Patient safety took another step forward recently with the introduction of the Saskatchewan Surgical Initiative. Health regions in the province are working towards universal implementation of surgical safety checklists in hospital operating rooms (OR) by the end of 2011. One of Sun Country Health Region's busiest surgeons, Dr. Khalid Sheikh, said the process only takes a couple of minutes of additional time and he and the operating room staff and other support staff at St. Joseph's Hospital and Weyburn's General Hospital where he works on a regular basis, have been following the procedures for at least 18 months. "This is my 37th year in surgery, so I have always done such things as count instruments first and then after. I started doing that in England working in large hospitals where you had eight or nine operating rooms busy all the time. In those instances even patients get mixed up sometimes, so in the big hospitals doing a surgical check list is certainly an issue especially if you're a new doctor or a new nurse," he said. The process being implemented begins with the OR staff introducing themselves to one another so that everyone knows who they are working with during the operation. "This is a guideline in Toronto and places like that, where once again, you're talking about multiple surgeons, nurses and multiple operating rooms," he said. "But in smaller communities like Estevan and Weyburn, we know who we're working with right away. We're familiar with one another." So the formal introductions may not always be necessary. But even in a one operating room setting, the checklist is followed explicitly. Doing the check also includes expressing any concerns that any member of the team may have right at the start with regards to the operation, patient or process. That dialogue continues throughout the operation so that if complications arise, the surgeon and members will be able to recall whether the issue was addressed earlier and what was done. "It's certainly a positive thing and it continues to post operative care," said Sheikh. So it's not just about counting instruments. "We're talking about somebody's life, so the better the checklist is, the better the chances are that things won't go wrong. If we can reduce the chance of mistake from one in 10,000, to one in 20,000, why wouldn't we do it?" The fact that the initiative doesn't slow things down, especially in the less busy operating rooms, makes the checklist even more convincing. The checks even include a more precise knowledge of when antibiotics or other medications are given to a patient prior to surgery. If the time an antibiotic is given is known by the surgeon, then they will know what to expect when the operating room nurses bring the patient in. They (OR nurses) will have checked with the ward nurse(s) regarding that detail, which will enhance the quality of the care in the OR. Dr. Sheikh said with the staff members in both Weyburn and Estevan knowing him and with their membership remaining stable, there is an advantage in performing the checklist routines and the process makes no difference with the actual working conditions. "We've never had time problems in the OR here and the advantage of a smaller hospital is the fact we can handle emergencies as they come in if they require surgery," he said. Dr. Sheikh said due to physician shortages in Estevan, elective surgeries had to be cancelled at St. Joseph's Hospital in June. The usual routine is for him to perform surgeries on Monday, with endoscopies schedules for Tuesday through Thursday. "We are not pushed for time though, if we have enough physicians," he said. Health Minister Don McMorris said the commitment to the program was another way to ensure the provincial health care system puts patients first. "Health and safety risks are usually very low for Saskatchewan's surgical patients, and surgical care providers already do routine checks to minimize risks," McMorris said. "However, we know those risks can be reduced even further through consistent use of practices that are proven to increase patients safety. The checklist should be used by every surgeon, for every patient, every time." With the support of the World Health Organization, hospitals around the world have successfully demonstrated that using a surgical checklist significantly lowers the risk of errors.The checklist is followed before, during and after procedures, and is confirmed verbally by team members and that includes first-of-all, the patient's identity, procedure being performed, equipment required and potential complications, as outlined by Dr. Sheikh, which would relate to the patient's health history or condition. The post operation checks include the instrument count, review of equipment issues or unexpected issues encountered during the surgery. "We have been surprised by the number of good catches found by using the checklist even though we were already watching for many of the items on the list," said Dr. Joy Dobson, senior medical officer for the Regina Qu'Appelle Health Region, who was referring to the Regina operating rooms. RQHR was one of the first regions to adopt the checklist, using it for gynecology procedures as early as 2009. The checklist even helps prevent medication errors and reduces surgical site infections, the Health Ministry said in a release issued in conjunction with the announcement.
