Surgical safety checklist: benefits, facilitators, and barriers in the nurses’ perspective

Tostes, Maria Fernanda do Prado; Galvão, Cristina Maria

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Original Article • Rev. Gaúcha Enferm. 40 (spe) • 2019 • https://doi.org/10.1590/1983-1447.2019.20180180 copy

Surgical safety checklist: benefits, facilitators, and barriers in the nurses’ perspective

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To identify the benefits, facilitators and barriers in the implementation of the surgical safety checklist, according to the reports of nurses working in the hospital surgical center.

METHOD

Cross-sectional study with 91 nurses in 25 hospitals in two municipalities of Paraná. Between the years 2015 and 2016, two structured instruments were used to collect data. For the analysis, Fisher's exact or Chi-Square test was used.

RESULTS

The implementation of the checklist brought benefits to the patient, surgical team and hospitals. Regarding the facilitators, the results presented a statistically significant difference between the groups in the items offering education (p=0.006) and acceptance by surgeons (p=0.029). In the barriers, the lack of administrative (p=0.006) and management (p=0.041) support, absence of the patient safety nucleus (p=0.005), abruptly introduced list (p=0.001) and absence of education (p<0.001).

CONCLUSION

The evidence generated allowed to identify the benefits, facilitators and barriers in the implementation of the checklist in the national context.

Keywords:
Perioperative nursing; Checklist; Patient safety

Variables	Group 1		Group 2		P
Variables	N=77	%	N=14	%	N=77
Benefits for the patient
Promotion of security					0.493^* * Fisher's Exact Test;
Yes	74	96.1	13	92.9
No	03	3.9	01	7.1
Increased patient confidence in care					1,000^ Chi-square test;
Yes	50	64.9	9	64.3
No	27	35.1	05	35.7
Reduction of anxiety and fear in relation to surgery					0.567^ Chi-square test;
Yes	29	37.7	07	50.0
No	48	62.3	07	50.0
Prevention of adverse events					0.683^* * Fisher's Exact Test;
Yes	66	85.7	13	92.9
No	11	14.3	01	7.1
Benefits for the surgical team
Communication improvement					0.726^* * Fisher's Exact Test;
Yes	59	76.6	12	85.7
No	18	23.4	02	14.3
Opportunity for dialogue with socialization of relevant information					1,000^* * Fisher's Exact Test;
Yes	64	83.1	12	85.7
No	13	16.9	02	14.3
Improving Teamwork					1,000^* * Fisher's Exact Test;
Yes	59	76.6	11	78.6
No	18	23.4	03	21.4
Benefits for the surgical center and/or hospital
Improving quality of care					0.292^* * Fisher's Exact Test;
Yes	72	93.5	12	85.7
No	05	6.5	02	14.3
Increased efficiency in the operating room					0.543^* * Fisher's Exact Test;
Yes	53	68.8	11	78.6
No	24	31.2	03	21.4
Improved safety culture in the surgical center					0.334^ Chi-square test;
Yes	57	74.0	08	57.1
No	20	26.0	06	42.9
Reduction of hospital costs for the prevention of adverse events					1,000^ Chi-square test;
Yes	49	63.6	09	64.3
No	28	36.4	05	35.7
Reduction of hospital costs due to optimization of efficiency in the operating room					1,000^ Chi-square test;
Yes	35	45.5	06	42.9
No	42	54.5	08	57.1
The benefits gained outweighed the difficulties to implement the SSC^* ***** SSC=Surgical Safety Checklist					0.909^ Chi-square test;
Yes	45	58.4	09	64.3
No	32	41.6	05	35.7

