OR Nurses To Lead
WHO Patient Safety Initiative
Operating room nurses can play a pivotal role in implementing the World Health Organization’s new Surgical Safety Checklist, says Irini Antoniadou,previous President of the European Operating Room Nurses Association.
The WHO checklist has been developed as a routine tool to help improve patient safety during surgery and includes a series of steps that should be taken during the peri-operative process. As part of its ‘Safe Surgery Saves Lives’ global campaign, the WHO is targeting the adoption of the checklist at 2,500 hospitals around the world by the end of this year.
“EORNA fully supports this WHO initiative,“ says Ms Antoniadou. “Our members are involved throughout the whole peri-operative process and they are ideally placed to make sure the requirements of the checklist are fulfilled. In hospitals where it is not yet part of the normal procedure, we are encouraging nurses to work with doctors and the authorities for its introduction.”
A WHO implementation manual accompanying the checklist states that many of the 24 individual steps are already accepted as routine practice in facilities around the world, “though they are rarely followed in their entirety.” To ensure full compliance, it recommends the appointment of a designate checklist coordinator within the operating room team who “will often be a circulating nurse, but it can be any clinician or healthcare professional participating in the operation.”
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The checklist identifies three phases of an operation: ‘sign in’, before the induction of anaesthesia; ‘time out’, before the incision of the skin; and ‘sign out’ before the patient leaves the operating room. In each phase, the surgical team must complete all the listed tasks before proceeding. These range from confirming the patient’s name, to carrying out an instrument count and checking that recommendations have Irini Antoniadou, Chairman EORNA 2005-2009 been made for the patient’s recovery treatment.
Ms Antoniadou and colleagues from the US and UK attended international conferences organised by WHO during the development of the checklist, the first time EORNA has been officially consulted by WHO.
“For many years our organization has run education programs focusing on patient safety and it is rewarding to see this work recognized by the WHO,” says Ms Antoniadou. |
Irini Antoniadou, Chairman EORNA 2005-2009.
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“Right from the beginning, Dr Atul Gawande,the WHO project leader, said the involvement of peri-operative nurses was essential for the successful operation of the checklist and he welcomed our input.
“During the discussions, we wereparticularly concerned about ensuring there are good sterilization procedures and checks that all instruments and facilities, such as the ventilation, are working properly. We also pointed out that it is important for patients to feel reassured they are in safe hands and peri-operative nurses are best placed to do this.”
Research findings in WHO pilot schemes at eight city hospitals in six regions around the world alreadyindicate the value of the checklist. Comparing data for almost 4,000 patients before and after the checklist’s introduction, the incidence of in-patient deaths following major operations fell by more than 40% (from 1.5% to 0.8%) and major complications after surgery were reduced by a third, from 11% to 7% (1).
“We have been very energized by working with the checklist,” adds Ms Antoniadou. “Although it is quite basic, it covers all the important precautions necessary for a safe operation. It’s an efficient way of making sure nothing gets overlooked, which includes the particular needs of all members of the operating team. In this way, it also improves teamwork and communication in the operating room.”
References:
1. New England Journal of Medicine, 29 Jan 2009: A Surgical Safety Checklist to Reduce Morbidity and Mortality in Global Population.