Surgical safety checklist at BHS: what does a ticked form actually represent?

Abstract

In 2010, the Correct Patient, Correct Site, Correct Procedure protocol at Ballarat Health Services was updated to incorporate the World Health Organisation (WHO)'s recommended Surgical Safety Checklist and the Royal Australasian College of Surgeons' guidelines. A 2012 internal audit showed a high rate of checklist form completion, however recent anecdotal evidence suggests that practical adherence was lower than expected. The aim of this study was to ascertain the level of adherence to the Surgical Safety Checklist procedure by direct observation of staff performance according to the standards set by the WHO guidelines. In addition, the study compared the observational results with retrospective audit of the checklist items reported in the form that accompanies patient medical records. A total of 50 procedures were audited. A poor level of practical adherence was noted, with only 44% of items observed to be preformed correctly, compared with 93% of items reported as complete in the medical records. The disparity in what was observed and what was documented suggests that staff at BHS may lack a thorough understanding of the correct use of the Surgical Safety Checklist. The results also suggest that practical adherence to the WHO guidelines may have always been poor. Some items on the current checklist form used are not practical and require review. It is important to adjust the manner in which the Checklist is used or it may fail to be effective at reducing the rate of preventable adverse events in the operating theatre.