Author’s Accepted Manuscript

Patient safety in operating room: Thoughts of

surgery team members on implementing the safe
surgery checklist (an example from turkey)

Bahar Candas, Ayla Gürsoy

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PII: S2405-6030(15)30023-6
DOI: http://dx.doi.org/10.1016/j.pcorm.2016.08.001
Reference: PCORM21
To appear in: Perioperative Care and Operating Room Management
Received date: 27 July 2015
Revised date: 28 June 2016
Accepted date: 23 August 2016
Cite this article as: Bahar Candas and Ayla Gürsoy, Patient safety in operating
room: Thoughts of surgery team members on implementing the safe surgery
checklist (an example from turkey), Perioperative Care and Operating Room
Management, http://dx.doi.org/10.1016/j.pcorm.2016.08.001
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 TITLE PAGE (Reference: PCORM 21)

Full title of the article: Patient Safety in Operating Room: Thoughts of Surgery Team Members on
Implementing the Safe Surgery Checklist (An Example from Turkey)

All authors and their affiliations:

1. Bahar Candas, MSc, RN, is a Research Assistant with the Faculty of Health Sciences, Karadeniz
Technical University, Trabzon, Turkey.
2. Ayla Gürsoy, PhD, RN, is a Lecturer and Associate Professor with the Faculty of Health
Sciences, Karadeniz Technical University, Trabzon, Turkey.

Corresponding Author:
Bahar Candas
Karadeniz Technical University,
Health Sciences Faculty,
61080 Trabzon – TURKEY
Tel: +90 462 3778877
Fax +90 462 2300476
E-mail: cnds88@hotmail.com

Abstract
Purpose: The ‘Safe Surgery Checklist’ (SSC) was created as part of the ‘Safe Surgery Saves Lives’
project; its aim was to provide safety during surgery. The Safe Surgery Checklist was adopted under
the name of ‘Safe Surgery ChecklistTR’ (SSCTR) in Turkey in 2009. To determine the attitudes of
surgery team members toward implementing safe surgery checklists in operating rooms.

Design: The study was planned as a descriptive model.

Method: The study was conducted with 303 surgery team members working in operating rooms of
hospitals located in the Trabzon city centre. Data were gathered using a questionnaire of 29 items
developed by the researcher and evaluated by number, percentage and chi-square test.

Results: It was found out that nearly three-fourths of the surgery team members believed that SSCTR
contributed to patient safety; however, only half thought that SSC TR was properly implemented at
their institutions. Most participants pointed out that the implementation of SSCTR differed
depending on whether the surgery was urgent or planned, the scale of the surgery and the attitudes

1
of surgery team members toward the implementation of the checklist. The surgery team members
who answered all items and questions in the list outnumbered those who did not. The items and
questions that were answered and ticked the most included questions regarding the patient’s allergy
history, preparation and sterilisation of the kits to be used in the surgery and confirming the unit to
which the patient was to be sent after surgery. In evaluating the answered questions related to the
SSCTR; the steps least often performed included implementation of ‘Anaesthesia Safety Checklist’,
team members introducing themselves to the patient, confirming the patient’s identity and verifying
the surgery type and site.

Conclusions: We suggest that the results of this study will facilitate increased implementation of
SSCTR.

Key Words: Nursing; operating room; safe surgery; safe surgery checklist; surgery team; patient
safety

