WHO Surgical Checklist in Dermatology: Compliance, Barriers, and Attitudes.

ABSTRACT

BACKGROUND: The World Health Organization (WHO) surgical checklist is associated with reduced morbidity and mortality. Efficacy correlates with compliance. OBJECTIVE: This study aims to (1) establish completion rate and (2) identify and address barriers to use. METHODS: Records of patients undergoing dermatological surgery were studied. Staff completed attitude and barriers questionnaires. Checklist process was modified, and use was reassessed twice. RESULTS: Cycle 1 involved 217 subjects; 72% had excisions. Thirteen percent had surgery to multiple sites. Five percent of checklists were fully completed, with an average of 76% of available points per checklist marked as checked. The lowest single field use included "patient identity" (76%) and "surgical site" (72%). Questionnaire responses from 25 staff showed the checklist to be "important" and "relevant" in dermatology; key barrier to completion was lack of time. Checklist modifications and educational sessions were undertaken; checklist use was reassessed twice more with 103 and 134 patients. Average use increased to 96% and 98%; full completion increased to 71% and 70%; "surgical site" and "identity" completion increased to 100%. CONCLUSION: The WHO checklist is relevant and important in dermatology. Introduction must be supported by repeated training sessions. Adequate time and training can significantly improve checklist completion and patient safety.