​After failing to achieve widespread adoption of the World Health Organization's surgical checklist in its operating rooms (ORs), a children's hospital implemented multifaceted interventions that boosted adherence to the checklist from 30% to 96% of all OR cases over a two-year period. The interventions, summarized in an article in the August 2014 issue of Surgery, included enlisting stakeholders to customize the checklist to the organization's needs, clarifying the checklist's definitions and expectations, and standardizing the process for executing the checklist. For example, when the checklist was first adopted, there was an expectation that the surgeon would execute the checklist, although the surgeon's role was never specified. To encourage the checklist's adoption and to promote its consistent use, the organization assigned the circulating nurse as the checklist moderator. Having the surgeon as the moderator only reinforces the OR's hierarchy and could dissuade other members of the surgical team from speaking up to raise concerns about the procedure to be performed, the article's authors write. Additionally, the organization named a pediatric OR safety council—consisting of surgeons, anesthesiologists, perioperative staff, and OR administration—to cultivate a culture of safety and to oversee adoption of the checklist, which could be viewed as a barometer of the safety culture. "Disseminated protocols and guidelines rarely lead to actual practice changes, and the success is dependent largely on the implementation strategies employed," such as changing the safety culture, achieving stakeholder buy-in, and modifying the checklist to reflect local needs and practices, write the authors.

HRC Recommends: Using a checklist to guide the performance of patient safety measures can ensure that no requisite steps are overlooked. The World Health Organization's surgical safety checklist is intended to help operating teams limit the risk of patient harm. The checklist is divided into three time frames: before anesthesia induction, before the initial incision, and before the patient leaves the OR. For each part of the process, the checklist includes basic steps such as confirming the patient's identity, discussing the patient's allergies, introducing all team members by name and role, and confirming that sponge, sharp, and instrument counts are correct. Users should customize the checklist and its accompanying implementation manual to suit their circumstances.