1. INTRODUCTION
Patient safety is defined as the whole series of measures taken to prevent or minimise patient
injury during the process of the utilization of health care services [1]. According to a 2003 report by
the Institute of Medicine (IOM), at least 100 patients die daily due to medical errors at hospitals in
the United States of America [2,3]. In Turkey, 9.9 million people were hospitalised in 2008. It was
determined that 18,950 of these patients died not because of the reason for hospitalization but
because of system failures (human, institutional or technical factors, etc.) [4].
Mortality due to preventable medical errors ranks fifth among the causes of death and is a
problem that increases cost of health services. The annual cost of medical errors in the USA was
19.5 million dollars in 2008. The Harvard Medical Practice Study states that the cost of medical
errors in New York City was almost 3.8 million dollars. A study by Andel et al. (2012) reported that
the cost of medical errors in Utah and Colorado was 662 million dollars in 1996, of which 308
million dollars was associated with preventable medical errors [5,6]. In addition, it is known that
medical errors prolong hospital stays for an average of 4.6 days [7].
An important element of safety is the provision of patient safety during surgery. Enabling
patient safety lays the foundation of the principle ‘First, do no harm!’, which has been an essential
component and basic constituent of patient care. Safe surgery can be defined as the protection of
patients against possible medical errors or the minimization of such errors during care and
treatment, including pre-surgery, during surgery and post-surgery, as well as from the time of
hospitalization to the time of discharge from the hospital. Providing safe surgery is achieved with
the cooperation and collaboration of inpatient service, and the operating room and post-anaesthesia
care units at each phase of surgical care and treatment.
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 Operating rooms are potential units that may threaten patient safety. According to data from
WHO, an average of 1.5 billion surgeries are performed each year, indicating that one of every 25
people undergoes an operation in a given year [8,9]. According to data from 2007, approximately
4000 operations are performed in Turkey each year [8]. It is known that 46.3% of medical errors in
Turkey occur in operating rooms [10]. According to data from the Joint Commission International
(JCI), 1100 adverse events occurred from 1995 to 2001, and 9.7% of these adverse events were
related to wrong site surgery. Studies examining the causes of wrong-site surgeries suggested that
lack of communication among the surgical team members was the main cause for these errors
[8,11,12].
Several studies reported that in developed countries the rate of disabilities and mortalities
during surgical procedures ranged between 0.4% and 0.8%, while the rate of complications varied
between 0.3% and 16%. Also, accounted for the death of at least 1 million people and post-
operative complications of 7 million people [13,14].
It was discovered in 807 of 2851 articles studied by Zahiri et al. (2011) that institutions
experienced anxiety about patient safety in operating rooms. When the causes of their anxiety were
investigated, the top five causes were listed as infections/complications, fires,
communication/teamwork, operating room traffic and retained foreign objects [15].
It is known that half of surgery-associated medical errors are preventable. The World Alliance
for Patient Safety initiated the Safe Surgery Saves Lives project in June 2008 by increasing legal
liability to raise awareness about patient care safety and to reduce the number of deaths caused by
surgeries worldwide [14,16-18]. As a part of the project objectives, the ‘WHO Safe Surgery
Checklist’ was established on 9 February, 2009. The WHO ‘Safe Surgery Checklist’ is composed of
three parts: before induction of anaesthesia (sign in), before the skin incision (time out) and before
the patient leaves the operating room (sign out). The checklist was implemented in eight developed
and under-developed pilot areas, including General Hospital and University Health Network. The
results of the pilot implementation, which was published in the New England Journal of Medicine,
showed that the rate of surgery-associated morbidity decreased from 11% to 7%, whereas the rate of
surgery-associated mortality decreased from 1.5% to 0.8% [16,19-22].
World Health Organization estimates that 500,000 deaths per year can be prevented with the
implementation of SSC [14]. The use of the Safe Surgery Checklist requires repeating each step
necessary for patient safety; thus, helps practitioners remember these steps, standardises the
complicated protocols and situations, minimises human-associated medical errors and care costs
caused by the errors, designates roles of each member of the surgical team and provides
coordination of team efforts [18,19,22-25]. The fact that SSC is applicable to all countries, regardless

3
of income group to which patients belong, has hugely contributed to patients’ surgical safety across
the world [24].
The statement by WHO that ‘Each institution can build up their own checklists according to
their own needs’ has permitted countries to arrange SSC according to their own specific needs. In
accordance with the permission, WHO SSC has been adjusted and adapted to Turkey by the
Department of Performance Management and Quality Development. With the thought of ‘Ensuring
patient safety begins before the patient enters to the operating room’, a fourth part was added to the
current checklist to provide patient follow-up before they leave the clinic and it was used under the
name of SSCTR in 2009 [26].
WHO specifies that the checklist should be conducted with the coordination of one staff
member, preferably a nurse, so that the checklist is reliably implemented. Emphasis on the fact that
nurses should be SSC coordinators demonstrates the roles and responsibilities of the nurses in
ensuring patient safety in the operating room. In addition, these roles and responsibilities invalidate
the definition of the operating room nursing as solely technical support and put them in a pioneering
position in terms of protecting the patients against anaesthesia risks and medical errors due to
surgical intervention, thereby allowing them full use of their knowledge and skills.
In Turkey, the ministry of health has made the implementation of SSC compulsory.
However, the number of studies on the implementation, process and functionality of SSCTR is
limited. The current study was undertaken to determine the thoughts of surgery team members
about SSCTR and implementing SSCTR in operating rooms.

