April 29, 2021

Tick the box for safety

Standard 6 – Communicating for Safety aims to ensure timely, purpose-driven and effective communication and documentation that support continuous, coordinated and safe care for patients. This standard recognises that effective communication is needed throughout patients’ care and identifies high-risk times when effective communication is critical.

Tracey Wyllie, Peri Operative Services Manager explained communicating for safety is very important in the peri operative theatre complex, like in many others.

“This is particularly important for our teams within theatre, as the patient transfers care from ward nurse to anaesthetic nurse, anaesthetist, surgeon, the recovery team and then back to the ward. We have to have certain steps along the way, to ensure we are keeping our patients safe and that our communication is where it needs to be,” she said.

To help the team tick all the safety boxes, the Surgical Safety Checklist was developed. It was designed off the back of check lists used in aviation, and following the three part structure.

“In aviation, the three parts were pre-flight, flight and before landing. The concept is similar within the theatre environment. We use the list before surgery, once the patient is in surgery but before we start, and then we use it at the end of the surgery to make sure everything we have done has been captured,” she explained.

“The checklist has dot points on it, and the tasks should have already been completed, so it’s basically checking that we have done the work”.

In the first part, the list includes questions about patient details, anaesthetics questions, and similar. The second part is the time-out section, which the team uses just before the surgery starts, and it’s about ensuring the team has everything for the surgery.

“Things like if the patient will need antibiotics, what’s the plan, is the site marked and similar,” Tracey added.

“Final part, signing out, is done at the end of the procedure, and we check if our final surgical count is complete, are all specimens handed over and labelled, and ready for collection in the right format and so on”.

Together, the three sections help the team track the patient’s journey, making sure the patient is safe.

“The World Health Organisation (WHO) released the concept of the surgical check list around 15-20 years ago and health services adapted WHO guidelines to their own needs. We look at our Risk Man, see what is happening in the theatre that we need to prevent from happening in the future and if we see a pattern, we review the check list and adapt it,” Tracey explained.

“Patients sometimes don’t understand why we ask them same questions multiple times, like their name, address and similar. It’s just about educating the patient and letting them know this is a standard procedure and it’s important we check in each stage of the journey, and we need to get the surgery right and keep patients safe,” she said.

“The biggest change I have seen is involving the patient in the conversation. Previously, doctor and nurse would read the details off the arm band, and confirm the details, but that has shifted to actually talking to the patient to confirm their details. It’s about including the patient in the information gathering process,” she added.

Northern Health has three surgical safety check lists – one in operating theatres, one in endoscopy room and one for ophthalmology patients.