist (Essay Sample)

Transforming Evidence: WHO Surgical Safety Checklist
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Abstract
Surgery is increasingly becoming an important process of treatment for various diseases. The risks associated with this process necessitated the formulation of surgical safety checklist by the WHO. In the analysis of the merits, obstacles, implementation, and criticism of the WHO safety checklist, a number of resources will be used. Also, the benefits accrued from the use of the WHO surgical checklist will be highlighted. In addition, the weaknesses of the WHO checklists are elucidated, prompting the analysis and evaluation of alternative surgical checklists.
Keywords: WHO surgical checklist, surgical operation, operations, checklist, surgeon
Introduction
Surgery and surgical processes are becoming inevitable in the treatment process for particular conditions and diseases. The risks associated with surgeries may start from as early as from the anaesthesia stage – and the more complex the surgery, the greater the risks (American Cancer Society, 2013). In 2008, WHO launched a patient safety challenge titled ‘Safe Surgery Saves Lives’ and the safety checklist was part of the outcome (NHS, 2009). In 2009, NPSA ordered all hospitals in England and Wales to adopt and implement the checklist by February 2010. In the directives, NPSA ordered all hospitals to: ensure clinical leads are identified to implement the surgical safety checklist within the hospitals, ensure the checklist is complete for every patient undergoing surgery, and ensure the use of the checklist is entered in the electronic records of the hospital by a member of the team. In the United Kingdom, many patients undergo surgery every year, and the implementation of the checklist is an important strategy for saving lives that are already at risk (BBC, 2009). As of 2012, there were 4000 hospitals in 122 countries that were registered users of the WHO surgical safety checklist (Walker et al., 2012).
Literature Search Strategy
A comprehensive literature search strategy was employed to gather all evidence regarding the WHO surgical checklist. The sources of information was not narrowed to one specific medium, rather all available sources were used –including the Internet. In the search for credible publications to provide evidence, the following questions were developed to provide insight:
* What are the obstacles to implementation?
* Are there alternatives to the WHO surgical checklists?
* How efficient are surgical checklists in improving safety in theatres?
To ensure that sources obtained are up-to-date, only literature published from 2008 onwards was used. To ascertain the success of implementation and efficiency of the surgical checklist in hospital set ups, various studies and surveys on the checklist –conducted in hospitals -- were used. The CINHAL database provided important information regarding the checklist. To get accurate information on the checklist, specific keywords --such as WHO checklist, safe surgery, and Implementation of surgical checklist -- were used. Also, various nursing books available at Google books offered insight into the whole process. The contributions of peer reviewed nursing journals, as well as scholarly nursing articles available at Google Scholar were not left out. In addition, various medical and nursing websites were used to source information. In the search for sources of information, relevance of the information and credibility of the source was considered.
Literature Review
The WHO surgical safety checklist is divided into three phases of the surgical procedure. A review of the checklist at the WHO (2014) website provides details for each phase. For instance, at the initial stage of ‘checking in’, the list requires information on patient’s allergies, aspiration risks, risks of blood loss, and safety check for anaesthesia. In addition, the section ensures that patient has confirmed the site, identity, and procedure, and consent for the procedure to take off. At the ‘time out phase’, the entire list requires the nurse, surgeon, and anaesthesia professional to verbally confirm the patient, site, and procedure. Also, the team members must introduce themselves by name and role. In addition, the team members conduct different reviews on the patient – depending on their respective roles. The last phase – sign out – requires .the nurses to verbally confirm with the team on: name of the procedure; how the specimen is labelled; confirm the count of needles, sponge, and instrument is correct; and any equipment problems to be addressed. The team members must review the key concerns for the recovery of the patient. Modifications of the checklist to fit local procedure are allowed (WHO, 2014).
At the initial drafting of the WHO safety checklist, there was little experience, if any, in the development of checklists. The authors of the WHO surgical safety list heavily relied on the Aviation industry to create an essential safety tool for nurses. The Aviation industry has approximately 75 years of experience in developing checklists. The methodologies applied were heavily borrowed from the airline industry (Weiser et al., 2010). Robotic surgeries have increased risks and challenges to care providers, and surgical checklists are essential to reduce peri-operative complications (Song, Goutham, Jonathan, and Sam, 2013).
The WHO surgical safety checklist has been instrumental in improving safety and saving lives of patients under surgical operations. Proper implementation of the checklist, based on the implementation manual provided, is guaranteed to improve safety in the theatres. ECAB (2012) concurs with sentiments, admitting that the checklist has been adopted in many hospitals across the world. Indeed, there have been marked reductions in the postoperative complications – after implementation of surgical checklist are reported (Annals of Surgery, 2012). There are reports, however, of incomplete compliance with the checklists. A cohort study conducted on 25,513 adult patients going through non-day case surgery established that crude mortality reduced from 3.13 percent to 2.85 percent –after implementation of the checklist. In the study, patient records and hospital administrative data was used to obtain the necessary data for the research (Annals of Surgery, 2012). In the book titled "Contentious Issues in Surgical Gastroenterology”, the various benefits accrued form the checklists are elucidated (ECAB, 2012).
At its initial introduction into the system, the WHO safety checklist was subjected to trials in various hospitals across the globe. These measures were necessary to ascertain the efficiency of the checklist before full implementation in the theatres. A UK pilot experience conducted by the Imperial College London established the effectiveness of the checklist (Vats et al., 2009). In the pilot experiment, two operating theatres were used, representing the bulk of surgeries conducted in the NHS – gastrointestinal and gynaecological procedures, and trauma and orthopaedic surgery. In this study, the checklist process was led by nurses, and data on the current practice was collected. The research found the nurses and anaesthetists were supportive of the procedure, but several surgeons were not enthusiastic about the procedure (Vats et al., 2009). During the time of drafting the first edition of the WHO safety checklist, there was little experience, if any, in the development of checklists. The authors of the WHO surgical safety list heavily relied on the Aviation industry to create an essential safety tool for nurses. (Weiser et al., 2010).The Aviation industry has approximately 75 years of experience in developing checklists. The methodologies applied were heavily borrowed from the airline industry.
Implementation
The implementation of the WHO surgical checklist is guided by standard manuals provided by WHO(NPSA,2013). In view of the necessity to properly implement the checklist, an analysis of the benefits accrued is important. The benefits notwithstanding, a further analysis of the shortcomings will provide insight into possible modifications, changes, or alternatives for the WHO surgical checklist.
Benefits and Obstacles
The WHO surgical safety checklist has become a useful tool in reducing surgical morbidity and mortality (ECAB, 2012). For instance, researchers in Netherlands have established that the WHO safety checklist have reduced mortality by 50 percent, and morbidity by a third (ECAB, 2012). In addition, the checklist does not require any financial investment, making it accessible to all hospitals. The WHO checklist is just a one page document, and requires less than a minute to complete it (BBC, 2009). When the WHO surgical safety checklist was released in 2008, it was met by scepticism from various medical practitioners. Its effectiveness and reliability, however, has led to embracing and adoption of the checklist in many hospitals. A study conducted on the treatment of trauma and orthopaedic patients shows a significant improvement on the safety after implementation of the checklist. Also, the study –conducted by International Orthopaedics – found that the use of checklists improved team communication (Sewell, et al, 2011).
Universal acceptance of the WHO surgical safety list is still low, and its simplicity creates a negative perception among practitioners. For some nurses, such a basic tool cannot guide safety measures in the theatre effectively (ECAB, 2012). There was a growing perception that the WHO safety checklist may not be effective among low-income set up and in third world countries. A study published in the British Medical Journal, however, refutes t...