Att modifiera eller inte modifiera? – En observationsstudie kring två avdelningars följsamhet till WHO:s checklista för säker kirurgi

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Sammanfattning: Background: In modern healthcare, various types of surgery are a huge part of the daily routine. Nevertheless, medical errors due to surgery are still part of the reality. The surgical environment constitutes as a high-risk environment, that makes it important for all staff members to work preventively to avoid medical errors. Published research has shown that good teamwork, communication and standardized communication-tools are essential to lower both, morbidity and mortality related to surgery. Therefore, the World health organization (WHO) produced a checklist regarding surgery safety already ten years ago, that has been implemented globally to improve patient safety. The WHO recommends medical institutions, to modify the checklist according to their own needs and operating unit. Aim: This observational study aimed to investigate whether compliance to the original WHO surgical safety checklist or the use of a modified version of the checklist would differ between two operating units, regarding time-out and sign-out. Method: A structured observational study was performed, observing 20 surgical procedures by using a structured observational protocol. The gathered data was analyzed using quantitative methods. Results: Operating unit 1 used the modified version of the WHO checklist and operating unit 2 was using the original version of the WHO checklist. Both units had a 100 % compliance in initiating time-out. But operating unit 1 had a higher degree of adherence to performing sign-out than operating unit 2. Neither of the two units has gone through all the points listed on the checklist regarding time-out and sign-out. Overall, unit 1 had a higher proportion of items performed on the checklist than unit 2 at both time-out (76 % vs 73 %) and sign-out (73 % vs 33 %). More disrupting elements occurred at unit 1 during time-out and sign-out, than at unit 2. Comparing the two units, there was a variation in the type of staff category that initiated the checklist, with 80% being initiated by the anesthesiologist in unit 1. The duration of time-out differed only marginally between the two units. Sign-out usually took longer to perform at unit 1 than at unit 2. Conclusion: Our results support the recommendation of the WHO, to encourage operating units to modify the surgical safety checklist to suit their specific units. The modification of the checklist contributes to that the points on the checklist are performed more reliably.

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