Surgical safety checklist: implementation in an ambulatory surgical facility
Surgical safety checklist: implementation in an ambulatory surgical facility
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DOI：
10.1007/s12630-013-9916-8
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发表时间：
2013-06-01
影响因子：
4.2
通讯作者：
Semple, John
中科院分区：
文献类型：
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作者：
Morgan, Pamela J.;Cunningham, Lisa;Semple, John
2007 年，世界卫生组织创建了一份手术安全检查表 (SSC)，其中包含一套简单的手术安全标准。本研究的三个目的是向 SSC 添加门诊专用项目，将这些项目引入门诊手术设施，并确定实施后患者术后疼痛和恶心/呕吐的结果是否有所改善。此外，还评估了安全态度、抗生素时机、区域麻醉/神经阻滞、先发性止痛药、预防性止吐药、住院时间和住院情况。经研究伦理委员会批准后，工作人员完成安全态度调查问卷。 SSC 中添加了 7 个项目。然后收集了 SSC 实施前 180 例手术病例和实施后 195 例手术病例的数据。评估对 SSC 各部分的依从性。术后第一天，实施前和实施后疼痛评分之间的中位（97.5% 置信区间 [CI]）差异为 0.5（97.5% CI，0 至 1；P = 0.13），出院后恶心/呕吐发生率的中位差异为 -8.4%（97.5% CI，-17.9 至 1.1；P = 0.06）。除了使用先发性止痛药物外，安全态度或任何次要结果没有改善。对检查清单三个部分（即“简报”、“暂停”和“汇报”）的遵守率分别为 99.49%、97.95% 和 96.92%。对添加的“流动特定项目”的口头表达的依从性较低。缺乏吸收和整合的潜在原因包括“用户”支持度低、清单过长以及缺乏流动特定项目的优先级。根据本研究的结果开发了缩短的 SSC。该试验已在 ClinicalTrials.gov 上注册，ID：NCT00934310。
In 2007, the World Health Organization created a Surgical Safety Checklist (SSC) that encompassed a simple set of surgical safety standards. The threefold purpose of this study was to add ambulatory-specific items to the SSC, to introduce the items into an ambulatory surgical facility, and to determine if patient outcomes regarding postoperative pain and nausea/vomiting improved following implementation. In addition, safety attitudes, antibiotic timing, regional anesthesia/nerve blocks, preemptive pain medications, prophylactic antiemetics, length of stay, and hospital admission were also assessed.After Research Ethics Board approval, staff complete a Safety Attitudes Questionnaire. Seven items were added to the SSC. Data were then collected on 180 surgical cases before SSC implementation and 195 cases following implementation. Compliance with each section of the SSC was assessed.On postoperative day one, the median (97.5% confidence interval [CI]) difference between pre- and post-implementation pain scores was 0.5 (97.5% CI, 0 to 1; P = 0.13), and the median difference in the rate of post-discharge nausea/vomiting was -8.4% (97.5% CI, -17.9 to 1.1; P = 0.06). There was no improvement in safety attitudes or any of the secondary outcomes, with the exception of the use of preemptive pain medications. Compliance with the three sections of the checklist, i.e., BRIEFING, TIME OUT, and DEBRIEFING was 99.49%, 97.95%, and 96.92%, respectively. There was low compliance in verbalization of the added "ambulatory-specific items".Potential reasons for lack of uptake and integration include poor "user" buy-in, an overly lengthy checklist, and lack of prioritization of ambulatory-specific items. A shortened SSC was developed based on the results of this study. This trial was registered at ClinicalTrials.gov ID: NCT00934310.