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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 Surgery Frimley Park Hospital NHS Foundation Trust G Lazz-Onyenobi , S Irwin, L. Godleman Supervised: Mr PFS Chong. The “5 Steps”.

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Department of Surgery Frimley Park Hospital NHS Foundation Trust

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  1. ‘WHO is kidding WHO’Prospective Re-Audit of the implementation Pre-briefing and the WHO Surgical Safety Checklist at FPH August 2011 Department of Surgery Frimley Park Hospital NHS Foundation Trust G Lazz-Onyenobi, S Irwin, L. Godleman Supervised: Mr PFS Chong

  2. The “5 Steps” • Pre-list briefing WHO checklistSign inpre-anaesthesia • Time out pre-incision • Sign outpost-closure • Post list de-briefing

  3. 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 FPHSurgical Safety training day with staff training and education on pre-brief and WHO SSC • Aug 2011 Re-auditing of WHO SSC implementation at FPH

  4. 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

  5. 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 patient 4. Leadership and execution of WHO SSC 5. Pre-brief implementation • Performed by ODPs or ATPs Blinded to other team members

  6. Data collection • 19 morning theatre lists at FPH • Random sample taken from 2 days of activity

  7. 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)

  8. Team members present at Pre-brief • ODP were present at 100% cases - Performed prospective audit data collection

  9. 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

  10. WHO SSC implementation for 1st patient on list • uhu

  11. Summary of latest audit versus last audit • Re-audited prospective data month 24 post WHO SCC launch and after WHO SCC staff training shows that 1. Pre-brief was performed in 9/10 theatres compared to 7/10 from previous audit 2. 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%)

  12. 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 2of patients 6. Main leaders of WHO SCC implementation were theatre nurses or ODPs comparable to previous audit

  13. 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.

  14. 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

  15. STOP! Please do your team pre-brief & WHO safety checklist.

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