PMID- 31856007 OWN - NLM STAT- MEDLINE DCOM- 20200624 LR - 20200624 IS - 1526-7598 (Electronic) IS - 0003-2999 (Print) IS - 0003-2999 (Linking) VI - 130 IP - 5 DP - 2020 May TI - Using the Knowledge to Action Framework to Describe a Nationwide Implementation of the WHO Surgical Safety Checklist in Cameroon. PG - 1425-1434 LID - 10.1213/ANE.0000000000004586 [doi] AB - BACKGROUND: Surgical safety has advanced rapidly with evidence of improved patient outcomes through structural and process interventions. However, knowledge of how to apply these interventions successfully and sustainably at scale is often lacking. The 2019 Global Ministerial Patient Safety Summit called for a focus on implementation strategies to maintain momentum in patient safety improvements, especially in low- and middle-income settings. This study uses an implementation framework, knowledge to action, to examine a model of nationwide World Health Organization (WHO) Surgical Safety Checklist implementation in Cameroon. Cameroon is a lower-middle-income country, and based on data from high- and low-income countries, we hypothesized that more than 50% of participants would be using the checklist (penetration) in the correct manner (fidelity) 4 months postintervention. METHODS: A collaboration of 3 stakeholders (Ministry of Health, academic institution, and nongovernmental organization) used a prospective observational design. Based on knowledge to action, there were 3 phases to the study implementation: problem identification (lack of routine checklist use in Cameroonian hospitals), multifaceted implementation strategy (3-day multidisciplinary training course, coaching, facilitated leadership engagement, and support networks), and outcome evaluation 4 months postintervention. Validated implementation outcomes were assessed. Primary outcomes were checklist use (penetration) and fidelity; secondary outcomes were perioperative teams' reactions, learning and behavior change; and tertiary outcomes were perioperative teams' acceptability of the checklist. RESULTS: Three hundred and fifty-one operating room staff members from 25 hospitals received training. Median time to evaluation was 4.5 months (interquartile range [IQR]: 4.5-5.5, range 3-7); checklist use (penetration) increased from 20% (95% confidence interval [CI], 16-25) to 56% (95% CI, 49-63); fidelity for adherence to 6 basic safety processes was high: verification of patient identification was 91% (95% CI, 87-95); risk assessment for difficult intubation was 79% (95% CI, 73-85): risk assessment for blood loss was 88% (95% CI, 83-93) use of pulse oximetry was 93% (95% CI, 90-97); antibiotic administration was 95% (95% CI, 91-98); surgical counting was 89% (95% CI, 84-93); and fidelity for nontechnical skills measured by the WHO Behaviorally Anchored Rating Scale was 4.5 of 7 (95% CI, 3.5-5.4). Median scores for all secondary outcomes were 10/10, and 7 acceptability measures were consistently more than 70%. CONCLUSIONS: This study shows that a multifaceted implementation strategy is associated with successful checklist implementation in a lower-middle-income country such as Cameroon, and suggests that a theoretical framework can be used to practically drive nationwide scale-up of checklist use. FAU - White, Michelle C AU - White MC AD - From the Centre for Global Health and Health Partnerships, King's College London, London, United Kingdom. AD - Department of Anaesthesia, Great Ormond Street Hospital, London, United Kingdom. AD - Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin. FAU - Daya, Leonid AU - Daya L AD - Department of Anaesthesia and Intensive Care, Faculty of Medicine and Biomedical Sciences of Yaounde, Yaounde, Cameroon. FAU - Karel, Fabo Kwemi Brice AU - Karel FKB AD - Yaounde Emergency Center, Yaounde, Cameroun. FAU - White, Graham AU - White G AD - Department of Anaesthesia, Royal Alexandra Hospital, Paisley, United Kingdom. AD - Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin. FAU - Abid, Sonia AU - Abid S AD - Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin. AD - Imperial School of Anaesthesia, London, United Kingdom. FAU - Fitzgerald, Aoife AU - Fitzgerald A AD - Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin. AD - Department of Intensive Care, Oxford University Hospitals, Oxford, United Kingdom. FAU - Mballa, G Alain Etoundi AU - Mballa GAE AD - Ministry of Public Health, Cameroon. AD - Faculty of Medicine and Biomedical Sciences of Yaounde, Yaounde, Cameroon. FAU - Sevdalis, Nick AU - Sevdalis N AD - Centre for Implementation Science, King's College London, London, United Kingdom. FAU - Leather, Andrew J M AU - Leather AJM AD - From the Centre for Global Health and Health Partnerships, King's College London, London, United Kingdom. LA - eng PT - Journal Article PT - Observational Study PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 SB - IM MH - Cameroon/epidemiology MH - Checklist/economics/*standards MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Operating Rooms/economics/*standards MH - Patient Safety/economics/*standards MH - Personnel, Hospital/economics/standards MH - Prospective Studies MH - *World Health Organization/economics PMC - PMC7147425 COIS- Conflicts of Interest: See Disclosures at the end of the article. EDAT- 2019/12/20 06:00 MHDA- 2020/06/25 06:00 PMCR- 2020/04/10 CRDT- 2019/12/20 06:00 PHST- 2019/12/20 06:00 [pubmed] PHST- 2020/06/25 06:00 [medline] PHST- 2019/12/20 06:00 [entrez] PHST- 2020/04/10 00:00 [pmc-release] AID - 10.1213/ANE.0000000000004586 [doi] PST - ppublish SO - Anesth Analg. 2020 May;130(5):1425-1434. doi: 10.1213/ANE.0000000000004586.