Implementation of a Surgical Safety Checklist: Interventions to Optimize the Process and Hints to Increase Compliance

BackgroundA surgical safety checklist (SSC) was implemented and routinely evaluated within our hospital. The purpose of this study was to analyze compliance, knowledge of and satisfaction with the SSC to determine further improvements.MethodsThe implementation of the SSC was observed in a pilot unit. After roll-out into each operating theater, compliance with the SSC was routinely measured. To assess subjective and objective knowledge, as well as satisfaction with the SSC implementation, an online survey (N = 891) was performed.ResultsDuring two test runs in a piloting unit, 305 operations were observed, 175 in test run 1 and 130 in test run 2. The SSC was used in 77.1% of all operations in test run 1 and in 99.2% in test run 2. Within used SSCs, completion rates were 36.3% in test run 1 and 1.6% in test run 2. After roll-out, three unannounced audits took place and showed that the SSC was used in 95.3%, 91.9% and 89.9%. Within used SSCs, completion rates decreased from 81.7% to 60.6% and 53.2%. In 2014, 164 (18.4%) operating team members responded to the online survey, 160 of which were included in the analysis. 146 (91.3%) consultants and nursing staff reported to use the SSC regularly in daily routine.ConclusionThese data show that the implementation of new tools such as the adapted WHO SSC needs constant supervision and instruction until it becomes self-evident and accepted. Further efforts, consisting mainly of hands-on leadership and training are necessary.研究背景：手术安全核查表（Surgical Safety Checklist, SSC）于本院实施并开展常规评估。本研究旨在分析医护人员对该核查表的依从性、认知水平与满意度，为后续优化工作提供实证依据。 研究方法：首先在试点科室开展SSC实施情况的观察。在向各手术室全面推行后，对SSC的临床依从性开展常规监测。为评估医护人员对SSC实施情况的主客观认知与满意度，本研究开展了一项样本量为891的线上调查。 研究结果：试点科室的两轮试点测试期间，共观察305台手术：第一轮试点175台，第二轮试点130台。第一轮试点中，77.1%的手术使用了SSC，第二轮试点该使用率升至99.2%；在已使用SSC的手术中，核查表完整填写率分别为36.3%与1.6%。全面推行后，三次突击审计结果显示，SSC使用率分别为95.3%、91.9%与89.9%，而在已使用SSC的手术中，核查表完整填写率从81.7%分别降至60.6%与53.2%。2014年，共有164名手术团队成员参与线上调查，占总调查样本量的18.4%，其中160份问卷纳入最终分析。146名受访者（占有效受访者的91.3%）为医师与护理人员，均表示会在日常临床工作中常规使用SSC。 研究结论：本研究数据表明，诸如经修订的世界卫生组织手术安全核查表（WHO SSC）这类新型临床工具的推行，需持续开展监督与指导，直至其成为医护人员的共识并被广泛接受。后续仍需重点通过实操性的现场督导与系统化培训，进一步推进该项工作的落地。