2. METHODS
2.1.Design
The study was planned in a descriptive model.
2.2.Sample and setting
The study was conducted at the operating rooms of all hospitals (one university hospital, four
state hospitals and two private hospitals) in a city centre located in the Black Sea Region, Turkey.
The population of the study included 528 personnel (175 surgeons, 40 anaesthesiologists, 76
assistants, 132 nurses and 105 anaesthesia technicians) who were members of the surgical team and
were not operating room administrators, hospital administrators or members of hospital quality
board.
It was aimed to recruit the whole population without sampling. During the study, 62 surgical
team members could not be contacted because they were off duty, three questionnaire forms were
not included because of incorrect completion and 160 personnel declined to participate in the study.
Therefore, the study was completed with 303 surgical team members (79 surgeons, 14

4
anaesthesiologists, 44 assistants, 101 nurses and 65 anaesthesia technicians) who met the inclusion
criteria.
2.3.Measuring instrument
As the data collection tool, a questionnaire consisting of 29 questions designed by the
researcher in line with the relevant literature [24,27-32] was employed. After questionnaire is
constituted, it was taken expert opinions of five healthcare professionals, afterwards a preliminary
application were carrid out with 10 healthcare professionals. In the questionnaire, 10 questions
addressed descriptive characteristics, six questions addressed thoughts of the surgical team about
the use of the checklist and its implementation at their institutions, nine questions addressed the
implementation of the each part of the checklist and four questions addressed recommendations of
the surgical team about the use of the checklist. The questionnaires were answered by the
participants themselves.
2.4.Statistical analysis
The data were assessed with SPSS Statistics for Windows, v20.0 (Armonk, NY: IBM Corp)
program and chi-square test.
2.5.Ethical considerations
Ethical approval was obtained from the Ethics Committee Directorate for Clinical Researches,
the hospital managements. In addition, subjects provided their informed consent to take part in the
study.
3. RESULTS
University degrees were held by 90.4% of the participants, 45.2% were physicians, 33.3%
were nurses and 21.5% were anaesthesia technicians. The participants had an average professional
experience of 11.6±7.9 years and had worked in operating rooms for 9.7±7.1 years.
Table 1 indicates the opinions of the surgical team about SSCTR. In addition to the statements
presented in the table, 67.3% of the participants expressed that the use of SSCTR was effective in
ensuring patient safety and 46.5% of the participants stated that they could rely on the
implementation of SSCTR if they were going to have an operation at their own hospitals. In addition,
69.0% of the participants emphasised that it was necessary to assign a coordinator for implementing
SSCTR, whereas 41.9% stated that they had an SSCTR coordinator at their own hospitals. Of those
who stated that they have SSCTR coordinators at their own hospitals, (n = 127), 78.7% stated that
circulating nurses were responsible for implementing SSCTR, 42.5% stated that anaesthesia
technicians were responsible for implementing SSCTR and 33.9% stated that sterile nurses were
responsible for implementing SSCTR. Although 75.9% of the participants stated that training in the
use of SSCTR was necessary, only 42.2% had received training on the checklist.

