Background: Errors related to patient safety are a major contributor to adverse incidents and preventable deaths. Interventions aimed at changing team behaviour and implementing World Health Organisation Safe Surgical Checklists (WHO SSCL) have been associated with improved outcomes. We required a cost- and timeefficient vehicle to address low adoption rates of the WHO SSCL, barriers to interdisciplinary teamwork, and inadequate attention to patient safety. Method: We aimed to test the feasibility and efficacy of a simulation-based intervention to improve behaviour influencing patient safety in operating theatres. We performed a prospective cohort study using survey tools for attendee feedback immediately after the event and at 6 weeks. We report feasibility and efficacy data plus qualitative feedback from the education team describing the advantages of this instructional design. The intervention was a 2-stage simulation. First, learners watched a 5-minute film, set in the operating theatre, depicting an error-filled WHO SSCL timeout. Second, learners entered a simulated operating theatre environment with multiple errors and risks to patient safety. Learners identified errors and prioritised them in order of importance. Their observations were discussed in a small group debrief session facilitated by novice debriefers before a whole group plenary discussion. Results: One hundred and three health workers attended the education event and 77 (75%) responded to the Immediate Questionnaire. Surgeons (27), Anaesthetists (18) and Scrub Nurses (12) made up the majority of respondents. Sixty-seven (87%) participants agreed or strongly agreed that they “now have an increased awareness of patient safety”, while 75 (97%) agreed or strongly agreed that they “feel more committed to ensuring a team approach to patient safety”. Thirty (29%) attendees responded to the Delayed Questionnaire distributed via email 6 weeks after the event. Twenty-eight (93%) agreed or strongly agreed that they felt more committed to ensuring a team approach to patient safety. Conclusion: The total cost of the event was low. Faculty reported that the instructional design afforded deliberate targeting of the importance of multi-disciplinary teamwork in patient safety. The simulation event was feasible at low monetary, time, and human resource costs. This approach offers a scalable instructional design that targets inter-professional learning.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2018-03-06T18:44:58Z No. of bitstreams: 1 Paulo Silas Ribeiro Nunes.pdf: 2342555 bytes, checksum: 867037189db2739736b4092de22d28be (MD5) / Made available in DSpace on 2018-03-06T18:44:58Z (GMT). No. of bitstreams: 1 Paulo Silas Ribeiro Nunes.pdf: 2342555 bytes, checksum: 867037189db2739736b4092de22d28be (MD5) Previous issue date: 2016 / Mestrado Profissional em Enfermagem Assistencial / O estudo aborda como temática a Segurança do Paciente no contexto específico da Meta 4 – Cirurgia Segura do Ministério da Saúde, cujo enfoque baseia-se em aplicar as metas de segurança e qualidade na gerência de risco dos processos de enfermagem transoperatório em pediatria, aperfeiçoando a dinâmica da assistência à saúde da criança cujo prognóstico é cirúrgico. A pesquisa propõe como objetivo geral, elaborar tecnologias assistenciais em enfermagem para avaliação de risco perioperatório do paciente cirúrgico pediátrico. Como específicos, prima em realizar uma análise da literatura científica sobre os eventos adversos relacionados ao bloco operatório e as principais estratégias para mitigá-los; Identificar o conhecimento dos enfermeiros a respeito da segurança do paciente cirúrgico pediátrico; Discutir os resultados deste processo, frente às recomendações do Programa Nacional de Segurança do Paciente, para a elaboração do produto da pesquisa. O estudo assume um caráter exploratório e descritivo, de natureza qualitativa. As informações foram obtidas através do método de pesquisa de revisão integrativa, e entrevistas com os enfermeiros responsáveis diretos pelo cuidado em um Hospital Público Pediátrico situado na Baixada Fluminense. As mesmas seguiram um roteiro com perguntas semiestruturadas, abertas e fechadas. Os resultados foram analisados e agrupados em categorias temáticas, e sobre tudo, analíticas. A pesquisa foi submetida à apreciação do Comitê de Ética e Pesquisa da Universidade Federal Fluminense/UFF, obtendo aprovação em dezembro de 2014 através do parecer consubstanciado de Nº 895.049. Resultado de Pesquisa: O bloco operatório, quando comparado às demais clínicas de uma unidade de saúde, apresenta alta taxa de incidência e/ou prevalência de erros e/ou acidentes ligados à assistência direta ao paciente. Estes eventos vão, desde a simples perturbação do fluxo operatório, sem consequências reais em potencial para o doente, até às mais graves complicações, com a produção de danos irreversíveis e/ou incapacitantes, ou mesmo, morte prematura, em detrimento de práticas assistenciais em saúde inseguras / The study discusses the Patient Safety theme in the specific context of Goal 4 - Safe Surgery from the Ministry of Health. The approach is based on applying the safety and quality goals in the risk management of the nursing processes in pediatrics, improving dynamics of health care to the child whose prognosis is surgical. The research proposes as a general objective to develop an assistive technology for evaluation of trans-operative risk of pediatric surgical patients. The specifics objectives is to perform an analysis of the scientific literature on adverse events related to the operating room and the main strategies to mitigate them; to identify the knowledge of nurses about the scenario regarding the safety of pediatric surgical patients; To discuss the results of this process, facing the recommendations of the National Program for Patient Safety – PNSP, to the development of the investigational