TEHNICAL NOTES

SAFE SURGERY
Safe Surgery Safe surgeries require communication, teamwork and recognition
of the importance of patient safety by the surgical team
(Campionia & Sasso, 2019)

Poor teamwork contributes prominently to most adverse events,

including those in the operating room. (Pronovost & Freischlag,
2010)

Work in the operating room is marked by the development of

complex and interdisciplinary practices, with a strong dependence
on the individual performance of some professionals, but also the
need for teamwork under conditions, often marked by pressure and
stress. Because of these characteristics, operating rooms are
considered to be high risk scenarios, extremely susceptible to
errors. The surgical complications account for a large proportion
of the deaths and damages (temporary or permanent) caused by
the care process, considered avoidable. For this reason, in 2004,
the World Health Organization (WHO) launched a campaign

entitled “Safe Surgeries Saves Lives” as part of the World Alliance

for Patient Safety, aimed at awakening professional awareness and

political commitment to improving health care, support the
development of public policies and the induction of good care
practices (Gutierres, et al., 2018).
Safe surgery Although it is a few years since the program is published in 2008,
implementation in hospital the implementation widely achieved in many hospitals and
surgical centers worldwide. WHO Patient Safety Alliance
continues to support the implementation through publishing
training and educational curriculum, brochures, and encourage
 research in this field. Also accreditation bodies produced and
updated their standards, and included the safe Surgery goal such
Joint Commissio International (JCI). They stated in the fourth
edition JCI Accreditation Standards for Hospitals; in the
international patient goals (IPSG) section;
- IPSG.1 Identify Patients Correctly
- IPSG.2 Improve Effective Communication
- IPSG.3 Improve the Safety of High-Alert Medications
- IPSG.4 Ensure Correct-Site, Correct-Procedure, Correct-
Patient Surgery
- IPSG.5 Reduce the Risk of Health Care–Associated
Infections..
- IPSG.6 Reduce the Risk of Patient Harm Resulting from
Falls.
The Implementation of use of the checklist in England & Wales
commenced in February 2009 and mandated February 2010. The
form was designed for surgery of all types, but it was not
appropriate for obstetrics and would not be used effectively.
Therefore, modified the perioperative safety checklist to represent
the needs of an obstetric patient more appropriately was designed
(Abdallah, 2011)

WHO surgical safety A tool to ensure safety culture, teamwork, communications,

checklist information handoff, patient involvement, and check of processes.
The WHO Surgical Safety checklist was designed to ensure the
minimal required standards for safety of practicing surgery, the
WHO checklist was developed to insure teamwork, enhance
communication between staff, enforce systematic checking, and
securing patient involvement to minimize the human factor in
medical errors. The use of checklist is aiming to improve the team
work, safety culture, documentation, recall, and safeguard
 systematic approach in processes and surgical procedures.
(Abdallah, 2011).

Such a tool could improve effective communication among

clinical staff and lead to patient safety and decreased deaths or
adverse events which might arise from surgical procedures
(Asefzadeh, et al., 2017).

The aim of this checklist is to enhance patient safety and reduce

adverse incidences at the time of surgery. This is achieved through
three stages. As part of the admission process by the medical team,
the pre-op verification is completed at time of consent. Sign in
commences prior to the anaesthetic being administered in the
anaesthetic room. The team introduces themselves, risks and
concerns are highlighted. Patient details are checked, the type of
surgery, consent, allergy status, any risks of bleeding are
identified, and venous thromboembolic prophylaxis is addressed.
Stage Two is the time out phase/surgical pause and is prior to the
skin incision. A safety pause is called and all team members are
introduced and accounted for, the patient details, consent and
surgery site are reconfirmed, patient position is checked, antibiotic
prophylaxis is discussed, as are specific patient concerns and
whether specific equipment is required. Stage Three is the sign out
Phase at wound closure. The procedure just performed is
confirmed, instruments, swabs and needles are accounted for,
specimens are identified and labelled and any patient concerns,
learning or problems are addressed. The sheet is signed and added
to the patient's medical records (Smith, 2019).
Implementation of WHO The checklist should be adapted to meet the specific challenges of
surgical safety checklist obstetrics and gynecology, also in urology the Surgical Safety
Checklist was used successfully in non-cardiac general surgery for
patients at least 16 year of age. This success may prompt the
European Association of Urology to develop a committee of
experts to extend and modify the checklist for urologic surgery. In
survey conducted for all maxillofacial units in the Yorkshire
region to determine the use of the WHO checklist, the author
found all respondents were aware of the checklist. Only 45% of
surgeons were using the checklist. Those not currently using the
WHO checklist stated that they were using an alternative form of
patient check and most (72%) were using pre- and postoperative
team briefings (Abdallah, 2011).

A case study in Iran Hospital found that the overall compliance

rate of safe surgery checklist was satisfactory except for time-out
and sign-out processes. Complimentary training and regular
assessment of checklist utilization could be suggested to ensure
the positive attitude among operating room’s staff about the value
of such a safety tool in improving patient safety. (Asefzadeh, et al.,
2017).

Barriers to consistent implementation of and adherence to quality

improvement initiatives can be extrapolated from the checklist
experience in LMICs, including fatigue, organizational culture
differences across varied operating theatres, and a lack of shared
responsibility. In an effort to combat this, interventions can
undergo local adaptations to improve adherence within specific
settings. In making these adjustments, one must ensure the key
components of a tool are not lost or diluted. For example, the
responsibility of the checklist should not be delegated to a single
individual in an effort to minimize the task’s overall burden, as the
intervention’s success truly depends on the full participation of all
involved in a surgical case (Eyob, et al., 2019).
Referensi :

Abdallah A. 2011. Implementation of Safe Surgery Saves Lives initiative in Ahmed-Gasim’s

Cardiac Center [Masters dissertation]. Dublin: Royal College of Surgeons in Ireland.

Asefzadeh, S., Rafiei, S., Saeidi, M. & Karimi, M., 2017. Compliance with WHO safe surgery
checklist in operating rooms: a case study in Iran Hospital. Bali Med J, 6(3), pp. 465-469.

Campionia, M. & Sasso, G. T. M. D., 2019. Safe Surgery: Application for Logistic Support for
Safe Surgery. International Medical Informatics Association (IMIA) and IOS Press, pp.
1974-1975.

Eyob, B., Boeck, M. A., FaSiOen, P. & Cawich, S., 2019. Ensuring Safe Surgical Care Across
Resource Settings Via Surgical Outcomes. International Journal of Surgery.

Gutierres, L. d. S. et al., 2018. Good practices for patient safety in the operating room: nurse'
recommendation. Rev Bras Enferm, 71(6), pp. 2775-2782.

Pronovost, P. J. & Freischlag, J. A., 2010. Improving Teamwork to Reduce Surgical Mortality.
JAMA, 304(15), pp. 1721-1722.

Smith, R. L. a. A., 2019. Sign in, time out, sign out checklist-changing practice through
interdepartmental teamwork to improve safety at caesarean section. Journal of
Perioperative Practice, pp. 1-7.