Department of Surgery Frimley Park Hospital NHS Foundation Trust

‘WHO is kidding WHO’Prospective Re-Audit of the

implementation Pre-briefing and the WHO Surgical Safety Checklist at FPH

August 2011

Department of SurgeryFrimley Park Hospital NHS Foundation Trust

G Lazz-Onyenobi, S Irwin, L. GodlemanSupervised: Mr PFS Chong

The “5 Steps” Pre-list briefing

WHO checklist Sign in pre-anaesthesia

Time out pre-incision

Sign out post-closure

Post list de-briefing

Background of Surgical Safety Checklist at FPH

July 2009 Initial briefing to staff at FPH Aug 2009 First WHO safety checklist (WHOSSC) adaptation for FPH launched in theatres Dec 2009 FPH delegation to RCS England symposium on Patient safety Jan 2010 Second staff briefing regarding “Pre-brief” Feb 2011 Prospective audit of WHO SSC implementation at FPH Jun 2011 FPH Surgical Safety training day with staff training

and education on pre-brief and WHO SSC Aug 2011 Re-auditing of WHO SSC implementation at FPH

What has happened in between the last audit and the present audit?

Staff training and education regarding pre-briefing and WHO SSC implementation at FPH Surgical Safety Day in June 2011

Simple Pre-brief template now available – “5 Ps”

1) PERSONNEL available and appropriate?

2) PROCEED with list as planned?

3) PROBLEMS with patient or procedure anticipated?

4) POSITION, PRODUCTS, PROTHESES requested?

5) POST-OP instructions for patient?

Re-auditing month 24 post launch (Aug 2011) after further staff training to complete the audit cycle

Audit Method

Audit designed to collate the following information

1. Data observed from all theatre – morning AM lists

2. WHO Surgical Safety check list implementation for 1st patient on theatre list

3. Compliance of the “5 Steps” for 1st patient4. Leadership and execution of WHO SSC5. Pre-brief implementation

Performed by ODPs or ATPs

Blinded to other team members

Data collection

19 morning theatre lists at FPH Random sample taken from 2 days of activity

Speciality theatre lists NumberGeneral Surgery 9

Urology 1

Trauma & Orthopaedics 6

Obstetrics & Gynaecology 2

Ophthalmology & ENT 1

Pre-brief implementation dataPresent vs. Past

Performed in 87% (13/15) vs. 69% of theatre lists 77% vs. 88% of pre-briefs took < 5 minutes to complete 0% vs. 21% were performed with the patient awake

67% vs. 46% of lists started on time (1st patient in theatre at start time)

65% vs. 49% of lists finished on time (Last patient out of theatre at finish time)

Team members present at Pre-brief

ODP were present at 100% cases- Performed prospective audit data collection

Team members Present vs. Past (%)

Consultant Surgeon 92 % vs. 92%Anaesthetist 100 % vs. 96%Theatre nurse 100 % vs. 88%Other (student nurses) 23 % vs. 33%

Discussions during Pre-brief

58% introduced team members and discussed adequacy of team skill mix

92% discussed the order of the list 1 in 4 lists were changed from original order (last audit)

76% anticipated specific clinical or logistical problems

84% requested specific products or equipment 46% discussed specific post operation plans for

patients

WHO SSC implementation for 1st patient on list

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WHO SSC steps and leadership Present vs. Past

Adequate “sign in” 100 % vs. 83%

Main leader: ODP 68 % vs. 47%

Adequate “time out” 89 % vs. 71%Main leader: Theatre nurse 47 % vs. 88%

Adequate “sign out” 21 % vs. 48%Main leader: ODP 100 % vs. 94% Theatre Nurse

Summary of latest audit versus last audit

Re-audited prospective data month 24 post WHO SCC launch and after WHO SCC staff training shows that1. Pre-brief was performed in 9/10 theatres

compared to 7/10 from previous audit2. Pre-brief is not time consuming. The majority

(77%) took < 5 minutes which is comparable to the previous audit results (83%)

3. Team members were more involved in the pre- brief compared to previous audit ( Anaesthetist 100% vs. 88%, theatre nurses 100% vs. 96%)

Summary of latest audit versus last audit

4. 100% of patients had adequate “sign in” compared to 83% in previous audit

5. Less than 1 in 4 of patients received adequate “sign out”. Similar trend present in previous audit with more than 1 in 2 of patients

6. Main leaders of WHO SCC implementation were theatre nurses or ODPs comparable to previous audit

Conclusion

The results for this re-audit demonstrate some improvement in WHO SCC implementation and completion of the “5 Steps”.

Staff training of value as improvements seen in more prevalent pre-briefing in FPH theatres.

Signing out remains haphazard Post-briefing assessment is almost absent at FPH –

there is no improvement feedback loop.

Recommendation

Further staff training with particular focus on the “sign out” step and building an effective “post-briefing” culture at FPH Surgical Safety Day June 2012.

Designing a simple “post-briefing” template to emphasise usefulness and importance.

Practical measures to enhance safety Repeat this audit again in 2012

STOP!

Please do your team pre-brief & WHO safety

checklist.