A implementação do checklist de cirurgia segura : estudo misto

Abstract

Adherence to the safe surgery checklist reduces mortality and complication rates among surgical patients. However, there is a low adherence to the instrument, especially when assessing the quality of the check items. Failure to comply with this protocol can lead to errors and jeopardize patient safety. Objective: To analyze the process and results indicators in the implementation of the safe surgery checklist. Method: Mixed study with concomitant embedded design, carried out in a large, public, philanthropic hospital in the Brazilian Midwest, in October 2019. The study population consisted of all safe surgery checklists completed in this period and available in the patient's chart in the chart supervision sector and, by 24 nursing professionals who work in the operating room, responsible for conducting the checklist. Data collection took place through document analysis and semistructured interviews. The data from the two approaches were presented concurrently and analyzed using descriptive statistics and content analysis.Results: The checklist of 654 surgeries was evaluated, with the majority in the specialty of orthopedics 445 (68%), medium to large 392 (60%), lasting up to four hours 614 (93.9%), performed in the daytime 641 (98%) on working days 566 (86.5%). 24 nursing professionals participated, mostly nursing technicians 18 (75%), female 22 (91.7%), with experience in the Surgical Center between 8 months to 11 years and with professional training between 4 and 19 years old. Nursing technicians conducted the majority of the 641 checklist (98.0%) evaluated. We found a 100% adherence rate to complete the safe surgery checklist. However, although the professionals are aware of the importance of the checklist and the right moment for its application, they recognize that it is not always conducted as recommended, with items only being checked, without proper proof, due to innumerable barriers and challenges encountered. They emerged as barriers to their adherence: lack of training of the team, relationship difficulties by the hierarchy, noise due to parallel conversations at the moment of application, little attention to the break time and the discredit in the checklist. The biggest challenge is related to the autonomy that checklist drivers need to have in conducting the checklist, which comes up against medical hegemony over them. Conclusion: The rate of adherence to completing the checklist is 100%, but, in the experience of the person who conducts it, most of the time, it is only checked and not performed as a protocol that must be followed before each stage of the surgical procedure. Actual adherence to the checklist represents a challenge, which requires its appreciation and understanding, as a tool that promotes the safety of surgical patients. This permeates the change in the organizational culture of managers and the team involved in surgical care.