1. Call 2: Background of the WHO Surgical Safety Checklist

2. Last Week’s Call Overview of the Safe Surgery 2015: South Carolina Initiative and call series. MUSC’s checklist journey.

3. Today’s Topics Building an implementation team. Poll The background of the WHO Surgical Safety Checklist. Website Overview.

4. Meeting the Team Lorri Gibbons, RN, BSN, CPHQ Vice President Quality & Patient Safety SCHA

5. Starting the Journey: Building a Checklist Implementation Team

6. Build an Implementation Team Administrator/Quality Improvement Officer Anesthesiologist and/or CRNA Circulating Nurse Scrub Tech Surgeon Others (Perfusionists, PA’s, Biomedical Engineers, Anesthesia Techs, Pre-op nursing, etc)

7. Find Clinical Champions The nurses will know. Pick those who are respected and who will be supportive. The support of “formal” leadership is absolutely necessary but those leaders are often not the ones who should guide this effort directly.

8. Recommendations on How Often and When to Meet as a Team Meet regularly. Choose someone to organize the meeting schedule and be a point of contact for people in your hospital and our team. An opportune time to meet together would be following each webinar. It is better to meet with part of the group than not at all.

9. Poll 1: Pick the most important thing that makes you feel like a case went well. Respected My concerns were heard We had all of the necessary equipment There were not any delays All of the paperwork was in order There were no wasted resources I had all of the information that I needed to know to take care of the patient The team worked well together The case ended on time

10. Poll 2: Pick all of the things that make a case go well. Respected My concerns were heard We had all of the necessary equipment There were not any delays All of the paperwork was in order The patient did well There were no wasted resources I had all of the information that I needed to know to take care of the patient The team worked well together The case ended on time

11. Development of the WHO Surgical Safety Checklist

12. The Problem

13. The 3 Central Problems in Surgical Safety Throughout the World Unrecognized as public health issue Lack of data on surgery and outcomes Even though we know what to do, but we don’t do it consistently

14. Global Annual Procedure Rates Source: WHO, 2008

15. Four Categories for Surgical Standards: CONTROL OF INFECTION AND CONTAMINATION ANESTHESIA AND PATIENT MONITORING SURGICAL OPERATOR QUALITY ASSURANCE

16. The Safe Surgery Saves Lives Program

17. Guiding Principles Simple Widely applicable Measurable Address serious and avoidable surgical complications Zero harm from the Checklist

19. Pilot Study

20. London, UK EUROEMRO WPRO I SEARO AFRO PAHO I Amman, Jordan Toronto, Canada New Delhi, India Manila, Philippines Ifakara, Tanzania WPRO II Auckland, NZ PAHO II Seattle, USA International Pilot Study 8 Evaluation Sites - Nearly 8,000 Patients

21. Results – All Sites BaselineChecklistP value Cases 37333955- Death 1.5%0.8%0.003 Any Complication 11.0%7.0%<0.001 SSI 6.2%3.4%<0.001 Unplanned Reoperation 2.4%1.8%0.047

22. Survey of Attitudes to Checklist Use Among Clinicians at Study Site (n=229) The checklist was easy to use78.6% The checklist improved operating room safety 79.0% The checklist took a long time to complete18.3% Communication was improved through use of the checklist 84.3% The checklist helped prevent errors in the operating room 78.2% If I were having an operation, I would want the checklist to be used 92.6%

23. The Checklist – September 2006 to December 2009 Quite a trip

35. SURPASS Checklist The Netherlands 100 item checklist implemented in 6 high performing hospitals Compared to controls the test hospitals had a greater than one-third reduction in complications and achieved an almost 50% reduction in deaths (from 1.5% to 0.8%) (N=7,580) de Vries EN, et al. Effect of a Comprehensive Surgical Safety System on Patient Outcomes. N Engl J Med 2010; 363:1928-1937

36. Veterans Health Affairs Implemented a surgical team training program incorporating a modified version of a surgical checklist in the operating theatres of 74 facilities Experienced a mortality reduction of 18% Neily J, Mills PD, et al. Association Between Implementation of a Medical Team Training Program. JAMA. 2010 Oct 20;304(15):1693-700

40. Teamwork & Communication

41. Site C Baseline (n=524) Checklist (n=598) Abx Given 0-60 Mins Except Dirty Cases 98.1%96.9% Adherence to All Six Safety Indicators 94.1%94.2% SSI 4%2.0%* Death 1.0%0.0%* Any Complication 11.6%7.0%* *p<0.05

44. JC/Standard of Practice WHO/SC Checklist SCIP

45. Safe Surgery 2015 Website Tour www.safesurgery2015.org

50. Homework Build an implementation team. Schedule a time and a venue for a meeting to take place after January 23 rd. This meeting is where the implementation team will be able to talk to as many OR physicians and staff as possible about the checklist at your hospital.

51. ? ? Questions

52. Next Week’s Topic: Measuring the Culture in Your Operating Rooms

53. Office Hours: Cancelled Happy Veterans Day

54. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu