Adherence to the use of the surgical checklist for patient safety

Evaluative study conducted at a teaching hospital in the south of Brazil in 2012. Data were collected by means of non-participant observation in 20 hip and knee replacement surgeries and an instrument that was created for research based on the checklist and used by the institution.

Results:

In the observed procedures (n = 20) there was significant adhesion (p<0.05) to the instrument in relation to the verification of documentation, fasting, hair removal in the surgical site, absence of nail varnish and accessories, identification of the patient and surgical site on admission to the surgical unit, availability of blood and functionality of materials. However, there was no significant adherence to the checklist in the operating room in relation to patient identification, procedure and laterality, team introduction, surgical break and materials count.

Conclusion:

The results showed that the items on the checklist were verified nonverbally and there was no significant adherence to the instrument.

Patient safety; Surgical procedures, operative; Program evaluation

Observed variables	Verbal verification at the unit of origin n (%)	Verbal verification during reception at the surgery unit n (%)	Non-verbal verification during reception at the surgery unit n (%)	Not verified during reception at the surgery unit and registered n (%)
Identification bracelet	17 (85)*	-	20 (100)*	-
Chart	18 (90)*	-	20 (100)*	-
Image scans	18 (90)*	-	20 (100)*	-
Pre-anaesthesia assessment	18 (90)*	-	19 (95)*	1 (5)
Surgery consent	18 (90)*	-	20 (100)*	-
Anaesthesia consent	18 (90)*	-	20 (100)*	-
Nursing assessment	18 (90)*	-	20 (100)*	-
Surgical site marked	18 (90)*	9 (45)	-	1 (5)
Trichotomy	18 (90)*	-	-	2 (10)
Fasting	18 (90)*	9 (45)	-	-
Free of accessories and belongings	18 (90)*	-	-	2 (10)
Free of nail enamel	18 (90)*		-	2 (10)
Free of prosthetics	18 (90)*	-	-	2 (10)

Observed variables	Verbal verification n (%)	Non-verbal verification n (%)	Not verified and registered n (%)	Not verified and not registered n (%)
Patient identity	10 (50)	9 (45)	1 (5)	-
Patient confirms the surgical site	10 (50)	9 (45)	1 (5)	-
Patient confirms surgery	10 (50)	9 (45)	1 (5)	-
Patient introduced to the team	-	-	20 (100)*	-
Blood reserve	1 (5)	18 (90)*	1 (5)	-
Surgical site marked and confirmed	2 (10)	18 (90)*	-	-
Anaesthesia equipment tested	-	20 (100)*	-	-
Material for CPR available	-	18 (90)*	1 (5)	1 (5)
Allergy verified	1 (5)	19 (95)*	-	-
Material for difficult intubation	-	20 (100)*	-	-
Instrumentals, orthoses and prostheses	-	20 (100)*	-	-
Material for anaesthesia	-	20 (100)*	-	-
Valid sterilization of materials	-	20 (100)*	-	-
Aspirator working	1 (5)	19 (95)*	-	-
Heating system	-	20 (100)*	-	-

Observed variables	Verbal verification n (%)	Non-verbal verification n (%)
Patient identification	-	20 (100)*
Surgical site marked	1 (5)	19 (95)*
Procedure confirmed	2 (10)	18 (90)*
Antibiotic prophylaxis performed	-	20 (100)*
Grounding pad connected	-	20 (100)*
Electrocautery working	1 (5)	19 (95)*
Risk related to positioning	-	20 (100)*

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Author's address: Eliane Cristina Sanches Maziero Rua Santa Ana, 53, Jardim Fátima 83405-070 Colombo - PR E-mail: elicris_maziero@yahoo.com.br