5
 It was noted that there was no difference among the members of the surgery team working at
these institutions in terms of considering that assignment of a coordinator was necessary for
implementing SSCTR at these institutions (pb = 0.072). However, when other views were examined,
it was observed that there were significant differences among the professional groups and
institutions (p < 0.05). Table 2 reflected thoughts of the surgery team members about the
implementation of SSCTR at their own institutions.
It was found that the nurses have more positive thoughts than the physicians and anaesthesia
technicians (Table 1 and 2). Also, surgery team members working in private hospitals are more
positive than the other hospitals about SSCCTR.
Table 3 included opinions of the surgery team members about the implementation of the
‘Before Induction of Anaesthesia’ SSCTR at their institutions. It was determined that the most
frequently asked item was whether the patient had a known allergy (82.8%), whereas the least
frequently implemented item was controlling Anaesthesia Safety Checklist (67.3%).
It was determined that 78.9% of the participants assured that surgical materials/supplies to be
used had been prepared before the surgery and controlled them in terms of sterilization, 75.2%
asked whether or not the patient had used anticoagulation drugs and 74.3% asked whether or not the
patient had taken prophylactic antibiotics during the pre-surgery period. Only 41.3% of the
participants stated that members of the surgical team had introduced themselves by name/surname
and explained their roles (Table 4).
When the ‘Before Patient Leaves Operating Room’ SSCTR in Table 5 was examined, the most
frequently implemented item was the confirmation of the unit the patient was to be transferred to
following the surgery (85.5%). It was discovered that the verbal confirmation of the patient’s
identity and the procedure performed before leaving the operating room was implemented the least
by the participants (66.3%).
When the person who completed the Safe Surgery ChecklistTR was examined, it was noted
that 66.0% of the participants stated that the part ‘Before Induction of Anaesthesia’ SSCTR was
filled in by anaesthesia technicians. On the other hand, it was observed that the parts ‘Before Skin
Incision’ and ‘Before Patient Leaves Operating Room’ SSCTR were filled in by circulating nurses
(63.7% and 63.4%).
Fifty-seven percent of the members of the surgery team (n = 293) stated that sufficient time
was not allocated to the implementation of SSCTR. According to 68.9% of these participants (n =
167), the reason for not allocating sufficient time for the implementation of SSC TR was that the
person who completed the items was also the person who should make preparations for the surgery.
Other reasons were lack of personnel (65.3%), request of the member of the surgery team who
completed the items for time to rest before performing the next surgery (44.9%), finding asking of
6
all the questions unnecessary (43.1%), not caring about SSCTR (38.8%) and the idea that answering
the items on the checklist took much time (24.0%).
4. DISCUSSION
The use of the Safe Surgery Checklist reduces rates of morbidity and mortality due to surgical
intervention by preventing operating-room associated medical errors. Therefore, correct and proper
use of the checklist plays a key role in providing safe surgery, which is one of the patient safety
constituents.
Almost two-thirds of the participants emphasised that they believed in the positive
contribution of SSCTR to patient safety, while fewer than half were of the opinion that SSCTR was
properly implemented at their institutions; this finding indicated that there were some problems in
the implementation of SSCTR, although they approved the positive contribution of the checklist to
patient safety. The study by Helmiö et al. [30] conducted with otorhinolaryngologists, anaesthetists,
and nurses demonstrated that 76.6% of the participants believed that SSC provided positive
contributions to the safety of patients.
Almost half of the participants stated that a coordinator assignment was made for
implementing the parts of SSCTR at their institutions. On the other hand, it was noted that only one
participant stated that the parts of SSCTR were completed by the coordinator assigned at his/her
institution, which underscores the weaknesses in the assignments of the coordinators and
implementation of SSCTR by these coordinators.
Half of the participants said that surgical team members knew how to apply SSCTR while two-
thirds of the participants were of the opinion that training was necessary for using SSC TR; this
finding shows that SSCTR training was not at the desired level. Training is a positive factor that
increases the awareness of and adaptation to new implementations. In the study by Sewell et al.
[21], it was determined that the rate of use of SSC went up to 69.9% from 7.9% after SSC training.
Almost half of the surgical team members in our study emphasised that there were standards
of SSCTR at their institutions and these standards were followed. However, the fact that the parts of
SSCTR were implemented by different surgical team members showed that there were no specific
standards, or that these standards were not appropriately followed.
The Safe Surgery ChecklistTR includes questions that should be answered and controlled by
the surgical team members together, should be asked of patients and should be answered by
reviewing the patient file. Answering these questions properly is important in terms of gaining
benefits from the form. Almost one-third of the participants said that they ‘generally’ answered the
questions that should be answered by the surgical team members together while another one-third
stated that they ‘sometimes’ did. This finding shows that there were attitudinal differences among
the surgical team members about answering the SSCTR questions that should be answered together.
7
 It was observed that almost one-fourth of the participants answered ‘generally’ to the items
‘The proper implementation of SSCTR varies depending on the type of the surgery’ and ‘The proper
implementation of SSCTR varies depending on the attitudes of surgery team members’, while
another one-fourth answered ‘never’ to these items. The fact that the participants presented two
contradictory opinions about the implementation of SSCTR demonstrated the inconsistency in the
implementation of SSCTR.
It was noted that the distribution of the answers given by the participants to the item ‘The
person who signs the relevant part of the checklist participates in answering phase of the questions
or checks the answers’ varied as ‘always’, ‘generally’ and ‘sometimes’. The fact that there were
different attitudes towards this item, which is very important in intra-team communication, hampers
the aim of the checklist. It was found out that opinions of the surgical team members about SSC TR
differed and the implementation of SSCTR at their institutions varied, which lead us to conclude that
no standard approaches existed among the safe surgery teams and their institutions in terms of the
implementation of SSCTR. Different approaches in the implementation of SSCTR that require
coordinated acts of the surgery team members to attain safety of the patients will prevent achieving
the aims of the checklist.
Almost three-fourths of the participants stated that each item and question in ‘Before
Induction of Anaesthesia’ was answered. In the study by Hannam et al. [32], it was determined that
during the surgeries completing this portion of the checklist was performed by 96.0% at one
hospital and 31.0% at another. A similar study by Vogst et al. [29] reported the rate of answering
and checking the same part by 56.0%. In our study, it was observed that the most frequently
completed item in ‘Before Induction of Anaesthesia’ was asking the patient whether he/she had an
allergy history. Some studies reported that patients were asked at nearly all hospitals whether or not
they had an allergy history [29,32]. Abbasoğlu et al. [33] found that the rate of asking about allergy
history was by 51.2%. In this part, it was noted that the least frequently checked item was ‘The
anaesthesia is not initiated without Anaesthesia Safety Checklist being controlled’. The study by
Vogst et al. [29] detected that the rate of medical examination of the patients in terms of anaesthesia
before the surgery was by 20.0%, which was similar to our study findings.
In our study, almost three-fourths of the surgery team members stated that the fourth, fifth,
sixth and seventh items were answered and checked in ‘Before Skin Incision’, SSCTR. Hannam et
al. [32] observed that checking of this part was performed by 99.0% at one hospital and by 48.0% at
another hospital during the surgeries. A similar study by Vogst et al. [29] reported the rate of the
checking the same part by 69.0%. The item completed the least was ‘It is assured that all team
members have introduced themselves by name/surname and role’. In the study by Kasatpibal et al
[34], it was found out that the rate of the surgery team members introducing themselves by
8
name/surname in ‘Before Skin Incision’ was 79.0%. The rate of answering the same item was by
3.0% at one hospital, while by 16.0% at another in the study by Hannam et al. [32]; it was by 74.0%
in the study by Vogst et al. (2014) [29].
When ‘Before Patient Leaves Operating Room’ (the last part of the Safe Surgery ChecklistTR)
was examined, it was found out that almost three-fourths of the surgery team members stated that
this part was checked. In the studies conducted, the rate of checking the same part ranged between
9% and 40% [29,32].
Almost one-fourth of the participants stated that the reason for the improper implementation
of SSCTR was that answering the items on the checklist took much time. In the study by Helmiö et
al. [30], the participants found the implementation of the whole checklist difficult. The current
study provided us information about the thoughts and attitudes of surgery team members towards
SSCTR, which will shed light upon the improvement and the adaptation to the implementation of the
checklist.

