Nursing staff’s perception of the surgical safety checklist’s sign-out stage
DOI:
https://doi.org/10.36517/2175-6783.20262796101Keywords:
Patient Safety; Checklist; Surgicenters; Organizational Culture.Abstract
Objective: to analyze the nursing staff’s perception of the factors that influence the surgical safety checklist’s sign-out stage. Methods: this is a quantitative-qualitative study. The setting was a Surgical Center and an Obstetrics Center of a large private hospital. The sample consisted of nursing technicians and nurses, with 70 participants in the first stage and 19 in the second. Data collection was carried out in two stages: survey and focus group. Quantitative data were analyzed descriptively and qualitative data through content analysis. Results: the staff observed a 58.62% adherence rate to the time-out process, contrasting with only 1.72% compliance with the sign-out procedure. Barriers hindering adherence to the sign-out process included lack of technical knowledge, organization, haste, resistance to change, and shift changes. Training, routine standardization, safety culture strengthening, and multi-professional engagement stand out for improving compliance, with an emphasis on valuing the nursing staff. Conclusion: adherence to the sign-out process is a critical point due to a lack of standardization and resistance from the staff. Effective implementation requires engaged leadership, nursing staff empowerment, active listening, and continuing education. Contributions to practice: it provides support for the development of strategies that promote greater staff engagement.
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1. Gasoma EB, Marouf MA. Enhancing surgical outcomes: evaluating the impact of implementing the world health organization surgical safety checklist-a prospective cross-sectional study. Surg J (N Y). 2024;10(4):e53-e59. doi: https://dx.doi.org/10.1055/s-0044-1800917
2. Mohamed A, Fuad U, Hagroo A, Elasad A. Best practices for surgical safety in orthopaedics: a comprehensive review of checklist implementation. Cureus. 2025;17(8):e89476. doi: https://doi.org/10.7759/cureus.89476
3. Qaiser S, Noman M, Khan M, Ahmed U, Arif A. The role of WHO surgical checklists in reducing postoperative adverse outcomes: a systematic review. Cureus. 2024;16(10):e70923. doi: https://dx.doi.org/10.7759/cureus.70923
4. Rossi N, Cortina-Borja M, Golinelli L, Bersani F, Geraci M. The association between surgical complications and compliance to the World Health Organization Surgical Safety Checklist: a retrospective analysis of hospital records. J Eval Clin Pract. 2025;31(3):e14208. doi: http://doi.org/10.1111/jep.14208
5. Osborne SR, Cockburn T, Davis J. Exploring risk, antecedents and human costs of living with a retained surgical item: a narrative synthesis of Australian case law 1981–2018. J Multidiscip Healthc. 2021;14:2397-413. doi: http://doi.org/10.2147/JMDH.S316166
6. Weprin S, Crocerossa F, Meyer D, Maddra K, Valancy D, Osardu R, et al. Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review. Patient Saf Surg. 2021;15(1):24. doi: https://dx.doi.org/10.1186/s13037-021-00297-3
7. Habtie TE, Feleke SF, Terefe AB, Adisu MA. Beyond compliance: examining the completeness and determinants of WHO surgical safety checklist - a systematic review and meta-analysis. BMC Health Serv Res. 2025;25(1):504. doi: https://doi.org/10.1186/s12913-025-12569-0
8. Bete DY, Sibhatu MK, Godebo MG, Abdulahi IJ, Liyew TW, Minas SM, et al. Improving surgical safety checklist utilisation at 23 public health facilities in Ethiopia: a collaborative quality improvement project. BMJ Open Qual. 2023;12:e002406. doi: https://doi.org/10.1136/bmjoq-2023-002406
9. Dall’Agnol CM, Ciampone MHT. Grupos focais como estratégia metodológica em pesquisas na enfermagem. Rev Gaúcha Enferm [Internet]. 1999 [cited Nov 6, 2025];20(1):5-25. Available from: https://seer.ufrgs.br/index.php/rgenf/article/view/4218/2228
10. Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2016.
11. Gabriel CS. 10 years of the National Patient Safety Program: progress, obstacles and Nursing protagonism. Rev Gaúcha Enferm. 2023;44:e20230194. doi:https://doi.org/10.1590/1983-1447.2023.20230194.en
12. Seabra A, Souza AB, Artioli RS, Tagaytayan R, Berends W, Sanders J, et al. Unintentionally retained foreign objects (URFOs): Adverse events influenced by the pandemic. A case series and literature review. J Patient Saf Risk Manag. 2023;28(5):237-44. doi: https://dx.doi.org/10.1177/25160435231185437
13. Witmer HD, Dhiman A, Jones AD, Laffan AM, Adelman D, Turaga KK. A systematic review of operative team familiarity on metrics of efficiency, patient outcomes, cost, and team satisfaction. Ann Surg. 2022;276(6):e674-e681. doi: https://doi.org/10.1097/SLA.0000000000005531
14. Amir H, Hariyati TS, Novieastari E, Pakasi TA. Continuing Professional Development (CPD) impact to clinical and nursing practice: a systematic literature review. Asia Pac J Health Manag. 2024;19(2):i2541. doi: http://doi.org/10.24083/apjhm.v19i2.2451
15. Alidina S, Chatterjee P, Zanial N, Alreja S, Balira R, Barash D, et al. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?. BMJ Qual Saf. 2021;30(12):937-49. doi: https://doi.org/10.1136/bmjqs-2020-011795
16. Carmack A, Valleru J, Randall K, Baka D, Angarano J, Fogel R. A multicenter collaborative effort to reduce preventable patient harm due to retained surgical items. Jt Comm J Qual Patient Saf. 2023;49(1):3-13. doi: https://doi.org/10.1016/j.jcjq.2022.09.005
17. Cochran K. Guidelines in practice: prevention of unintentionally retained surgical items. AORN J. 2022;116(5):427-40. doi: https://doi.org/10.1002/aorn.13804
18. Varshney A, Dwivedi S, Naga R. Ensuring patient safety and optimal outcomes: a surgeon’s perspective on safe surgery practices. J Mar Med Soc. 2025;27(3):274-9. doi: https://doi.org/10.4103/jmms.jmms_21_25
19. Lia H, Mobilio M, Rudzicz F, Moulton C. It’s not the arrow, it’s the archer: the role of the surgeon leader in a safety driven-era. Surg Endosc. 2023;38(2):992-8. doi: https://doi.org/10.1007/s00464-023-10538-4
20. McNamara C, Markey K, O’donnell C, Murphy J, O’Brien B. Factors that enhance compliance with the Surgical Safety Checklist. Br J Nurs. 2022;31(21):1080-6. doi: https://dx.doi.org/10.12968/bjon.2022.31.21.1080
21. Gomes ET, Albuquerque ÉLMS, Pereira ACM, Püschel VAA. Surgical counting: design of implementation and maintenance of a standardized evidence-based procedure. Rev Bras Enferm. 2023;76(1):e20220144. doi: https://doi.org/10.1590/0034-7167-2022-0144
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Copyright (c) 2026 Renata Pereira Silva Artioli, Márcio Wagner Camatta, Rita Catalina Aquino Caregnato, Giovana Abrahão de Araújo Moriya, Denilse Damasceno Trevilato, Ana Maria Müller de Magalhães

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Conselho Nacional de Desenvolvimento Científico e Tecnológico
Grant numbers 404041/2023