product. The study takes on an exploratory and descriptive feature, of a qualitative nature. The information was obtained integrative review, through interviews with nurses, directly responsible for the care of a Pediatric Public Hospital located in the Baixada Fluminense. The interviews followed a script with open and closed semi-structured questions that were analyzed and grouped into deductive categories and themes. The research was submitted to the Ethics Committee and the Federal Fluminense University (Universidade Federal Fluminense), getting approval in December 2014 through the consolidated report No. 895,049. As expected results: The operating block, when compared to other clinics in a health unit, has a high incidence rate and prevalence of errors and / or accidents related to direct patient care. These events range from the simple disturbance of the operative flow, with no real potential consequences for the patient, to the most serious complications, with the production of irreversible and incapacitating damages, or even premature death, to the detriment of Health hazards

Världshälsoorganisationen (WHO) introducerade 2008 checklistan för säker kirurgi, som ett led i att minska vårdskador i samband med kirurgiska ingrepp och stärka kommunikationen mellan de olika professionerna på operationssalen. Denna checklista är uppdelad i tre delar; kontroll inför anestesistart, kontroll inför operationsstart (time-out), samt avslutning. Eftersom vår profession är operationssjuksköterskor, valde vi att fokusera på time-out, för att beskriva operationssjuksköterskors upplevelser av kommunikationen och följsamheten i samband med time-out. Uppsatsen är en litteraturstudie baserad på tio kvalitativa vetenskapliga artiklar, vilka granskades och analyserades. I artiklarna sökte vi efter gemensamma nämnare, de kategoriserades till huvudteman och underteman. Under huvudtemat kommunikation återfinns hierarki, som var en starkt bidragande faktor till bristfällig kommunikation inom det interprofessionella operationsteamet och till en låg följsamhet till WHO´s checklista för säker kirurgi. I huvudtemat utbildning framkom problem i samband med implementeringen av WHO´s checklista för säker kirurgi, där det saknas adekvat utbildning och handledning för hela teamet. Resultatet för uppsatsen kan ligga till grund för vidare forskning inom ämnet och bidraga till utbildning i interprofessionell kommunikation och utveckling, samt hantering av de olika hierarkierna på en operationsavdelning. / In 2008, the World Health Organization (WHO) introduced the Surgical Safety Checklist as a means to reduce surgical complications and improve communication among healthcare professionals in the operating room. The checklist is divided into three parts: pre-anesthesia check, time-out before incision, and closing check. As operating room nurses, we chose to focus on the time-out component to describe operating room nurses' experiences with communication and compliance during time-out.   This literature review is based on ten qualitative scientific articles, which were reviewed and analyzed. We searched for common themes in the articles, which were categorized into main themes and sub-themes. Under the main theme of communication, we found that hierarchy was a strong contributing factor to poor communication within the interprofessional operating team and low compliance with the WHO's Surgical Safety Checklist.   Under the main theme of education, we found problems with the implementation of the WHO's Surgical Safety Checklist, including inadequate education and training for the entire team. The results of this study can form the basis for further research on interprofessional communication and development, as well as the management of different hierarchies in the operating room.

WHO´s checklista för säker kirurgi är ett världsomfattande verktyg som implementerats i större delen av världen sedan dess introduktion 2008. Studier visar att korrekt användande av checklistan leder till en minskning av både mortalitet, morbiditet samt postoperativa komplikationer. Trots bevisade fördelar finns fortsatt brister i följsamheten gällande checklistan. Ett stort antal patienter drabbas av skador i samband med kirurgi som skulle kunna undvikas. Vårdskador får konsekvenser för patienter, närstående, personal och samhället som helhet. Syftet med studien var att identifiera faktorer som påverkar operationsteamets användning av WHO´s checklista för säker kirurgi i den perioperativa vården. Metoden som användes var en integrativ litteraturöversikt. 13 vetenskapliga artiklar analyserades med ett integrativt förhållningssätt enligt Whittemore och Knafl (2005). Resultatet visar att faktorer som teamkänsla, utbildning och stöd till personalen påverkar om och i vilken utsträckning WHO´s checklista för säker kirurgi används. Efter analysen framträdde två huvudteman; betydelsen av teamsamverkan för patientsäkert arbete och WHO´s checklista; stöd för patientsäkert arbete. Dessa två huvudteman mynnade ut i fyra subteman. Teamkänsla och kommunikation, samverkan mellan professioner, kompetens och utbildningsbehov samt förbättringsarbete och motsättningar. Operationssjuksköterskan vakar över och skyddar patienten från vårdskador. Checklistan är ett verktyg som lyfter detta. Genom att använda forskning som påvisar faktorer som påverkar användandet av checklistan för säker kirurgi kan implementeringen av rutiner och checklistor inom operationssjukvården underlättas / The Safe surgery checklist by WHO is a worldwide tool that has been implemented in most of the world since its introduction in 2008. Studies show that correct use of it leads to reduction in mortality, morbidity and postoperative complications. Despite proven benefits, there are shortcomings in compliance with the checklist. A large proportion of patients suffer injuries in connection with surgery that could have been avoided. Medical injuries