Surgical Safety in Pediatrics: practical application of the Pediatric Surgical Safety Checklist

Pires, Maria Paula de Oliveira; Pedreira, Mavilde L. G.; Peterlini, Maria Angélica Sorgini

doi:10.1590/0104-1169.0553.2655

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 23 (6) • Nov-Dec 2015 • https://doi.org/10.1590/0104-1169.0553.2655 copy

Surgical Safety in Pediatrics: practical application of the Pediatric Surgical Safety Checklist¹ 1 Paper extracted from master's thesis "Cirurgia Segura em Pediatria: Elaboração e Validação de Checklist de Intervenções Pré-operatórias", presented to Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, process # 476088/2010-0.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

to assess the practical application of the Pediatric Surgical Safety Checklist on the preoperative period and to verify family satisfaction regarding the use of the material.

Method:

exploratory study that aimed to analyze the use of the checklist by children who underwent surgical interventions. The sample was constituted by 60 children (from preschoolers to teens) and 60 family members. The variables related to demographic characterization, filling out the checklist, and family satisfaction, being evaluated through inferential and descriptive statistical analysis.

Results:

most children (71.7%) were male, with a median age of 7.5 years. We identified the achievement of 65.3% of the checklist items, 30.0% were not filled due to non-performance of the team and 4.7% for children and family reasons. In the association analysis, we found that the removal of accessories item (p = 0.008) was the most checked by older children. Regarding satisfaction, the family members evaluated the material as great (63.3%) and good (36.7%) and believed that there was a reduction of the child's anxiety (83.3%).

Conclusion:

the use of the checklist in clinical practice can change health services regarding safety culture and promote customer satisfaction.

Patient Safety; Pediatric Nursing; Preoperative Care

Variables related to children	n (%)		Variables related to family	n (%)
Gender			Gender
	Male	43 (71.7)			Female	58 (96.7)
	Female	17 (28.3)			Male	2 (3.3)
Age (years)			Age (years)
	Median (Q1-Q3)*	7.5 (4-10)			Male	2 (3.3)	Median (Q1-Q3)*	37 (33-43)
	Min-Max^†	3-16			Min-Max^†	20-64
Education			Education
	Elementary school	35 (58.3)			Min-Max^†	20-64	High school	28 (46.7)
	Preschool	16 (26.7)			Elementary school	23 (38.3)
	High school	3 (5.0)			College	9 (15.0)
	Does not study	6 (10.0)		Degree of kinship
Previous hospitalizations				Mom	53 (88.3)
	No	44 (73.3)			Grandparents and great-grandparents		6 (10.0)
	Yes	16 (26.7)			Father		1 (1.7)

Checklist items	Filled	Not filled	Not executed
Checklist items	N (%)	N (%)	N (%)
My name is	59 (98.3)	1 (1.7)	-
I arrived at the hospital	58 (96.7)	2 (3.3)	-
Today is the day of my surgery	55 (91,7)	5 (8,3)	-
I won a bracelet with my name	52 (86.7)	4 (6.7)	4 (6.6)
The nurse explained what will happen to me here at the hospital	48 (80.0)	2 (3.3)	10 (16.7)
The nurse asked me if I had allergies	48 (80.0)	5 (8.3)	7 (11.7)
The nurse told me that I cannot eat or drink anything	47 (78.3)	4 (6.7)	9 (15.0)
I took a shower	26 (43,3)	1 (1.7)	33 (55.0)
The nurse asked me if I have milk teeth	14 (23.3)	1 (1.7)	45 (75.0)
I was asked to remove earrings/rings/piercing/accessories	13 (21.7)	4 (6.7)	43 (71.6)
My doctor showed me and my family where the surgery will be performed	11 (18,4)	2 (3.3)	47 (78.3)
Total	431 (65.3)	31 (4.7)	198 (30.0)

