Implementation of the «Safe Surgery» checklist: perception by patients during Caesarean section operation

Authors

DOI:

https://doi.org/10.15574/PP.2023.94.29

Keywords:

surgical checklist, safety in the operating room, cesarean section, pregnancy

Abstract

The effectiveness of the checklist in reducing mortality and major postoperative complications is proven, but its implementation is not easy and requires not so much technical as organizational and cultural changes. In conscious patients undergoing surgery under neuraxial or regional anesthesia, completing the checklist may have psychological or mental consequences (anxiety, fear, etc.), as the procedure involves discussing the risks of complications, anesthetic and surgical tactics.

Purpose - to assess the perception and compliance of conscious patients during cesarean section with the procedure of filling out the «Safe Surgery» checklist; to identify possible negative psychological effects of this procedure.

Materials and methods. The study included 100 patients after planned or urgent caesarean section (except for 1 category of urgency). The study was conducted on the basis of an anonymous survey (online Google form) of patients in the postoperative period (1-2 hours after surgery). Patients were asked to rate the impact of completing the Safe Surgery Checklist on their comfort and anxiety levels, and whether they believed that routine use of such technologies increased their safety.

Results. The results of this study indicate that the majority of patients responded positively to the use of the WHO checklist implemented in the operating room. More than half of the surveyed patients (56%) were worried about a possible error during the preparation or carrying out of the surgical intervention. Almost all patients - 13 (92.9%) who had experienced medical errors before, worried that a medical error during this intervention could harm their health (OR=13; 95% CI: 1.6-103.7; p=0.006). The procedure of filling out the checklist alleviated the feeling of loss in 66% of patients and did not cause discomfort in 96% of respondents. 68% of patients agreed that the procedure of filling out the checklist reduced anxiety.

The vast majority of patients (90%) agreed that the procedure of filling out the «Safe Surgery» checklist increases their level of safety in the operating room. 96% of patients believed that the checklist should be used before every surgical intervention and 96% would like it to be used during future surgical interventions.

Conclusions. Patients who were conscious during Caesarean section positively perceived the procedure of filling out the «Safe Surgery» checklist and believed that the use of such a checklist increases safety during surgery. Most patients also reported no discomfort and reduced fear and anxiety during the Safe Surgery Checklist procedure.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Author Biographies

K.Yu. Belka, Bogomolets National Medical University, Kyiv

Kyiv City Maternity Hospital No. 5, Ukraine

I.V. Sirenko, Bogomolets National Medical University, Kyiv

Kyiv City Maternity Hospital No. 5, Ukraine

References

Bielka K, Kuchyn Yu, Frank M, Sirenko I, Sazhyn D, Fomina H. (2022). Vprovadzhennia chek-lystu bezpeky VOOZ v Ukraini: Komplaiens medychnoho personalu ta inshi aspekty. Pain, anaesthesia & intensive care. 4 (101): 13-17. https://doi.org/10.25284/2519-2078.4(101).2022.275111

Jain D, Sharma R, Reddy S. (2018, Jan-Mar). WHO safe surgery checklist: Barriers to universal acceptance. J Anaesthesiol Clin Pharmacol. 34 (1): 7-10. https://doi.org/10.4103/joacp.JOACP_307_16; PMid:29643615 PMCid:PMC5885453

Kawano T, Tan M, Taniwaki M, Ogata K, Yokoyama M. (2014, Nov). A preliminary study of patients' perceptions on the implementation of the WHO surgical safety checklist in women who had Cesarean sections. J Anesth. 28 (6): 894-898. doi: 10.1007/s00540-014-1852-0. PMID: 24990547.

Kisacik OG, Cigerci Y. (2019). Use of the surgical safety checklist in the operating room: operating room nurses' perspectives. Pakistan Journal of Medical Sciences. 35 (3): 614. https://doi.org/10.12669/pjms.35.3.29; PMid:31258563 PMCid:PMC6572950

Mahajan RP. (2011). The WHO surgical checklist. Best Practice & Research Clinical Anaesthesiology. 25 (2): 161-168. https://doi.org/10.1016/j.bpa.2011.02.002; PMid:21550541

Papadakis M, Meiwandi A, Grzybowski A. (2019). The WHO safer surgery checklist time out procedure revisited: Strategies to optimise compliance and safety. International Journal of Surgery. 69: 19-22. https://doi.org/10.1016/j.ijsu.2019.07.006; PMid:31310820

Preckel B, Staender S, Arnal D et al. (2020). Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects. European Journal of Anaesthesiology. 37 (7): 521-610. https://doi.org/10.1097/EJA.0000000000001244; PMid:32487963

Russ S, Sevdalis N, Moorthy K et al. (2014). A qualitative evaluation of the barriers and facilitators towards implementation of the WHO surgical safety checklist across hospitals in England: Lessons from the 'Surgical Checklist Implementation Project'. Ann Surg. 259 (1): 166-177. https://doi.org/10.1097/SLA.0000000000000793; PMid:25072435

Santana HT, de Freitas MR, Ferraz EM, Evangelista MS. (2016). WHO Safety surgical checklist implementation evaluation in public hospitals in the Brazilian Federal District. Journal of Infection and Public Health. 9 (5): 586-599. https://doi.org/10.1016/j.jiph.2015.12.019; PMid:26924253

Symons NR, Almoudaris AM, Nagpal K, Vincent CA, Moorthy K. (2013, Jan). An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery. Ann Surg. 257 (1): 1-5. https://doi.org/10.1097/SLA.0b013e31826d859b; PMid:23044786

Vats A, Vincent CA, Nagpal K, Davies RW, Darzi A, Moorthy K. (2010). Practical challenges of introducing WHO surgical checklist: UK pilot experience. BMJ. 340: b5433. https://doi.org/10.1136/bmj.b5433; PMid:20071413

White MC, Peven K, Clancy O, Okonkwo I, Bakolis I, Russ S et al. (2021). Implementation strategies and the uptake of the world health organization surgical safety checklist in low and middle-income countries: A systematic review and meta-analysis. Annals of Surgery. 273 (6): e196-e205. https://doi.org/10.1097/SLA.0000000000003944; PMid:33064387

Published

2023-06-28