have consequences for patients, relatives, staff and society as a whole. The purpose of this study was to identify factors that influence the surgical team's use of the WHO's checklist for safe surgery in perioperative care. The method was integrative literature review. The 13 scientific articles were analyzed with the integrative approach further developed by Whittemore and Knafl (2005). The results show that factors such as teamspirit, training and supporting the staff are the ones that primarily influence whether and to what extent the checklist will be used. In the analysis, two main themes emerged; The significance of team cooperation as a patient safety measure and the WHO surgical safety checklist as a tool for patient safety work and four sub-themes. The four subthemes were teamspirit and communication, cooperation between professions, competence and educational needs and the last subtheme work improvement with contradictions. The operating room nurse is watching over and protecting the patient from harm in the operating room. The checklist is one tool to highlight this. With research that demonstrates factors that affect use of the Safe surgery checklist any implementation of routines and checklists within the surgery care can be facilitated

WHO tog 2009 fram en checklista för att öka patientsäkerheten i samband med operationer, SafeSurgery Checklist [SSC] eller på svenska: Checklista för säker kirurgi. Syftet med checklistan är attförebygga de risker som kan leda till vårdskador vid operationer och att förbättra operationsteametskommunikation. Detta via ett antal säkerhetsfrågor samt att alla på operationssalen presenterar sig mednamn och profession.En rad studier visar på att checklistan om den är rätt använd reducerar operationskomplikationerna.Dessvärre finns det också studier som menar att följsamheten till checklista för säker kirurgi brister.I en kartläggning på författarens arbetsplats så identifierades flera förbättringsgap. Det framkom blandannat att det i operationsteamen brister i följsamhet på flera punkter i checklistan och att det var storaskillnader i hur den genomfördes. Det visade sig också att flera professioner i mikrosystemet inte kändesig delaktiga och inkluderade när checklistan genomfördes.Författaren valde därför att genomföra ett förbättringsarbete för att få bättre följsamhet till checklistaför säker kirurgi. Förbättringsarbetet genomfördes i samband med att den ursprungliga checklistanskulle ersättas med en uppdaterad version, Checklista 2.0 framtagen av Landstingens ömsesidigaförsäkringsbolag.Med Nolans förbättringsmodell som stöd så genomfördes utbildningsdagar, workshops och dialogerunder 2020–2021. Därefter infördes Checklista 2.0 på en operationssal som ett pilottest.En majoritet av medarbetarna upplevde att de nya rutinerna förbättrat delaktigheten. Sedan november2021 så är de nya rutinerna implementerade på hela avdelningen.Under 2022 genomfördes en kvalitativ intervjustudie som undersökte operationsteamets uppfattningav vilka faktorer som påverkat följsamheten under tiden förbättringsarbetet pågick. Resultatet mynnadeut i tre teman; motivation, ledarskapets betydelse och känsla av tillhörighet.Resultatet kan användas som vägledning för framtida förbättringsarbeten och förändringar i rutiner.Det kan ge en ökad förståelse för att operationsteamets professioner har olika utgångslägen. Därförbehöver förändringar som berör flera professioner ta hänsyn till dessa utgångslägen för att bliframgångsrika.Mer forskning kring vad som påverkar patientsäkerhetskulturen inom hälso- och sjukvården behövs ochden behöver ta hänsyn till samtliga professioner som verkar inom kontexten. / In 2009, WHO introduced a checklist to increase patient safety during surgery, Safe Surgery Checklist[SSC]. The purpose of the checklist is to prevent risks that can lead to medical injuries during surgeryand to improve team communication.A number of studies show that the checklist, if used correctly, reduces surgical complications.Unfortunately, there are also studies that suggest that compliance with the checklist for safe surgery isinaccurate.In a survey at the author's workplace, several improvement gaps were identified. It emerged, amongother things, that there was a lack of compliance in surgery teams and there were major differences inhow the checklist was carried out. It also turned out that several professionals in the microsystem didnot feel involved and included when the checklists were conducted.The author therefore chose to carry out an improvement work to get better compliance to the SSC. Theimprovement work was carried out in connection with the original checklist being replaced with anupdated version, Checklist 2.0, developed by the County Council's mutual insurance company.With Nolan's improvement model as support, training days, workshops and dialogues were heldbetween 2020–2021. Then Checklist 2.0 was introduced in one theatre as a pilot test.A majority of the employees felt that the new routines improved participation. Since November 2021,the new routine have been implemented throughout the department.In 2022, a qualitative interview study was conducted that examined the surgical team's perception ofthe factors that affected compliance during the improvement work. The result resulted in three themes.Motivation, the importance of leadership and sense of belonging. The perception differed somewhatdepending on one's professional affiliation.The results can be used as a guide for future implementations and changes in routines. It can provide anincreased understanding that the surgical team's professions have different starting points and thereforechanges that affect several professions need to take these starting points into account in order to besuccessful.More research on what affects the patient safety culture in health care is needed and it needs to take intoaccount all professions that operate in the context.