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      Safe Surgery Checklist, Patient Safety, Teamwork, and Responsibility—Coequal Demands? A Focus Group Study

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          Abstract

          The use of World Health Organization’s (WHO’s) Safe Surgery checklist is an established practice worldwide and contributes toward ensuring patient safety and collaborative teamwork. The aim of this study was to elucidate operating room nurses’ and operating room nursing students’ experiences and opinions about execution of and compliance with checklists. We chose a qualitative design with semistructured focus group discussions. Qualitative content analysis was conducted. Two main themes were identified; the Safe Surgery checklists have varied influence on teamwork and patient safety, and taking responsibility for executing the checks on the Safe Surgery checklist entails practical and ethical challenges. The experiences and opinions of operating room nurses and their students revealed differences of practices and attitudes toward checklist compliance and the intentions of checklist procedures. These differences are related to cultural and professional distances between team members and their understanding of the Safe Surgery checklists as a tool for patient safety.

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          Most cited references32

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          Effect of a comprehensive surgical safety system on patient outcomes.

          Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway. We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The checklist was implemented in six hospitals with high standards of care. All complications occurring during admission were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar data were collected from a control group of five hospitals. In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals. Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care. (Netherlands Trial Register number, NTR1943.).
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            Reality check for checklists

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              Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial.

              We hypothesized reduction of 30 days' in-hospital morbidity, mortality, and length of stay postimplementation of the World Health Organization's Surgical Safety Checklist (SSC).
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                Author and article information

                Journal
                Glob Qual Nurs Res
                Glob Qual Nurs Res
                GQN
                spgqn
                Global Qualitative Nursing Research
                SAGE Publications (Sage CA: Los Angeles, CA )
                2333-3936
                28 March 2018
                Jan-Dec 2018
                : 5
                : 2333393618764070
                Affiliations
                [1 ]Oslo and Akershus University College of Applied Sciences, Oslo, Norway
                [2 ]Akershus University Hospital, Lørenskog, Norway
                Author notes
                [*]Elin Thove Willassen, Assistant Professor, Oslo and Akershus University College of Applied Sciences, Campus Kjeller, Postboks 4 Street Olavs plass, NO-0130 Oslo, Norway. Email: ElinThove.Willassen@ 123456hioa.no
                Article
                10.1177_2333393618764070
                10.1177/2333393618764070
                5881961
                e9917229-752f-490d-9b11-0ee3619bc26e
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 2 July 2017
                : 1 February 2018
                : 5 February 2018
                Categories
                Article
                Custom metadata
                January-December 2018

                patient safety,checklist,responsibility,operating room nurse,culture,qualitative

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