Surgical Safety Practices in Pakistan

Objectives: To evaluate the current practices regarding formal or informal implementation of individual elements of the World Health Organisation s Surgical Safety Checklist in tertiary care hospitals of Karachi and to establish a pre-checklist baseline to suggest a plan for implementation of the checklist. Methods: The qualitative knowledge-attitude-practice (KAP) survey was conducted from May 1, 2009 to January 31, 2010, during whch 103 surgeries were observed in 10 hospitals across Karachi based on simple stratified sampling. Initially, 15 tertiary care hospitals were selected, but response and consent was received from 10 of them. The WHO checklist was applied after some basic changes according to local needs and perspectives. The surgical teams were also observed for coordination and working harmony. The data was analysed on SPSS version 12 and statistical tests were applied accordingly. Results: Of the 103 surgeries observed, 13 (13.4%) patients did not confirm their identity, site of surgery or procedure. There was no concept of timeout in 91 (88.5%) cases, while in 52 (53.8%) cases, the anaesthetist did not ask for known allergy, and prophylaxis antibiotic was not given in 36 (37.5%) cases. In 20 (21.2%) cases, sponge, needle and instruments were not counted. Conclusion: The results suggest that the safety of surgical patients in the operating theaters in hospitals under review was far from satisfactory. Introduction of and adherence to a safety checklist would result in significant reduction in death and complication rate.