UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF NURSING,

DEPARTEMENT OF SURGICAL NURSING

CLINICAL AUDIT GROUP ASSIGNMENT

TOPIC: SURGICAL SAFETY CHECKLIST UTILIZATION IN MAJOR OPERATION

ROOM AT UNIVERSITY OF GONDAR COMPRHENSIVE SPECIALIZED HOSPITAL.

Submitted By:

No. Name student

1 Alamirew Enyew
2 Aliyi Benti
3 Birtualem Fentahun
4 G/Eyesus Abera
5 Tiruye Azene
6 Yeshimebet Tamir

Submitted to: Demeke Yilkal (Msc, Assistant professor)

January, 2021
Gondar, Ethiopia

i
Acknowledgment
First we would like to thank our Instructor Demeke Yilkal (Assistant Professor in Anaesthesia
and Critical care) for providing us the chance to conduct this Clinical audit assignment/project.
Then, we would like to thank our nursing school and the Emergency and Critical Care Nursing
department for giving the chance to take the Clinical audit course. Finally, we would like to
thank UOGCSH emergency department staffs for providing us an important information to
conduct this audit.

I
 Table of Contents
Acknowledgment.......................................................................................................................................I

Introduction...............................................................................................................................................1

Aim...........................................................................................................................................................2

Objective...................................................................................................................................................2

Standard checklist/tool..............................................................................................................................3

Methods and materials..............................................................................................................................4

Audit population...................................................................................................................................4

Sample population.................................................................................................................................4

Audit sampling technique.....................................................................................................................4

Audit sample size..................................................................................................................................4

Data collection method.........................................................................................................................5

Work plan...............................................................................................................................................6

Reference..................................................................................................................................................7

1
1
1
Introduction
Surgical safety checklists used as some of the tools to prevent complications in surgery. The global
introduction of the World Health Organization Surgical Safety Checklist improves safety in both
anesthesia and surgery and reduces complications and mortality by better teamwork, communication,
and consistency of care (1). Surgical safety checklist reduces the incidence of wrong-site surgeries and
other medical errors; however, checklists alone will not prevent all errors. Successful implementation
requires perioperative stakeholders to understand the nature of errors, recognize the complex dynamic
between systems and individuals, and create a just culture that encourages a shared vision of patient
safety (2).

Strategies for successful checklist implementation included enlisting institutional leaders as local
champions, incorporating staff feedback for checklist adaptation and avoiding redundancies with
existing systems for collecting information (3). Patients exposed to a surgical safety checklist
experience better postoperative outcomes, but this could simply reflect wider quality of care in
hospitals where checklist use is routine (4).

The WHO Checklist has three components –

sign in, time out
1
and sign out – with some 19 checkpoints
though the number of
these vary with local adaptation. Audits of
compliance have pro-
duced varied and often disappointing results
reporting that team
members were often absent or disengaged
and checks were incom-
pletely performed.
7–9
An Australian qualitative study published in
this journal from the Gold Coast described an
array of behaviours
and excuses that compromised full
participation in the Surgical
Safety Checklist process, including
workload, time-constraints and
staff availability.
10
The WHO Checklist has three components –
sign in, time out
2
and sign out – with some 19 checkpoints
though the number of
these vary with local adaptation. Audits of
compliance have pro-
duced varied and often disappointing results
reporting that team
members were often absent or disengaged
and checks were incom-
pletely performed.
7–9
An Australian qualitative study published in
this journal from the Gold Coast described an
array of behaviours
and excuses that compromised full
participation in the Surgical
Safety Checklist process, including
workload, time-constraints and
staff availability.
1

3
Aim
 To improve safety in both anesthesia and surgery and to reduce complications of surgical patients
by better teamwork, communication, and better care.

Objective
 To determine the application of surgical safety checklist before induction of anesthesia

 To assess the application of surgical safety checklist before skin incision

 To determine the application of surgical safety checklist before the patient leave operation room

