ADAPTATION AND VALIDATION OF A SURGICAL SAFETY CHECKLIST IN THE CESAREAN DELIVERY

Boeckmann, Lara Mabelle Milfont; Rodrigues, Maria Cristina Soares

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Original Article • Texto contexto - enferm. 27 (3) • 2018 • https://doi.org/10.1590/0104-070720180002780017 copy

ADAPTATION AND VALIDATION OF A SURGICAL SAFETY CHECKLIST IN THE CESAREAN DELIVERY¹ 1 Article extracted from the dissertation - Pregnant women’s safety in the cesarean delivery: an analysis of the application of the surgical safety checklist in a public hospital in the Federal District, presented to the Programa de Pós-Graduação em Enfermagem (PPGEnf), Nursing Department, Faculty of Health Sciences, Universidade de Brasília (UnB), in 2016.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

adapt and validate a surgical safety instrument in the cesarean delivery, based on an integrative review of the literature, and on the World Health Organization protocol and surgical safety checklist.

Method:

methodological study, with triangulation of data, involving a total of 43 participants, being eight judges for the validation of content and apparent of the instrument, using the Delphi technique, and for the semantic validation, another 35 professionals from the surgical team of a public hospital in the Federal District, Brazil. The reliability coefficient was applied to the instrument.

Results:

the instrument achieved general content validity index of 0.9 and inter-rater agreement of 1. The total coefficient of Cronbach’s alpha was 0.86, and the mean score of the dimensions obtained high scores.

Conclusion:

the instrument presented validity in the three criteria studied and reliability to be applied in future studies evaluating the surgical safety in cesarean deliveries.

DESCRIPTORS:
Women’s health; Patient safety; Checklist; Nursing surgical center; Cesarean section

Item	Dimensions A, B and C^* * A: before the anesthetic induction; B: before the surgical incision; C: before the patient leaves the operating room.	CVI
A1	The identity of the patient, the procedure and the surgical site were confirmed.	1
A2	The patient’s consent for the cesarean section and anesthesia were confirmed.	1
A3	All the equipment has been checked and are in proper working order, including the electric scalpel.	0.92
A4	The connection of the multiparametric monitor, including the pulse oximeter, was tested on the patient to verify its functioning.	1
A5	It was investigated whether the patient has any known allergies.	1
A6	The anesthesiologist checked if there is a difficult airway and risk of aspiration. If so, he requested equipment/assistance available.	0.85
A7	The intravenous access has been checked for its adequate and functioning condition.	0.98
A8	It was checked if there was a risk of blood loss >500 mL. If so, the planning for blood components and derivatives is checked.	1
B9	All the team members introduce themselves by name and role.	0.98
B10	The team verbally confirms the patient’s identification, surgical site and procedure.	1
B11	The obstetrician foresees critical steps, possible critical events and blood loss. If so, verbally revise the planning performed.	0.88
B12	Have any anesthetic complications been predicted by the anesthesiologist? If so, verbally revise the planning performed.	1
B13	The nursing team revises the materials needed, to check if they are all present.	1
B14	It is checked by the nursing team if all the materials are within the sterilization period (including the indicator results).	0.92
B15	Issues related to equipment or any concerns that need to be addressed were raised by the nursing team.	0.85
B16	The placement of the scalpel plate was performed and communicated to the team.	0.98
B17	The nursing counts the gauze, checks the number of instruments and needles before the incision.	0.98
B18	The antimicrobial prophylaxis was performed 1 hour before the cesarean section delivery.	1
B19	The intravenous anti-HIV chemoprophylaxis for seropositive pregnant women was performed.	0.96
C20	The registry of the procedure performed by the obstetrician, anesthesiologist and nursing was verbally confirmed.	1
C21	The team confirmed orally whether the surgical instrument and needle count was the same as the beginning of the cesarean section.	1
C22	The gauze count was reported to see if it matches the onset of cesarean section delivery.	0.98
C23	The nursing professional verbally confirms the correct labeling of any pathological sample when obtained during the procedure.	1
C24	The surgical team reviews essential concerns for the postpartum recovery of the patient, such as pain, hydration, dressing, among others.	1

