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Adherence to the Pediatric Preinduction Checklist Is Improved When Parents Are Engaged in Performing the Checklist
Marisa A Bartz-Kurycki1, Kathryn T Anderson1, Dylan N Supak1
1Center for Surgical Trials and Evidence-based Practices (C-STEP), The University of Texas Health Sciences Center at Houston, TX, USA; Children's Memorial Hermann Hospital, Houston, TX, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, TX, USA.
Insights
Engaging parents in the pediatric surgical safety checklist significantly improves adherence and checklist completion rates. This simple intervention enhances patient safety during critical pre-operative procedures.
Area of Science:
- Pediatric Surgery
- Patient Safety
- Healthcare Quality Improvement
Background:
- The World Health Organization advocates for parental involvement in pediatric surgical safety checklists.
- Preinduction surgical safety checklists are often performed in the preoperative holding area with healthcare staff and parents present.
Purpose of the Study:
- To investigate whether parental engagement in the preinduction surgical safety checklist improves adherence to its performance.
- To quantify the impact of parental presence and engagement on checklist completion in pediatric surgery.
Main Methods:
- An observational study analyzed 484 preinduction checklists for nonemergent pediatric operations between 2016-2017.
- Adherence was measured by verbalization of key checkpoints relevant to parental knowledge.
- Parental engagement was assessed through non-verbal cues and understanding of checklist items.
Main Results:
- Overall checklist completion was poor (41% fully completed).
- Checklist adherence was significantly higher when parents were present (5 checkpoints) versus absent (2 checkpoints).
- Increased parental engagement strongly correlated with improved preinduction checklist adherence (linear regression analysis).
Conclusions:
- Preinduction surgical safety checklist performance is suboptimal in pediatric surgery.
- Parental presence and active engagement during checklist completion demonstrably enhance adherence and patient safety.
Background:
The World Health Organization recommends including the parents in completion of the pediatric surgical safety checklist. At our hospital, the preinduction surgical safety checklist is conducted in the preoperative holding with anesthesia, nursing, and often with the parents of children undergoing an operative procedure. We hypothesized that adherence to the preinduction checklist is better when parents are engaged in surgical safety checklist performance.
Methods:
An observational study of adherence to the preinduction checklist for nonemergent pediatric operations was performed (2016-2017). Adherence was defined as verbalization of checkpoints. Only checkpoints (patient identification, procedure, site marking, weight, allergies, and NPO status) relevant to parental knowledge were evaluated. Parental engagement was based on: positive body language, eye contact, lack of distractions, and understanding of checkpoints.
Results:
484 preinduction surgical safety checklists were observed (interrater reliability >0.7). Partial completion occurred in 55% cases; only 41% checklists were fully completed. Parents were present for 81% of checklists, and more checkpoints were performed when parents were present (5, IQR 4-6) versus absent (2, IQR 1-3, P < .001). Increased preinduction adherence was associated with increased parent engagement by linear regression analysis (1.20, 95%CI 1.05-1.33). Staff confirmed more checkpoints with engaged parents (28-78%) versus when parents were not engaged (1-9%, P < .001 for all checkpoints).
Conclusion:
Overall preinduction surgical safety checklist performance was poor (less than half of checklists fully completed). In contrast, checklist adherence improved with parental presence and engagement during performance of the checklist.
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