4
Standard checklist/tool
We use the WHO Checklist that has three components which are sign in, time out and sign out. It has
22 check points which was taken from different guidelines (5).
No. Step of Surgical safety Checklist Yes No
Sign in
1 Dose the patient has verified identity, the surgical site and procedure, and consent?
2 Is the surgical site mark checked?
3 Are anesthesia equipment and medication checks completed?
4 Is the pulse oximeter is on the patient and function checked?
5 Do all members of the team are aware of whether the patient has a known allergy?
6 Is the patient’s airway and risk of aspiration have been evaluated and appropriate
equipment and assistance are available?
7 Is a risk of blood loss > 500 ml (>7 ml/kg in children) and availability of fluids
checked?
8 Is blood requirement checked?
Time out
9 Do all team members have been introduced by name and role?
10 Does the patient’s identity, surgical site, and procedure checked?
Reviews the anticipated critical events
11 Does the surgeon reviews critical and unexpected steps?
12 Does the surgeon explain operative duration?
13 Does the surgeon explain anticipated blood loss?
14 Do anesthesia staffs review concerns specific to the patient?
15 Do nursing staffs review confirmation of sterility, equipment availability, and other
concerns?
16 Is the prophylactic antibiotics administration ≤60 min before incision or antibiotics
are not indicated checked?
17 Do essential imaging displayed results of patient in the OR confirmed?
Sign out
18 Is the name of the procedure recorded?
19 Do the needle, sponge, and instrument counts are completed (or not applicable)?
20 Does the specimen label checked?
21 Does any issue with equipment to be addressed?
22 Do the surgeon, nurse, and anesthesia professional review key concerns for the
recovery and care of the patient?

5
Methods and materials

Audit population

The audit population will be all post operative patients who admitted at university of Gondar
comprehensive specialized hospital after major surgery in the study period.

Sample population

The sample population will be all selected post operative patients who admitted at university of
Gondar comprehensive specialized hospital after major surgery in the study period.

Audit sampling technique

Simple random sampling technique will be used.

Audit sample size

To determine the sample size, single population proportion formula will be used. The sample size of
the study will be determined in to the consideration of 95% confidence interval, 5% margin of error,
and 0.5 as proportion will be used.

n= (Z a/2)2 *p (1-p)
(d) 2
Where: n= minimum sample size required
Given: z a/2=1.96,
Zα/2= standard normal variable with 95% CI (1.96)
d= margin of error =0.05 , p=0.5
Total source population (N) = the sum of 6 months anesthetic record from the hospital.
n= (1.96)2*.5(1-.5) =1.96*1.96(.5*0.5) = 384

0.05*0.05 0.0025
The final minimum sample size will be 384; however; we are unable to do this large sample size with
our limited time. Therefore; we want to do our audit on 54 charts.

6
Data collection method

Data will be collected by 6 MSc surgical nursing students of university of Gondar. To select
the study charts, all the charts numbers of patients who admitted UOGCH wards after major
surgery from 18-20th January 2021 will be received from the coordinators of wards. Then, the
study charts will be selected by using simple random sampling technique using their medical
record number.

7
Work plan
Table 1: work plan to assess surgical safety checklist utilization in major surgery at University of
Gondar Specialized Hospital.

No. Task to be Responsible person Date of each activities

performed 13/0 14/0 15/0 16/0 17/01 18/0 20/0 21/0 22/0
1/21 1/21 1/21 1/21 /21 1/21 1/21 1/21 1/21
1 Topic selection All members of the 
group

2 Searching All members of the 

evidence group

3 Develop All members of the 

standard group

4 Develop audit All members of the 

plan group and
stakeholders
5 Submit the All members of the 
audit plan group

6 Comment on Our teacher/advisor 

audit plan

7 Correct the All members of the 

comments group

8 Data collection All members of the  

group

9 Data analysis All members of the 

group

10 Develop action All members of the 

plan for group and
identified gaps stakeholders
11 Audit All members of the 
presentation group
and report

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Reference
1. Haugen AS, Sevdalis N, Søfteland EJATJotASoA. Impact of the world health organization
surgical safety checklist on patient safety. 2019;131(2):420-5.
2. Collins SJ, Newhouse R, Porter J, Talsma AJAj. Effectiveness of the surgical safety checklist
in correcting errors: a literature review applying Reason's Swiss cheese model. 2014;100(1):65-79. e5.
3. Treadwell JR, Lucas S, Tsou AYJBq, safety. Surgical checklists: a systematic review of
impacts and implementation. 2014;23(4):299-318.
4. Abbott T, Ahmad T, Phull M, Fowler A, Hewson R, Biccard B, et al. The surgical safety
checklist and patient outcomes after surgery: a prospective observational cohort study, systematic
review and meta-analysis. 2018;120(1):146-55.
5. Safety WP, Organization WH. WHO guidelines for safe surgery: 2009: safe surgery saves
lives: World Health Organization; 2009.