Item	1 Not important		2 Little important		3 Fairly important		4 Extremely important		5 Indispensable
Item	n^* * N: number of assignments according to the Likert scale.	%	n^* * N: number of assignments according to the Likert scale.	%	n^* * N: number of assignments according to the Likert scale.	%	n^* * N: number of assignments according to the Likert scale.	%	n^* * N: number of assignments according to the Likert scale.	%
A1	-	-	-	-	-	-	7	23.3	23	76.6
A2	-	-	-	-	4	13.3	7	23.3	19	63.3
A3	-		-		7	23.3	7	23.3	16	53.3
A4			1	3.33	6	20.0	3	10.0	20	66.6
A5	-	-	-	-	1	3.3	5	16.7	24	80.0
A6	-	-	-	-	-	-	4	13.3	26	86.6
A7	-	-	-	-	1	3.3	3	10.0	26	86.6
A8	-	-	-	-	-	-	4	13.3	26	86.6
A9	-	-	-	-	3	10.0	3	10.0	24	80.0
A10	-	-	-	-	-	-	5	16.7	25	83.3
A11	-	-	-	-	1	3.3	5	16.7	24	80.0
B12	1	3.33	-	-	6	20.0	10	33.3	13	43.3
B13	-	-	3	10.00	2	6.6	9	30.0	16	53.3
B14	-	-	-	-	3	10.0	9	30.0	18	60.0
B15	-	-	-	-	2	6.6	6	20.0	22	73.3
B16	-	-	-	-	3	10.0	8	26.7	19	63.3
B17	-	-	-	-	2	6.6	10	33.3	18	60.0
B18	-	-	-	-	2	6.6	8	26.7	20	66.6
B19	-	-	1	3.33	-	-	5	16.7	24	80.0
B20	-	-	1	3.33	4	13.3	7	23.3	18	60.0
C21	-	-	-	-	-	-	3	10.0	27	90.0
C22	1	3.33	2	6.67	-	-	10	33.3	17	56.6
C23	-	-	-	-	1	3.3	7	23.3	22	73.3
C24	-	-	-	-	2	6.6	5	16.7	23	76.6
C25	-	-	-	-	1	3.3	5	16.7	24	80.0
C26	-	-	-	-	-	-	9	30.0	21	70.0

Item	Dimensions A, B and C^* * A: before the anesthetic induction; B: before the surgical incision; C: before the patient leaves the operating room;	Scale^† † 1: the item is in compliance; 2: the item is not in compliance. NA: not applicable.
A1	Patient confirmed identity (identification bracelet and medical record).	1	2
A2	Patient confirmed procedure.	1	2
A3	Patient confirmed surgical site.	1	2
A4	The Informed Consent Terms (childbirth and anesthesia) were signed by the patient.	1	2
A5	The equipment: gas sources, anesthesia equipment, multi-parameter monitor, electric scalpel, aspirator and focus were checked, tested and/or replaced.	1	2
A6	Medications and materials have been verified, checked and/or replaced.	1	2
A7	The anesthesia safety check was completed.	1	2
A8	Does the patient have a known allergy? □ No □ Yes. If so, which?	1	2
A9	Did the anesthesiologist assess whether there is a difficult airway/risk of aspiration? □ No □ Yes and has he requested equipment/assistance available?	1	2
A10	Verified suitable venous access.	1	2
A11	Is there a significant risk of blood loss? □ No □ Yes, and planning for fluids and/or blood components and/or derivatives.	1	2
B12	All the team members introduce themselves by name and role.	1	2
B13	Obstetricians, anesthesiologists and nursing staff confirm verbally: identification, surgical site and procedure.	1	2
B14	Obstetricians check for critical steps and cesarean delivery duration.	1	2
B15	The anesthesiology team checks if there is any specific concern regarding the patient.	1	2
B16	The nursing team reviews whether materials, instruments and gauze are present and within the sterilization period, including the indicator result.	1	2
B17	Are there any equipment-related issues or concerns? □ No □ Yes. If so, which?	1	2
B18	Was the scalpel plate placed and communicated to the team? □ No □ Yes □ NA	1	2
B19	The nursing counts the gauze, checks the number of instruments and needles before the incision.	1	2
B20	The antimicrobial prophylaxis was performed 1 hour before the cesarean section delivery.	1	2
C21	The mother and newborn identification wristbands were placed and checked according to the service standard.	1	2
C22	The professional of the surgical team confirms verbally what was the surgical procedure performed.	1	2
C23	The nurse practitioner or obstetrician verifies whether or not the numbers for surgical instruments, gauze, and needles are correct.	1	2
C24	Was there a sample for pathological anatomy from the cesarean section? □ No □ Yes and it has been stored and labeled according to service standards.	1	2
C25	Does the nursing team identify if there is a problem with equipment to be solved? No □ Yes. If so, which?	1	2
C26	The surgical team reviews key concerns for the postpartum recovery and management of the patient.	1	2

Dimension	Average	Standard Deviation	Minimum	Maximum
A^* * A: before the anesthetic induction; B: before the surgical incision; C: before the patient leaves the operating room.	93.8	5.6	80.0	100.0
B^* * A: before the anesthetic induction; B: before the surgical incision; C: before the patient leaves the operating room.	89.7	9.6	53.3	100.0
C^* * A: before the anesthetic induction; B: before the surgical incision; C: before the patient leaves the operating room.	93.6	8.5	66.6	100.0

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Lara Mabelle Milfont Boeckmann, University of Brasília, Department of Nursing, Darcy Ribeiro University Campus, Faculty of Health Sciences, 70910-900 - Brasília, DF, Brazil. E-mail: laramilfont@gmail.com