Understanding WHO surgical checklist implementation: tricks and pitfalls. An observational study.

BACKGROUND: The purpose of the present study was to assess the reliability of implementation data regarding the surgical safety checklist (SSC) and to identify which factors influence actual implementation. METHODS: The study was a retrospective record-based evaluation in a regional network of nine Spanish hospitals, combined with a complementary direct-observation study that included a survey of the surgical teams' attitudes. SSC compliance and associated factors were assessed and compared in a retrospective sample of 280 operations and a concurrent sample of another 85 surgical interventions. RESULTS: In the retrospective evaluation the SSC was present in 83.1 % of cases, fully completed in 28.4 %, with 69.3 % of all possible items checked. The concurrent direct-observation study showed that recorded compliance was unreliable (κ < 0.13 for all items) and significantly higher (p < 0.001) than actual compliance. Over-registration occurred across hospitals and surgical specialties. Factors associated with recorded compliance included hospital size, surgical specialty, and the use of an electronic format. In actual (direct-observation) compliance, a positive attitude on the part of the surgeon is an overriding significant factor (OR 12.8), along with using the electronic format, which is consistently and positively associated with recorded compliance but negatively related to actual compliance. CONCLUSIONS: Recorded SSC compliance may be widely unreliable and higher than actual compliance, particularly when recording is facilitated by using an electronic format. A positive attitude on the part of the surgical team, particularly surgeons, is associated with actual compliance. Effective use of the SSC is a far more complex adaptive process than the usual mandatory strategy.

Good infection prevention practices in three Brazilian hospitals: Implications for patient safety policies.

OBJECTIVE: Healthcare-associated infections (HAI) are a serious patient safety problem. There are effective preventive practices, but little information on adherence in Brazilian hospitals. This study aims at assessing adherence to good HAI prevention practices. METHODS: A cross-sectional observational study was conducted at 3 different types of hospitals (public-federal, public-state and private) in Rio Grande do Norte state, Brazil. A total of 19 structure and process indicators were measured based on 7 National Quality Forum Patient Safety Practices. RESULTS: Overall adherence was low, but higher in the private hospital, followed by the public-federal and public-state institutions. There was adequate maintenance of central venous catheters and high vaccine coverage against the influenza virus among health professionals. However, hand hygiene adherence was low, and surgical antibiotic prophylaxis and prevention of multidrug-resistant bacteria transmission, urinary tract infection by urinary catheter and associated with mechanical ventilation were inadequate. CONCLUSIONS: Despite the availability of evidence-based recommendations, there is ample room for improvement in adherence to safe practices in the hospitals under study, contributing to the heightened risk of unnecessary harm to patients.