Review: Evidence Based Practice of Surgical Safety Checklists

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Surgical Safety Checklists and Patient Safety
JoAnna L. McLeod
Washington State University

Abstract
Patients are at heightened risk of complications while undergoing surgery. The use of a checklist for surgical safety has been utilized to lower these rates of complications. This paper was developed to respond to the question: When health care professionals implement a surgical safety checklist, compared to regular procedure without use of a checklist, do incidence of complications in patients decrease during hospital stay? CINAHL, Pub Med, and the Cochrane Library databases were searched using keywords: checklist, patient safety, surgery, adverse events, and complications for credible publications and retrieved five relevant articles. One out of the five publications is a systematic review and the other four are cohort studies. Four out of the five included studies concluded that implementation of the surgical safety checklist contributed to significant decrease in the rate of patient complications. One studied was inconclusive and concluded that further research needed to be done to better assess the effectiveness of safety checklists. Research supplied sufficient evidence of lowered complications that supports the use of the surgical safety checklist within hospital surgical units. Best practice would be to implement the surgical safety checklist into surgical units. The author recommends that mandating surgery teams to complete simulation training with educational proficiency of the checklist to implement the checklist into best practice.

Surgical Safety Checklists and Patient Safety
Patients undergoing surgical procedures are at a heightened risk for complications and death, although it is unclear whether these risks can be modified with the surgical safety checklist. The purpose of this paper was to respond in part to the question: When health care professionals implement a surgical safety checklist, compared to regular procedure without use of a checklist, do incidence of complications in patients decrease during hospital stay? The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Pub Med, and the Cochrane Library databases were searched using keywords: checklist, patient safety, surgery, adverse events, and complications. Five credible publications were retrieved and assessed for evidence-based data. Of the five credible publications retrieved, one was a Level I systematic review (Ko, Turner & Finnigan 2011). The remaining publications were Level III cohort studies (Weiser et al. 2010), (Haynes et al. 2009), (Panesar et al. 2011), and (Zegers et al. 2011). Ko, Turner, & Finnigan (2011) conducted a quantitative systematic review of 9 cohort studies assessing the effectiveness of a safety checklist within acute hospital settings. Trends across all studies were impossible to summarize due to variations in checklist design, setting, given training, and the outcomes measured. The studies suggest benefits of using safety checklists to improve patient safety, but results should be interpreted with caution due to risks of bias and low level of evidence available. Authors concluded that further research is needed to be able to clearly determine the effectiveness of safety checklists in hospital settings. Weiser, Haynes, Dziekan, Berry, Lipsitz, and Gawande (2010) conducted an applied, longitudinal, quantitative study that measured the effects of a 19-item surgical safety checklist over the rate of patient complications and was approved by the human subjects committees of Harvard School of Public Health and the WHO. Data of clinical process and outcome was prospectively collected from 1750 patients undergoing urgent noncardiac surgery, consecutively admitted within 8 varied hospitals around the world and analyzed with SAS 9.1 statistical software package. The rates of complications and deaths dropped (18.4% to 11.7% [P=0.0001] and 3.7% to 1.4% [P=0.0067] respectively) after introduction of...
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