4.1. Limitations
The study was conducted with those who answered questionnaire forms in a province located in
the Eastern Black Sea Region, Turkey. The data included the participants’ subjective opinions and
thoughts. Therefore, these opinions and thoughts cannot be generalised for the implementation of
SSCTR in other provinces.
5. CONCLUSIONS
It is inevitable for team members and to collaborate for the common purposes towards ‘Safe
Surgery’ being one of the important elements of the patient safety. Because operating rooms are
places where personnel work hard with a heavy burden, significant stress, faced with time
constraints and lack of communication among the team members patient safety is at risk in these
units. In particular, nurses play a key role in establishing the foundation of safe surgery because
they are the first members of the surgery team coming to mind as SSC coordinators.
We need to improve patient safety culture in operating rooms. For this purpose, different tools
which are effective, reliable and in compliance with medical team are needed. Safe surgery
checklist is a tool that is suggested to be implemented around the world. Our study enables us to
gain information about the thoughts of surgery team members towards SSC TR and the
implementation of it. The participants believed that the use and implementation of SSC was
necessary and would contribute to patient safety, they stated that there were shortcomings or errors
in its practice. In addition to this, there are differences among hospitals and surgical team members
about SSCTR. These results show similarities with many researches that were done in other
countries. Also another contribution of the study is describing factors that affect the compliance to
9
implementation of the checklist. The first reason for not allocating sufficient time for the
implementation of SSCTR was that the person who would fill in the items was the ‘same person as
the one who should make preparations for the surgery’. But, more detailed information is needed
about problems which are related to compliance with SSCTR. So, conducting studies with
observational and detailed research methods on the use of SSCTR should be done to uncover the
reasons of why the checklist doesn’t implement as required and what the barriers to compliance
with the checklist are. Futhermore, the training and activities about SSCTR should be held at the
hospitals to raise awareness among the surgical team members, which may provide an improvement
the implementation of the checklist. Also, optimal time intervals between surgeries should be
arranged by taking the preparation process of the next surgery into consideration will provide
sufficient time for SSCTR. Another takehome point is the use of the checklist is an obligation in
Turkey. But, in our study we found that the surgical team members didn’t trained before beginning
use it or their readiness weren’t considered. In this direction, the hospitals occasionally should
organize some programmes to adopt the surgical team members to checklist and towards determine
the failure cause of the checklist. Lastly, there aren’t enough research related to SSC in Turkey.
Accordingly, our research may be a shedlight on new researches and to set a course for
improvement of it on international fields.

