Implementation of World Health Organization behaviorally anchored rating scale and checklist utilization: promising results for LMICs

Frontiers in Medicine

Medicine

Muhammad Saqib¹  Abdullah Nadeem²  Omer Farooq³  Qazi Muhammad Sibghatullah⁴  Muhammad Haroon Abdullah⁵  Adeel Ahmed⁶  Ashhar Arshad⁷  Syed Yousaf Khalid⁸  Sandal Ashraf⁹  Hassan Mumtaz^1,10 

[1] Department of Emergency Medicine, Khyber Medical College, Peshawar, Pakistan;Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan;Department of Surgery, District Headquarter Hospital, Attock, Pakistan;Department of Surgery, District Headquarter Hospital, Rawalpindi, Pakistan;Department of Surgery, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan;Department of Surgery, Gujranwala Medical College, Gujranwala, Pakistan;Department of Surgery, King Edward Medical University, Lahore, Pakistan;Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland;Department of Surgery, Midland Regional Hospital Mullingar, Mullingar, Ireland;Maroof International Hospital, Health Services Academy, Islamabad, Pakistan;

关键词: WHOBARS;    surgical safety;    LMIC;    quality improvement;    humans;   

DOI  :  10.3389/fmed.2023.1204213

 received in 2023-04-11, accepted in 2023-06-29,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundOperating teams can decrease the likelihood of patient risk by using the WHO Surgical Safety Checklist. To ascertain the impact of demographic factors on behaviorally anchored ratings and investigate operating room (OR) staff attitudes toward checklist administration, we set out to better understand how OR personnel use the checklist in a tertiary care hospital in Pakistan.Materials and methodsA monocentric sequential mixed-methods study employing a quantitative approach of using World Health Organization Behaviorally Anchored Rating Scale (WHOBARS) assessments of surgical cases by OR personnel and two independent observers, who were certified surgeons having extensive experience in the rating of the WHOBARS scale for more than 1 year, followed by a qualitative approach of staff interviews were carried out in a tertiary care setting. In June and July 2022, over the period of 8 weeks, an intervention (training delivery) was implemented and evaluated. The information, skills, and behavior adjustments required to apply the checklist were taught in the course using lectures, videos, small group breakouts, participant feedback, and simulations.ResultsAfter the introduction of WHOBARS, 50.81% of respondents reported always using the checklist, with another 30.81% using it in part. Participants' years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with always counting instruments (51.08%), patient identity (67.83%), difficult intubation risk (39.72%), the risk of blood loss (51.08%), prophylactic administration of an antibiotic (52.43%), and the use of pulse oximeter (46.75%). Interviewees felt that the checklist could promote teamwork and a safe culture, particularly enabling speaking up. Senior staff were of key importance in setting the appropriate tone.ConclusionThe use of a multi-disciplinary course for checklist implementation resulted in 50.81% of participants always using the checklist and an increase in counting surgical instruments. Successful checklist implementation was not predicted by the participant's length of medical service, hospital size, or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.

【 授权许可】

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Copyright © 2023 Khalid, Sibghatullah, Abdullah, Farooq, Ashraf, Ahmed, Arshad, Nadeem, Mumtaz and Saqib.