A Multi-Faceted Progress Evaluation of the Use of the Surgical Safety Checklist

SQANNovember 16, 2012

Quality and Patient Safety

But Before I Begin….

But Before I Begin….

Yes this is for Movember….

But Before I Begin….

Yes….I know it is creepy….

Why use the Surgical Safety Checklist?

• Interactive tool• Structures team communication • Ensures that all team members possess

accurate and explicit information regarding the patient and procedural plan

• Gives team members the same context (situational awareness)

Surgical Safety Checklist

Surgical Safety Checklist

39 different versions!!!!

Objectives of the Surgical Safety Checklist Evaluation

• Assessment of the Surgical Safety Checklist post implementation

• Quantify the use of the Surgical Safety Checklist in procedures across the region

• Qualify how the tool is being used:– Pieces that provide beneficial information,– Areas that need improvement

• Reconcile documented use to actual use• Identify good catches

Evaluation Tools1. Observations of surgical procedures

1. Surgical cases by 5 observers2. Facilities include VGH, UBCH, LGH, RH, SPH & MSJ

2. An electronic survey 1. All surgical staff members across VCH received an invitation to

participate

3. Interviews of front line staff1. At minimum, 3 nurses, 3 surgeons, and 3 anesthesiologists from

each facility.2. Nursing graduate student and Human Factors Specialist

interviewers

How did we do?

Evaluation Actual

Interviews 25

Observations 47

Electronic Survey 162

Observations

• Each observer paired up with our HF Specialist to observe 2 – 4 cases

• Observations were compared after each case to ensure our they were “reliable” and then we were set free

• Goal was about 6 – 8 observations per site

What were we looking for?

• A distinct pause for each component• Did it flow with the work• Who was in the room and were all team

members paying attention• How did the team interact with each other• Where was the patient

Surgical Safety Checklist Completion

Evaluation Type Overall Briefing Time-Out Debriefing

Observations(n=47)

70.7% Standard Above Standard

Standard

Observationsn=47

Question Overall - Average Score (0-3)

Ranking

Overall, the use and completion of the Safety Checklist was:

2.34 Standard

The completion of the briefing section was: 2.16 Standard

The completion of the time-out section was: 2.55 Above Standard

The completion of the debriefing section was:

2.08 Standard

(Scoring included 0 = not complete, 1 = below standard, 2 = standard, 3 = above standard)

What parts of the Surgical Safety Checklist have been working well?

• Antibiotic prophylaxis administration• DVT prophylaxis considerations• Availability of appropriate implants and

equipment • Allergies awareness and confirmation• Overall increased communication in the OR

Good Catches (Electronic Survey Responses)

What parts of the Surgical Safety Checklist have NOT been working well?

• Briefing and Debriefing• Lack of awareness and understanding of the

purpose• Attention• Responsibility and accountability• Designates

Areas for Improvement

• Minor changes to the briefing & debriefing section of the Surgical Safety Checklist

• Awareness and education on the value of team communication

• Supporting leadership, responsibility, and accountability

• Celebrate the ‘good catches’

Recommendation: Minor changes to the Briefing and Debriefing Section of the Surgical Safety Checklist

• Identify the components involved in a meaningful briefing and debriefing conversation

• Refining the essential components to be discussed – Briefing: Focus on process– Debriefing: Focus on process and content

• Ensuring all team members are present• Ensure the timing of the debriefing occurs at an

appropriate (non-critical) time for all team members– Ex: Not during emergence for anaesthesia

Recommendation: Awareness and education on the value of team communication

• Comprehensive verses Prescriptive• Emphasis on the team having a conversation for

each phase of the checklist and talk about “critical” items for the surgery

• Awareness and education on the value of team communication

Recommendation: Supporting leadership, responsibility, and accountability• Reinforce the use of the checklist as acceptable

practice in our surgical suites• Positive role-modeling in safety conversations

with the checklist• Celebration for those teams who have

incorporated the checklist successfully in their cases.

• Accountability of those team members who choose not to participate in the checklist

Recommendation: Celebrate the ‘good catches’

“Good catches are great as front line staff are identifying places where the safety checklist has helped improve upon patient and staff safety. Looking at antibiotics, allergy awareness, and equipment availability are issues where systems within our organization can be improved.”

More than just a checklist!

Questions?