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Table 1 Thoughts of the surgical team about SSCTR (n = 303)

Yes Partly No No idea

S (%) S (%) S (%) S (%) 2 p

I think SSCTR is correctly implemented at the 17.643 pa = 0.007*

126 (41.6) 113 (37.3) 41 (13.5) 23 (7.6)
operating room where I work. 24.999 pb = 0.000

12
There are standards established by our
71.169 pa = 0.000*
institution about who should implement the 153 (50.5) 50 (16.5) 49 (16.2) 51 (16.8)
28.748 pb = 0.000
TR
parts of SSC .

The standards about the implementation of 45.506 pa = 0.000*

143 (47.2) 77 (25.4) 38 (12.5) 45 (14.9)
SSCTR are followed. 26.104 pb = 0.000

The members of the surgery team know how

25.250 pa = 0.001*
TR
to implement SSC . 167 (55.1) 72 (23.8) 36 (11.9) 28 (9.2)
28.931 pb = 0.001

pa: According to the medical fields of the members of the surgery team. p b: According to the institutions of the members
of the surgery team where they worked.
* For statistical analyses; professional groups of the team were united under physician, nurse, anaesthesia technicians.

Table 2 Thoughts of the surgical team about the implementation of SSCTR at their own institutions
(n = 303)
Thoughts about the implementation of Always Generally Sometimes Never No idea
2 p
TR
SSC S (%) S (%) S (%) S (%) S (%)

As the members of the surgical team;

27.698 pa = 0.001*
we check and answer the questions of 47 (15.5) 94 (31.0) 112 (37.0) 28 (9.2) 22 (7.3)
42.441 pb = 0.000
the checklist together.

The questions about the patients are 38.740 pa = 0.000*

93 (30.7) 120 (39.6) 59 (19.5) 9 (3.0) 22 (7.2)
asked to them and ticked. 58.630 pb = 0.000

The questions are asked, answered and 30.858 pa = 0.000*

55 (18.2) 85 (28.1) 111 (36.6) 29 (9.6) 23 (7.5)
ticked after controlling the patient file. 41.513 pb = 0.000

The proper implementation of SSCTR

36.062 pa = 0.000*
varies depending on the gravity of the 41 (13.5) 79 (26.1) 58 (19.1) 89 (29.4) 36 (11.9)
48.438 pb = 0.000
surgery.

The proper implementation of SSCTR

varies depending on the surgery being 46.729 pa = 0.000*

39 (12.9) 90 (29.7) 98 (32.3) 44 (14.5) 32 (10.6)
urgent or planned or the scale of the 28.110 pb = 0.000

surgery.

The proper implementation of SSCTR

24.057 pa = 0.002*
varies depending on the attitudes of 30 (9.9) 77 (25.4) 75 (24.8) 81 (26.7) 40 (13.2)
pb = **
surgery team members about how to

13
fill in the checklist.

