Surgical safety: more than just a tick-box exercise

Miss Tina Halai BDS MJDF RCS(Eng) is a final year Oral Surgery Registrar in London. In April at the annual Association of Surgeons in Training (ASiT) Conference held in Edinburgh, Miss Halai won the Patient Safety Prize. The Prize, awarded in conjunction with RCS Membership Engagement is awarded to the highest scoring abstract related to patient safety.

As a final year Oral Surgery Registrar at the Eastman Dental Hospital, I have been one of several nominated WHO Champions, with a role in driving patient safety.  Following this, I was asked to organise a training session on how to undertake the WHO Surgical Safety Checklist in my department.  I was keen to ensure that the training was not didactic and uninteresting for clinicians and dental nurses.  My aim was to maximise the learning opportunities from the training sessions and to ensure the Checklist was carried out to generate meaningful conversation amongst the team members as opposed to being used as a tick-box exercise.

I introduced an innovative approach to WHO Checklist training using simulation.  Scenarios used replica patient notes with purposely created subtle errors.  However, team members were not aware of this beforehand.  Clinicians were given time to look through the notes and prepare any paperwork beforehand.  The brief given was that participants were expected to undertake the WHO Checklist as they would for a real patient.  Errors ranged from another patient’s radiograph being present in the notes, wrong date of birth, reverse mounting of radiographs and incorrect final notation of teeth for extraction.  In the second training session, medical aspects were also included such as allergies and the use of brand names of medications, for example for oral anticoagulants and bisphosphonates.  This helped to ascertain whether clinicians had checked what the medications were used for and to identify whether they recognised possible implications to their planned extraction.

As this training was well-received, the Patient Safety Management Team at the Eastman Dental Hospital advised roll-out to all other dental specialities.  The Oral Surgery team have subsequently provided guidance for other departments to replicate this.   Overall, this work highlights the benefits of carrying out the WHO Checklist systematically to avoid missing things which could compromise patient care and safety.  Participants commented on how useful the sessions were and how easily mistakes could be made.

My colleagues and I then submitted the results of the training sessions as a poster for presentation at the Association of Surgeons in Training Conference in Edinburgh in April 2018.  For this work I was honoured to receive the Patient Safety Prize awarded by ASIT/ Royal College of Surgeons England.

Following this training session, I have been furthering my interest in the role of Human Factors.  Within both aviation and medicine, it has been known that Human Factors are often key elements associated with adverse incidents.  However dentistry has been lagging behind in terms of Human Factors training.  Therefore I have initiated a combined Simulation-in-situ and Human Factors Training session for the department which has received positive feedback.  Scenarios included medical emergencies, wrong site surgery, Duty of Candour and management of difficult relatives and colleagues.  I am passionate about developing the team to help improve patient care and training sessions such as these help to accomplish this.  I hope to continue my role in leading these types of training sessions and look forward to developing this within my specialty of Oral Surgery.