An investigation into the barriers preventing the implementation of the surgical safety checklist in the operating room in tertiary hospitals in the Cape Metropole

Koopman, Gerda (2018-03)

Thesis (MCur)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: Background Peri-operative patient safety remains crucial in healthcare to prevent avoidable errors. The World Health Organization developed a surgical safety checklist that was implemented by the Western Cape Department of Health in 2009. However, no evidence could be found regarding barriers during the implementation thereof in the South African context. Research question The study was guided by the question: “What are the barriers preventing the implementation of the surgical safety checklist in the operating room in tertiary hospitals in the Cape Metropole?” Aim The aim of the study was to investigate the barriers that prevent the implementation of the surgical safety checklist in the operating room in two tertiary hospitals in the Cape Metropole. Objectives The objectives of the study were to determine:  The attitudes of the staff towards the implementation of the checklist  Communication amongst surgical team members, related to the checklist  Beliefs of surgical team members about the checklist  Support from surgical team members, implementing the checklist  Feedback on potential barriers  Any statistical associations between the biographical data and the barriers preventing the implementation of the checklist Research methodology To reach the objectives of this study, a descriptive design with a quantitative correlational approach was followed. Approval was granted from the Health Research Ethics Committee of Stellenbosch University (Ethics reference 0557), and the two tertiary hospitals. After a pilot-study, data was collected through a self-administered questionnaire and analysed using descriptive and inferential data analyses. The population of 304 participants included surgeons, surgical assistants, anaesthetists, nurses and theatre technicians. Reliability and Validity The instrument used in this study was used in a previous study where an alpha score of 0.7 indicated an acceptable level of internal consistency. A pilot-study was done to test the methodology and the data collection tool. The instrument was reviewed by experts to ensure validity. Results The study results confirm that the surgical checklist is well suited, although participants over 50+ (23.8%), with more than 10 years’ experience (19.4%) and doctorate education (30.8%) disagreed that the SSC was always implemented. A statistical significant difference (p=0.010) between the years of experience and proper training on the implementation of the checklist was identified. Congruently, participants (59.9%) observed that nurses just tick off the checklist. Anaesthetists (60.9%) and participants with a degree (47.7%) indicated that sections of the checklist were sometimes not completed. Also, statistical significant differences between occupation (p=0.004), age (p=0.030), education (p=0.006) and that the checklist is an added responsibility, were identified, and 88.1% find it time consuming. Recommendations Identify and train local champions to represent management in quality improvement initiatives to promote the correct use of the checklist. Inter-professional team training on quality improvement initiatives should be instituted to address practical issues regarding the correct implementation of the surgical safety checklist. Conclusion The study highlighted incomplete use of the checklist and insufficient training that may result in a tick-box exercise. Consequent to improper use of the SSC, institutions may not experience the full benefits of the surgical safety checklist.

AFRIKAANSE OPSOMMING: Agtergrond Peri-operatiewe pasiëntveiligheid bly kritiek te wees in gesondheidsorg om peri-operatiewe skadelike gebeurtenisse te verhoed. Die Wêreld Gesondheidsorganisasie het ‘n chirurgiese kontrolelys ontwikkel wat deur die Wes-Kaapse Departement van Gesondheid in 2009 geïmplementeer is. Nietemin, geen bewyse kon verkry word oor die hindernisse wat gedurende die implementering van die chirurgiese veiligheidskontrole-lys in die Suid-Afrikaanse konteks voorkom nie. Navorsingsvraag Die studie was deur die volgende vraag gelei: “Wat is die hindernisse wat verhoed dat die chirurgiese veiligheidskontrole-lys in die operasiesaal by tersiêre hospitale in die Kaapse Metropool geïmplementeer word?” Doel Die doel van die studie was om die hindernisse te ondersoek wat die implementering van die chirurgiese veiligheidskontrole-lys in die operasiesaal in twee tersiêre hospitale in die Kaapse Metropool verhoed. Doelwitte Die doelwitte van hierdie studie was om die volgende te bepaal:  Die houding van die personeel oor die implementering van die kontrole-lys  Kommunikasie onder chirurgiese spanlede ten opsigte van die kontrole-lys  Oortuigings van die chirurgiese spanlede oor die kontrole-lys  Ondersteuning van chirurgiese spanlede aangaande die implementering van die kontrole-lys  Terugvoering in verband met potensiële hindernisse  Enige statistiese assosiasies tussen die biografiese data en die hindernisse wat die implementering van die kontrole-lys verhoed Navorsing metodologie Om die doelwitte van die studie te bereik, is ‘n nie-eksperimentele, beskrywende ontwerp, met ‘n kwantitatiewe korrelerende benadering geselekteer. Etiese goedkeuring is vooraf verkry van die Gesondheidsnavorsingsetiekkomitee aan die Universiteit van Stellenbosch (Etiese Verwysing 0557) en twee tersiêre hospitale in die Kaapse Metropool. Na ‘n loods-studie, is data deur middel van ‘n selfgeadministreerde vraelys ingesamel en deur beskrywende en afleibare data-analise uitgevoer. Die populasie van 304 deelnemers het geneeshere, chirurgiese assistente, narkotiseurs, verpleegsters en teatertegnici ingesluit. Betroubaarheid en geldigheid Die instrument wat gebruik word in hierdie studie is gebruik in 'n vorige studie waar 'n alpha telling van 0.7 'n aanvaarbare vlak van interne konsekwentheid aangedui is. 'n Loods-studie is gedoen om die metodologie en die data versameling instrument te toets. Die geldigheid van die instrument is deur kundiges verseker. Resultate Die studie resultate bevestig dat die chirurgiese kontrolelys is goed geskik, alhoewel deelnemers oor 50+ (23.8%), met meer as 10 jaar se ervaring (19.4%) en doktorsgraad onderwys (30.8%) nie saamgestem het dat die SSC altyd geïmplementeer was nie. 'n Statistiese beduidende verskil (p=0.010) tussen die jare van ervaring en behoorlike opleiding op die implementering van die kontrolelys is geïdentifiseer. Enersyds, deelnemers (59.9%) het waargeneem dat verpleegsters net die kontrolelys afmerk. Narkotiseurs (60.9%) en deelnemers met 'n graad (47.7%) het aangedui dat dele van die kontrolelys soms nie voltooi word nie. Ook, statistiese beduidende verskille is geïdentifiseer tussen beroep (p=0.004), ouderdom (p=0.030), onderwys (p=0.006) en dat die kontrolelys 'n bykomende verantwoordelikheid is, en 88.1% vind dit tydrowend. Aanbevelings Identifiseer en lei plaaslike kampioene op om bestuur te verteenwoordig in gehalte verbetering inisiatiewe om die korrekte gebruik van die kontrolelys te bevorder. Inter-professionele span opleiding op gehalte verbetering inisiatiewe moet ingestel word om praktiese kwessies met betrekking tot die korrekte implementering van die chirurgiese veiligheid kontrolelys. Gevolgtrekking Die studie het onvolledige gebruik van die kontrolelys en onvoldoende opleiding uitgelig wat kan lei tot 'n af merk lys oefening. As gevolg van onbehoorlike gebruik van die kontrolelys, mag instansies nie die volle voordele van die chirurgiese veiligheid kontrolelys ervaar nie.

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