Who's WHO In the Obstetrical Operating Room

Purpose for the program: To discuss the World Health Organization’s (WHO’s) Safe Surgery Saves Lives initiative of utilizing a safety checklist for all surgical procedures to avoid surgical complications.  The reported perioperative death rate is 0.4% to 0.8 % with a complication rate of 3 – 17 % .  Since it has been determined by the WHO that half of the surgical complications are avoidable, the WHO published guidelines including a safety checklist to ensure safety of the surgical patient. The checklist is designed to include surgical site infection (SSI) and venous thrombosis event (VTE) indicators for the obstetrical surgical population. Finally, the checklist is a communication tool for the surgical team that will encourage verbal confirmation among all team members to share the operative plan, promote teamwork and efficiency by developing a shared understanding of the intended procedure(s) to reduce preventable harm.       

Proposed change: Utilize a safety checklist designed to meet institutional process and patient population to prevent  surgical complications. The tool designed by the surgical team members  should engage all team members who will contribute relevant information to prevent patient harm.  The “Time Out “ universal protocol step that is practiced in most if not all surgical suites is  sometimes found to be an inattentive event that needs cognitive engagement. Therefore, incorporating the WHO checklist into the operative process would encourage team members to engage in the "Time Out" as well as to contribute relevant information to prevent patient harm.

 Implementation, outcomes and evaluation: The WHO safety checklist comprises three components of the surgical procedure that includes before anesthesia induction, before incision and before the patient leaves the operating room that is used in conjunction with the JCAHO Universal Protocol. Implementing the tool involves education and practice designed for the adult learner. The surgical checklist is individualized for each surgical suite to ensure that antibiotics and VTE prophylaxis are provided according to ACOG guidelines to improve outcomes. Ongoing evaluation of the tool may identify additional information that needs to be communicated among team members. 

Implications for nursing practice: Preventing surgical complications or patient harm is the ethical practice of nonmaleficence that drives nursing practice. Utilizing a surgical safety checklist allows the healthcare team to identify opportunities to improve care to the surgical patient in the obstetrical operating room.

 Keywords: WHO; safe surgery