Implementation of a surgical safety checklist in Brazil: cross-sectional study

this is a cross-sectional study with 531 participants during a Congress of Perioperative Nursing, promoted by the Brazilian Association of Operating Room Nurses, Anesthetic Recovery and Material and Sterilization Center, in 2017.

Results:

among the nursing professionals included, 84.27% reported the checklist implementation in the workplace. Regarding daily application in the Sign-in stage, 79.65% of professionals confirmed patient identification with two indicators; in the Time-out stage, 51.36% of surgeries started regardless of confirmation of one of the items. In the Sign-out stage, 69.34% of professionals did not count or occasionally counted the surgical instruments and suture needles, and only 36.36% reviewed concerns about postoperative recovery.

Conclusion:

this study identified needs for improvements in applying the checklist in the Brazilian reality, to guarantee safer surgical procedures.

Descriptors:
Nurses; Patient Safety; Checklist; Perioperative Care; Risk Management

Variables	n	%
Professional category (n= 508)
Nursing assistant	1	0.19
Nursing technician	20	3.93
Nurse	487	95.86
Working region (n=403)
Northeast	50	12.40
North	20	4.96
Southeast	223	55.33
South	68	16.87
Center-west	42	10.42
Age (n=476)
21-30	114	23.95
31- 40	216	45.38
41-50	87	18.28
51 -60	48	10.08
> 60	11	2.31
Working time in operating room (n=531)
< 1 year	67	12.62
1-5 years	166	31.26
6-10 years	127	23.92
11-15 years	74	13.94
16-20 years	38	7.16
21-25 years	32	6.03
> 26 years	27	5.08

Variables	n	%
Size (n=508)
Small (up to 50 beds)	48	9.45
Medium (51-150 beds)	137	26.97
Large (151-500 beds)	260	51.18
Extra Large (501 or more)	63	12.40
Profile (n=514)
Philanthropic	123	23.93
Public	170	33.07
Private	175	34.05
Mixed	46	8.95
National/International Accreditation (n=523)
Yes	216	41.3
No	307	58.7

Variables	n	%
Verification of patient identification with two indicators (n=511)
Totally filled-in	407	79.65
Partially filled-in	82	16.05
Not filled-in	22	4.31
Surgical site demarcation (n=512)
Always demarcated	202	39.45
Occasionally demarcated	226	44.14
Not demarcated	84	16.41
Allergy verification (n=511)
Always assessed	463	90.61
Occasionally assessed	44	8.61
Not assessed	4	0.78
Risk of blood loss (n=504)
Always assessed	318	63.10
Occasionally assessed	164	32.54
Not assessed	22	4.37
Difficult airway risk (n=506)
Always assessed	300	59.29
Occasionally assessed	186	36.76
Not assessed	20	3.95

Variables	n	%
Confirmation of presence of all staff members (n=449)
Always assessed	178	40.18
Occasionally assessed	223	50.34
Not assessed	48	9.48
Confirmation of patient identification, surgical site and procedure (n=447)
Always assessed	138	30.87
Occasionally assessed	206	46.09
Not assessed	103	23.04
Need for special materials and equipment (n=449)
Always assessed	259	57.68
Occasionally assessed	157	34.97
Not assessed	33	7.35
Concerns about procedure and blood loss (n=449)
Always assessed	250	57.08
Occasionally assessed	147	33.56
Not assessed	41	9.36
Confirmation of antibiotic prophylaxis prior to surgical incision (n=438)
Always assessed	266	60.73
Occasionally assessed	136	31.05
Not assessed	36	8.22
Beginning of surgery without confirmation of any Time-out item (n=449)
Always assessed	112	25.34
Occasionally assessed	227	51.36
Not assessed	103	23.3

Variables	n	%
Counting surgical instruments and suture needles (n=349)
Always assessed	107	30.66
Occasionally assessed	138	39.54
Not assessed	104	29.80
Counting compresses and gauzes (n=280)
Always assessed	183	65.36
Occasionally assessed	74	26.43
Not assessed	23	8.21
Identification anatomopathological (n=395)
Always assessed	360	30.66
Occasionally assessed	26	39.54
Not assessed	9	29.80
Anesthesiologist and nursing staff review concerns for patient recovery and management (n=396)
Always assessed	144	36.36
Occasionally assessed	200	50.51
Not assessed	52	13.13

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Vanessa de Brito Poveda. E-mail: vbpoveda@usp.br