A criterion-based audit on the use of surgical safety Checklist among obstetrics and gynaecology patients undergoing emergency operations at Kawempe National Referral Hospital, Uganda.

Abstract

Background: Surgical Safety Checklist (SSC) is 19 item document that was implemented by WHO in 2007 to enhance communication between surgical team members and it was adopted by MOH Uganda in 2011 to enable reduction in surgical morbidity and mortality. The objective wasto assess the adherence and factors influencing the use of WHO SSC among health workers conducting emergency operations at Kawempe National Referral Hospital. Methods: A criterion-based audit was used in explanatory sequential design. Criteria for checklist adherence was defined as non-adherence (none of the 19 items checked off), low adherence (at least 1 to 9 items checked off) and high adherence (10-19 items checked off), the target adherence score was 53% and above (high adherence). Using an audit cycle, 385 patient charts were audited in each audit January and May respectively using a questionnaire based on the WHO SSC. Results of the first audit were shared with key stakeholders in the clinical morning audit meeting and gaps in adherence to the use of SSC were identified. Recommendations were made and implemented. Focus Group Discussions and three key informants interviews were conducted after the second audit to describe the health unit, health care provider and tool-based factors that could have influenced the audit findings. Results: The results are presented as sign-in, time-out and sign-out for second audit. The preliminary audit found zero use of the SSC. However, four items of the SSC that were being done in both audits (Table1), patient intravenous fluids, patient intravenous access, patient consent, and antibiotic prophylaxis. After training (second audit) was conducted and there was improvement in the use of the SSC in all three components of the WHO SSC. (Table 2,3and 4). Evidence of use of SSC in patient charts was 100%. Timeout mean percentage completion score was 36.7%, sign out mean percentage completion score was 30.1%, sign in mean percentage completion score was 20%,with low overall adherence percentage score of 29.1%.The audit findings were explained by focus group discussion and key informants interviews most of the participants reported negative attitude towards it that it looks foreign, adds on their workload, lack of local adaptation and unavailability of the SSC. Conclusion: This study revealed low overall adherence to WHO SSC which was linked to negative attitude towards it. However, continuous training and mentorship of healthcare worker and use of local champions are recommended