Even though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance.
If the surgeons were impatient during the utilization of the checklist, to draw attention toward themselves (and the checklist) the scalpel was sometimes hidden until the "Time-Out" had been completed.
The patients and personnel present at the OR during the utilization of the checklist also gave informed consent.
During the utilization of the checklist, the coordinator sometimes had to pursue the surgeon in order to get attention.
Increasing the patient safety through participating in and coordinating the utilization of the checklist on a daily base, was considered an important work.
The dominant condition in this strategy was the nurses' experience of a positive and respectful attitude towards one another within the surgical team, including the utilization of the checklist.
However, through the utilization of the checklist key issues in team collaboration that were currently invisible to team members and seemed integrated as part of the culture, were made visible.
The nurses' main concern in relation to the surgical team was however not linked directly to the utilization of the checklist involved, but as how to obtain social or professional acceptance within the team in general.
Thus, to improve safety culture in the OR, interventions should aim at minimizing the hierarchy and empower nursing staff, in addition to standardizing and structuring the practicalities concerning the utilization of the checklist.
As seen in our study, the nurses downgraded the intentional utilization of the checklist by avoiding negative attention, awaiting team initiative, and selecting focus as to whom they got involved with in the team, and which questions they addressed in the checklist as part of adjusting their team involvement.
the effective use of checklists.