Items*	Gender of the child n (%)	Education of the child n (%)	Previous hospitalizations n (%)	Realization of surgery n (%)	Education of the family member n (%)	Degree of kinship of the family member n (%)
Items*	Female	Male	NE + PE ^†	EF + EM ^‡	Yes	No	On the day	Next day	EF ^§	EM+S ^\|\|	Mom	Other
1 (n=56)
Yes	16 (100.0)	36 (90.0)	17 (89.5)	35 (94.5)	15 (100.0)	37 (90.2)	38 (90.5)	14 (100.0)	20 (95.2)	32 (91.5)	46 (93.8)	Other	6 (85.7)
No	-	4 (10.0)	2 (10.5)	2 (5.5)	-	4 (9.8)	4 (9.5)	-	1 (4.8)	3 (8.5)	3 (6.2)	1 (14.3)
p^¶	0.314	0.598	0.564	0.562	1.000		0.423
2 (n=53)								-	1 (4.8)	3 (8.5)	3 (6.2)
Yes	14 (93.3)	34 (89.5)	18 (94.7)	30 (88.2)	12 (92.3)	36 (90.0)	36 (92.3)	12 (85.7)	17 (85.0)	31 (94.0)	43 (91.5)		5 (83.3)
No	1 (6.7)	4 (10.5)	1 (5.3)	4 (1.8)	1 (7.7)	4 (100.0)	3 (7.7)	2 (14.3)	3 (15.0)	2 (6.0)	4 (8.5)	1 (16.7)
p^¶	1.000	0.643	1.000	0.598	0.353		0.465
3 (n= 51)								2 (14.3)	3 (15.0)	2 (6.0)	4 (8.5)
Yes	12 (92.3)	35 (92.1)	16 (88.8)	31 (94.0)	13 (100.0)	34 (89.5)	37 (92.5)	10 (91.0)	16 (88.8)	31 (94.0)	42 (91.3)		5 (100.0)
No	1 (7.7)	3 (7.9)	2 (11.2)	2 (6.0)	-	4 (10.5)	3 (7.5)	1 (9.0)	2 (11.2)	2 (6.0)	4 (8.7)	-
p^¶	1.000	0.607	0.561	1.000	0.607		1.000
4 (n= 60)								1 (9.0)	2 (11.2)	2 (6.0)	4 (8.7)
Yes	15 (88.2)	40 (93.0)	19 (86.3)	36 (94.7)	15 (93.7)	40 (91.0)	42 (91.3)	13 (92.8)	21 (91.3)	34 (91.8)	48 (90.5)		7 (100.0)
No	2 (11.8)	3 (7.0)	3 (13.7)	1 (5.3)	1 (6.3)	4 (9.0)	4 (8.7)	1 (7.2)	2 (8.7)	3 (8.2)	5 (9.5)	-
p^¶	0.615	0.345	1.000	1.000	1.000		1.000
5 (n= 17)								1 (7.2)	2 (8.7)	3 (8.2)	5 (9.5)
Yes	6 (85.7)	7 (70.0)	2 (50.0)	11 (84.6)	2 (66.7)	11 (78.5)	8 (80.0)	5 (71.5)	4 (66.6)	9 (81.8)	12 (80.0)		1 (50.0)
No	1 (14.3)	3 (30.0)	2 (50.0)	2 (15.4)	1 (33.3)	3 (21.5)	2 (20.0)	2 (28.5)	1 (33.4)	2 (18.2)	3 (20.0)	1 (50.0)
p^¶	0.602	0.218	1.000	1.000	0.584		0.426

Checklist items	Age of the child (years)		Age of the family member (years)
Checklist items	P*	NP ^†	p ^‡	P*	NP ^†	p ^‡
I won a bracelet with my name (n=56)	7.8 (3.3)	6.2 (3.2)	0.399	37.9 (9.0)	41.3 (16.0)	0.707
The nurse asked me if I had allergies (n=53)	7.4 (3.4)	9.0 (2.7)	0.296	37.5 (8.9)	36.4 (10.3)	0.817
The nurse told me that I cannot eat or drink anything (n=51)	7.4 (3.0)	7.5 (3.7)	0.996	37.0 (9.1)	33.7 (6.1)	0.387
Today is the day of my surgery (n=60)	7.6 (0.4)	8.2 (4.9)	0.810	38.1 (9.5)	38.6 (12.3)	0.937
I was asked to remove earrings/rings/piercing/accessories	10.6 (3.2)	6.5 (1.7)	0.008	36.3 (6.6)	38.3 (13.6)	0.809

Satisfaction	N (%)
Global with the checklist
	Very good	38 (63.3)
	Good	22 (36.7)
	Neither good, nor bad	-
	Bad	-
	Terrible	-
The child's
	Very good	-	30 (50.0)
	Good	27 (45.0)
	Neither good, nor bad	3 (5.0)
	Bad	-
	Terrible	-
To supervise the child's care
	Very good	-	32 (53.3)
	Good	27 (45.0)
	Neither good, nor bad	1 (1.7)
	Bad	-
	Terrible	-
Reduction of the child's anxiety
	Reduced	-	50 (83.3)
	Sometimes reduced	5 (8.3)
	I don't know	4 (6.7)
	Did not reduce	1 (1.7)
Clarity of information
	Clear	1 (1.7)	50 (83.3)
	Some clear some unclear	10 (16.7)
	Unclear	-
	I don't know	-

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Maria Paula de Oliveira Pires Universidade Federal de São Paulo. Escola Paulista de Enfermagem Rua Napoleão de Barros, 754 Vila Clementino CEP: 04024-002, São Paulo, SP, Brasil E-mail: ma_paulinha@yahoo.com.br