Variables	Group 1		Group 2		P
Variables	N=77	%	N=14	%	P
Organizational
Administration support					0.871^* * Chi-square test;
Yes	28	36.4	06	42.9
No	49	63.6	08	57.1
Support of the heads of surgery, anesthesia and nursing					1,000^ Fisher's exact test;
Yes	54	70.1	10	71.4
No	23	29.9	04	28.6
Hospital have patient safety nucleus					0.378^* * Chi-square test;
Yes	31	40.3	08	57.1
No	46	59.7	06	42.9
Implementation process
Participation of the surgical team in the planning stage					0.094^* * Chi-square test;
Yes	23	29.9	08	57.1
No	54	70.1	06	42.9
Educational program offer					0.006**
Yes	28	36.4	11	78.6
No	49	63.6	03	21.4
Conducting a pilot test					0.169^* * Chi-square test;
Yes	31	40.3	09	64.3
No	46	59.7	05	35.7
Gradual introduction of SSC^* ***** SSC = Surgical Safety Checklist					0.189^* * Chi-square test;
Yes	17	22.1	06	42.9
No	60	77.9	08	57.1
Involvement of patients to introduce the SSC					0.706^ Fisher's exact test;
Yes	13	16.9	03	21.4
No	64	83.1	11	78.6
Involvement of patients to introduce the SSC					0.545*
Yes	43	55.8	06	42.9
No	34	44.2	08	57.1
Surgical Team
Leadership present at the surgical center to stimulate the use of SSC					0.154^ Fisher's exact test;
Yes	38	49.4	10	71.4
No	39	50.6	04	28.6
Acceptance by nurses					0.119^* * Chi-square test;
Yes	66	85.7	09	64.3
No	11	14.3	05	35.7
Acceptance by surgeons					0.029 ^* * Chi-square test;
Yes	23	29.9	09	64.3
No	54	70.1	05	35.7
Acceptance by anesthetists					0.234^* * Chi-square test;
Yes	33	42.9	09	64.3
No	44	57.1	05	35.7

Variables	Group 1		Group 2		P
Variables	N=77	%	N=14	%	P
Organizational
Lack of management support					0.006^* * Chi-square test;
Yes	11	14.3	07	50.0
No	66	85.7	07	50.0
Lack of support from the heads of surgery, anesthesia and nursing					0.041^ Fisher's Exact Test;
Yes	31	40.3	10	71.4
No	46	59.7	04	28.6
Absence of patient safety nucleus					0.005^* * Chi-square test;
Yes	14	18.2	08	57.1
No	63	81.8	06	42.9
Implementation process
Imposition of use of SSC^* ***** SSC = Surgical Safety Checklist by the manager					0.288^ Fisher's Exact Test;
Yes	13	16.9	04	28.6
No	64	83.1	10	71.4
Abrupt introduction of SSV in the operating room without planning					*0.001^ * Chi-square test;**
Yes	08	10.4	07	50.0
No	69	89.6	07	50.0
Absence of educational program					<0.001^ Fisher's Exact Test;
Yes	11	14.3	11	78.6
No	66	85.7	03	21.4
Absence of pilot test					0.160^* * Chi-square test;
Yes	12	15.6	05	35.7
No	65	84.4	09	64.3
Lack of monitoring of the use practice					0.243^* * Chi-square test;
Yes	28	36.4	08	57.1
No	49	63.6	06	42.9
Surgical Team
Absence of leadership in the surgical center					0.387^ Fisher's Exact Test;
Yes	09	11.7	03	21.4
No	66	88.3	11	78.6
Difficulty of communication and teamwork					0.064^* * Chi-square test;
Yes	17	22.1	07	50.0
No	60	77.9	07	50.0
Hierarchy among professionals					0.135^* * Chi-square test;
Yes	20	26.0	07	50.0
No	57	74.0	07	50.0
Resistance of surgeons					0.148^ Fisher's Exact Test;
Yes	37	48.1	10	71.4
No	50	51.9	04	28.6
Resistance of anesthetists					0.594^* * Chi-square test;
Yes	19	24.7	05	35.7
No	56	75.3	09	64.3
Resistance of nurses					0.648^ Fisher's Exact Test;
Yes	08	10.4	02	14.3
No	69	89.6	12	85.7
Resistance of nursing technicians					1.00^* * Chi-square test;
Yes	26	33.8	05	35.7
No	51	66.2	09	64.3
Disbelief about SSC benefits by team members					1.00^* * Chi-square test;
Yes	40	51.9	07	50.0
No	37	48.1	07	50.0

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[1] Corresponding author:
Maria Fernanda do Prado Tostes. mfpprado@gmail.com