Compliance and associated factors with WHO safety surgical checklist

Abstract

Objective:

To evaluate the compliance to and factors associated with the use of surgical safety checklist during obstetrics and gynaecological surgeries at one referral and two district hospitals in Rwanda

Methodology.

A prospective cross-sectional study was conducted from March to May 2021. A self- administered questionnaire was used to obtain information from healthcare providers and a standard WHO surgical safety checklist was audited from patient’s files. Each section and each item in the section were assigned a score of 2 if complete, 1 if partial, and 0 if no record. The completion score was the sum of sections and signature scores, the accuracy score was the sum of the detailed score of each item in the sections, and the compliance score as the summation of completion and accuracy scores. Student t-test was used for mean comparison.

Results

Among 119 healthcare providers in this study, only 61.3% had correct knowledge on the timing of the checklist filling. During study period, 1948 surgeries were performed, only 70% had a checklist filled. Surgeries at referral hospital were significantly more likely to have the checklist used (98.9% vs 56.8%, OR: 65.514, 95%, p<0.001) and less likely in weekends and nights. All the section scores were significantly lower at the district hospitals with same observation on completion, accuracy and compliance scores regardless of the day or time of the surgery. Lack of training and time constraints were highlighted as factors hindering utilization of SSC.

Conclusion

The surgical safety checklist is used only in 2/3 of the surgeries and none of them was completely fully checked. Poor utilization of the checklist can lead to preventable complications to the patient and to the system. A plan for continuous training and audit on the surgery safety needs to be enacted to ensure compliance.