WHO Checklist - The Writing’s on the Wall

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Background

The World Health Organisation (WHO) Surgical Safety Checklist has been shown to improve patient safety, as well as improving teamwork and communication in theatres. Currently, there is no standardised way the checklist is performed. In Gloucester and Cheltenham hospitals, a paper checklist was used. In April 2018, a review of current practice (survey of 110 theatre staff and an audit) showed not all points were consistently discussed, and those that were, were often done without the full engagement of the team. Compliance with completing all sections of ‘sign in’ was 68% and for ‘time out’ was 87%. During ‘time out’, full engagement by the entire theatre team was achieved 58% of the time.

Aim

The aim was to achieve 90% compliance and engagement with the WHO Checklist by the entire theatre team by April 2019.

Method

To achieve this, it was proposed to move from a paper checklist to a wall-mounted checklist, to refine the points included, and to change the timing of ‘time out’ to immediately prior to knife-to-skin. The new wall-mounted checklist was designed, and trialled in one of the general theatres in Gloucester Hospital in September 2018.

Results

Following its introduction, the new checklist was re-audited. The new process was well received. Compliance improved to 92% with ‘sign in’ and to 93% with ‘time out’. Engagement by the entire theatre time was achieved 100% of the time.

Feedback was gained, adjustments made, and the new checklist was rolled out in stages to all theatres. A further re-audit was done in December 2018. Compliance improved further, and engagement was maintained at 100%. Since April 2019, the new checklist is being used in all theatres across the Trust.

To improve staff awareness during this process, presentations, emails, posters, simulation sessions, and a video of the new checklist in use were arranged.