The person who signs the relevant part

of the checklist participates in 66.784 pa = 0.000*

79 (26.1) 85 (28.1) 81 (26.7) 27 (8.9) 31 (10.2)
answering phase of the questions or 49.343 pb = 0.000

checks the answers.

pa: According to the medical fields of the members of the surgery team. p b: According to the institutions of the members
of the surgery team where they worked.
* For the statistical analyses; professional groups of the team were united under physician, nurse, anaesthesia
technicians.
** No statistical analyses were performed.

Table 3 Thoughts of the surgery team members about the implementation of the ‘Before Induction
of Anaesthesia’, SSCTR (n = 303)
Yes Sometimes No No idea
QUESTIONS
S (%) S (%) S (%) S (%)
It is confirmed that his/her identity,
243 (80.2) 20 (6.6) 24 (7.9) 16 (5.3)
surgery site, procedure, and consent by patient

It is controlled whether or not the site is marked. 235 (77.6) 30 (9.9) 21 (6.9) 17 (5.6)

The anaesthesia is not initiated without Anaesthesia Safety

204 (67.3) 39 (12.9) 28 (9.2) 32 (10.6)
Checklist being controlled.

The pulse oximeter is placed on the patient and activated. 24 (79.5) 14 (4.6) 17 (5.6) 31 (10.3)

The patient is asked whether or not he/she has a known

251 (82.8) 17 (5.6) 16 (5.3) 19 (6.3)
allergy.

The imaging devices necessary for the surgery are

244 (80.5) 22 (7.3) 15 (5.0) 22 (7.2)
prepared.

Risk of blood loss is evaluated. 236 (77.9) 30 (9.9) 16 (5.3) 21 (6.9)

Table 4 Thoughts of the surgery team members about the implementation of the ‘Before Skin
Incision’, SSCTR (n = 303)
Yes Sometimes No No idea
QUESTIONS
S (%) S (%) S (%) S (%)

It is assured that all team members have introduced 125 (41.3) 46 (15.2) 107 (35.3) 25 (8.2)

themselves by name/surname and role.

14
It is assured that one of the team members confirms the 177 (58.4) 49 (16.2) 55 (18.2) 22 (7.2)

patient’s name, procedure, and surgery site will be made.

It is assured that anticipated critical events in SSCTR have

been controlled.

 Anticipated surgery time

 Anticipated blood loss 184 (60.7) 40 (13.2) 56 (18.5) 23 (7.6)

 Unexpected events during the surgery

 Possible anaesthesia risks

 Position of the patient

It is asked whether or not the patient has taken prophylactic 225 (74.3) 22 (7.3) 26 (8.6) 30 (9.8)

antibiotics.

It is assured that surgical materials and supplies are 239 (78.9) 19 (6.3) 18 (5.9) 27 (8.9)

prepared.

Surgical materials and supplies are controlled in terms of 239 (78.9) 14 (4.6) 20 (6.6) 30 (9.9)

sterilisation.

It is asked whether or not controlling blood glucose is 224 (73.9) 31 (10.2) 22 (7.3) 26 (8.6)

necessary.

It is asked whether or not the patient has used anticoagulation 228 (75.2) 25 (8.3) 23(7.6) 27 (8.9)

drugs during the pre-surgery period.

It is asked whether or not deep vein thrombosis prophylaxis 186 (61.4) 33 (10.9) 41 (13.5) 43 (14.2)

is necessary.

Table 5 Thoughts of the surgery team members about the implementation of the ‘Before Patient
Leaves Operating Room’, SSCTR (n = 303)
Yes Sometimes No No idea
QUESTIONS
S (%) S (%) S (%) S (%)

The name of the procedure is verbally confirmed with

201 (66.3) 42 (13.9) 38 (12.5) 22 (7.3)
patient’s name and surgery site.

Sponge/compress and needle counts are confirmed. 254 (83.8) 15 (5.0) 10 (3.3) 24 (7.9)

It is controlled whether specimen-labelling taken from the

252 (83.2) 12 (4.0) 8 (2.6) 31 (10.2)
patient includes the name of the patient and incision site.

15
Consulting with the anaesthetist and the surgeon; post-
229 (75.6) 30 (9.9) 19 (96.3) 25 (8.2)
surgical critical needs of the patient are checked.

It is confirmed which unit the patient is to be transferred

259 (85.5) 17 (5.6) 8 (2.6) 19 (6.3)
to following the surgery.

16