Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety. Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist. Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden. Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower. Team member introductions, patient ID, planned surgery and antibiotic prophylaxis had highest compliance. Theatre nurse responsibilities in Timeout, particularly sterility and positioning of the patient had low compliance. During Sign In the majority of theatre nurses greeted the patient in the operating room and everyone performed skin control. One theatre nurse asked the patient about allergies/intolerance. The theatre nurses participated rarely in Sign Out. Conclusions: The study showed that there are large differences in compliance between items of the checklist. Theatre nurses can increase their participation by being more involved in the surgical team communication and thus clearly demonstrate her responsibilities in the perioperative nursing. Revisited routines and continuous monitoring may be needed for increased checklist compliance

Bakgrund Antalet kirurgiska ingrepp förväntas öka, och därmed ökar även den totala risken för komplikationer. Världshälsoorganisationen, World Health Organization, WHO, har tagit fram en Checklista att använda i samband med kirurgiska ingrepp för att minska komplikationer och öka patientsäkerheten. Syftet med föreliggande studie är att undersöka operationssjuksköterskors erfarenheter av Checklistan. Metod En pilotstudie genomfördes och fem operationssjuksköterskor intervjuades. Intervjuerna transkriberades ordagrant och en manifest kvalitativ innehållsanalys gjordes med induktiv ansats. Resultatet visar att det fanns hinder vid användning av Checklistan, det fanns en ovana vid de nya rutiner som Checklistan innebär, arbetslagets attityder påverkar användningen och att vissa i operationsteamet visade oförståelse för Checklistans syfte. Osäkerhet rådde bland operationssjuksköterskorna för när Checklistans olika faser skulle utföras samt vem som ska initiera Checklistan. Användning av Checklistan medförde trygghet för så väl patient som personal, liksom en ökad handlingsberedskap för operationssjuksköterskan. Presentation av personalen på operationssalen ansågs vara positiv för ny personal, och negativ då detta tar tid och innebär upprepning. Slutsats WHO:s Checklista är ett bra verktyg för att öka kommunikationen och därmed öka patientsäkerheten. Det fanns ett behov av att anpassa Checklistan till den egna kliniken. / Background The number of surgical procedures is expected to increase, and thus also the total number of complications might increase. World Health Organization, WHO, has developed a Checklist for use in connection with surgical procedures to minimize the risk of errors and to enhance patient safety. The aim of this study was to investigate the theatre nurses' experiences of this Checklist. Method A pilot study was performed and five theatre nurses were interviewed. The interviews were transcribed verbatim, and a qualitative manifest content analysis was conducted with an inductive approach. The result shows that there were obstacles in the use of the Checklist, the staff was unaccustomed to the new procedures the Checklist had led to, the surgical team’s attitudes affected the use of the Checklist, and some in the surgical team showed lack of understanding of the purpose of the Checklist. Uncertainty prevailed among theatre nurses when to perform the different phases of the Checklist, and who should be initiating the Checklist. The use of the Checklist led to increased safety for the patients as well as for the staff, and also led to an increased preparedness for theatre nurses. The presentation of the staff in the theatre room was considered to be positive for new staff, and negative since this took time and involved repetition. Conclusion The WHO's Checklist is a useful tool to increase communication and thereby increase patient safety. There was a need to adapt the Checklist to the own clinics.

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.

Bakgrund: WHO:s checklista är avsedd för operationskliniker världen över som vill reducera komplikationer i samband med operativa ingrepp. Studier har visat att checklistan inte bara förbättrade patientsäkerheten utan också bidrog till bättre teamarbete och kommunikation mellan personal. Få studier finns om hur patienter som är vakna under operation påverkas av att man använder checklista. Syfte: Syftet med denna pilotstudie var att belysa hur ett antal operationssjuksköterskor upplevde att använda checklistan inför vaken patient. Metod: En pilotstudie med kvalitativ ansats där datainsamlingen genomfördes i form av halvstrukturerade intervjuer med tre operationssjuksköterskor. Det samlade intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys. Resultatet: Resultatet presenterades utifrån sex kategorier som beskrev hur operationssjuksköterskorna upplevde att använda checklistan inför vaken patient; Anpassning, Information, Kommunikation, Obehag, Oro och Säkerhet. Slutsats: Operationssjuksköterskorna upplevde säkerheten i arbetet kring patienten som den viktigaste aspekten med att använda checklista. Samtidigt var man dock tveksam till att använda den inför vaken patient. Detta beskrevs i form av oro för patienten och en egen obehags-känsla. Operationssjuksköterskorna funderade kring möjligheter med förändringar i en sådan situation, exempelvis genom information om checklistan preoperativt, att tala tyst eller vid sidan om patienten. Inga tydliga förslag gavs om hur checklistan skulle anpassas till vaken patient. / Background: The WHO checklist is intended for operating clinics around the world to reduce the number of complications combined with surgery. Studies have shown that the checklist not only does improve patient safety but also contributes to better teamwork and communication between staff. Little is known how the checklist affects non sedated patients undergoing surgery. Aim: The aim of this study was to illustrate how a couple of theatre nurses experience the use of checklist in presents of non sedated patient. Method: The study hade a qualitative approach and semistructured interviews were made involving three theatre nurses. The collected material was analyzed by content analysis. Result: The result was presented six categories describing how the theatre nurses experienced using the checklist in presents of non sedated patient; adjustment, information, communication, anxiety, discomfort, safety. Conclusions: The theatre nurses experienced safety as the most important issue in using the checklist. At the same time they were doubtful to use it in presents of non sedated patients. They described it as a feeling of discomfort and an unpleasant feeling that they felt. The theatre nurses suggested that more preoperative information conserning the checklist and other adjustments could make it easier to use the checklist in front of non sedated patients. However, they gave no specific suggestions how to adjust the checklist to non sedated patients.

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