Effectiveness of Adapting Surgical Time-Out Policy - Research Proposal Example

Effectiveness of Adapting Surgical Time-Out Policy in Improving Patient Safety in Operating Room - Research Proposal - Submission: Total Number of Words: 2,752 Introduction Each time a group of healthcare professionals are working under pressure, human errors such as performing a wrong surgical procedure to a wrong patient or a wrong surgical site can accidentally happen to anyone (Hamlin, Richardson-Tench and Davies, 2009, p. 87). In line with this, the process of creating and implementing a surgical time-out policy has been considered as one of the most important steps in preventing human errors which can be committed by a group of health care professionals few minutes before performing a surgical procedure (i.e. surgeon, surgical nurses, anaesthesiologist, etc.) (Gillespie et al., 2010; Fry, 2008, p. UP-14). In general, a surgical time-out policy is all about identifying the right patient, the right site where surgical procedure will be performed, observing the right body positioning, signing the consent form which strongly suggest that the patient has agreed to receive the said surgical procedure, and to ensure that special arrangements are made to get hold of a particular equipment needed to perform the surgery (Fry, 2008, p. UP-14). Often times, it is the registered nurse who is in-charge and is accountable for performing the surgical count of surgical items like cotton swabs, sponges, gauze, needles, blades, and scalpels among others (Hamlin, Richardson-Tench and Davies, 2009, p. 88). Miscommunication can happen among a group of healthcare professionals who are working within the operating room (Halverson et al., 2011). In line with this, several studies acknowledges that the process of using a “surgical safety checklist” as suggested by the World Health Organization (WHO) is effective in terms of preventing the risks of mortality caused by human errors (Kasatpibal et al., 2012; van Klei et al., 2012; Conley et al., 2011). However, despite the process of continuously educating the healthcare professionals on how to accurately perform surgical time-out process, there are still some cases wherein the surgical team may fail to comply with the surgical time-out procedures (Gillespie et al., 2010). Research Aims, Specific Main and Sub-Objectives, Research Questions, and Research Hypothesis It is part of the duty and responsibility of healthcare professionals to continuously improve patient safety within the operating room. In line with this, the surgical team is normally composed of surgeons, anaesthesiologists, and registered nurses. For this reason, the proposed research study aims to determine how well the surgical team in Hong Kong are able to adopt with the local hospitals’ surgical time-out policy. Specifically the main research objective is to test the ability of surgeons, anaesthesiologists, and registered nurses in Hong Kong in terms of observing the practice of formal surgical time-out policies within the surgical operating rooms. In line with this, the following sub-research objectives will be considered throughout the proposed research study: (1) To measure the knowledge and skills of Hong Kong-based surgeons, anaesthesiologists, and registered nurses particularly when it comes to observing the surgical time-out policy in operating rooms; (2) To determine whether the Hong Kong-based surgeons, anaesthesiologists, and registered nurses have encountered cases of accidentally performing wrong surgical procedure on patients; and (3) To determine whether the Hong Kong-based surgeons, anaesthesiologists, and registered nurses have encountered cases of performing surgery on wrong patient. In relation the main purpose and research objectives presented above, this study will purposely make use of the following questions as a guide throughout the completion of the proposed research study: (1) How well do Hong Kong-based surgeons, anaesthesiologists, and registered nurses observe the practice of formal surgical time-out policies within the surgical operating rooms? (2) Do Hong Kong-based surgeons, anaesthesiologists, and registered nurses have sufficient knowledge and skills when it comes to performing the surgical time-out procedure? (3) Are there cases in Hong Kong wherein the surgeon had accidentally performed wrong surgical procedure on patients? (4) Are there cases in Hong Kong wherein the surgeon had accidentally performed surgery on wrong patient? Proposed Research Study Design/Approach and Analysis To determine how well the Hong Kong-based surgeons, anaesthesiologists, and registered nurses are able to adopt with the local hospitals’ surgical time-out policy, the proposed research study design will make use of PICO framework in designing a semi-structured research interview questionnaire which will be used in the actual research interviews. Specifically letters “P”, “I”, “C”, and “O” in the PICO framework represents the major problems being faced by a group of patients, the type of intervention used in research to the study, comparator intervention, and the outcomes (Pauniaho et al., 2009). In the proposed research study, “P” represents all patients who have just received surgery. “I” is referring to the use of a checklist when performing the surgical time-out procedure as compared to “C” which means not using a checklist. “O” includes the act of reducing the risks of unconsciously leaving surgical items like cotton swabs, sponges, gauze, and needles inside the surgical site. In relation to the process of conducting interpretative approach in research study, Keegan (2009, p. 16) explained that the use of qualitative research study design is “subjective” by nature. In general, the use of qualitative research method or “descriptive phenomenology” is more effective in terms of generating the previous and current experiences of each research participant (Holloway, 2005, p. 116). Specifically the use of qualitative type of research questions will enable the researcher to generate a more subjective response with regards to their knowledge and skills when performing time-out procedures. Likewise, the use of the proposed research study design will provide the researcher with a more descriptive response concerning their personal experiences or ideas about the past and current incidence of wrong surgical procedures performed on patients or incidence of performing surgery on wrong patient. As a common knowledge, there are limitations in the use of qualitative research method. In line with this, Munhall and Chenail (2008, p. 40) explained that the use of qualitative research method will not provide the researcher with a generalized response coming from the group of research participants. It means that in using pure qualitative research method, the researcher will not be able to obtain figures that could generalise the research findings (Holloway and Wheeler, 2010, p. 43). Even though the use of the proposed research study design is not effective in terms of generalizing research findings, the use of PICO framework during the actual research interviews is more than enough to provide the researcher with a better insight with regards to the ability of the Hong Kong-based surgeons, anaesthesiologists, and registered nurses to adapt the necessary surgical time-out policy in order to improve the patients’ safety within the operating room. Eventually, the gathered qualitative research findings will be critically analyzed together with the gathered literature. Sampling and Recruitment of Participants Qualified research participants for this study include Hong Kong-based surgeons, anaesthesiologists, and registered nurses who are currently working in the operating room departments of local-based hospitals in ____, Hong Kong (Hi, kindly insert a specific geographical area in Hong Kong which you can do the research survey study). Regardless of age, gender, nationality, and race, a total of 30 Hong Kong-based surgeons, anaesthesiologists, and registered nurses will be invited to participate in the actual research interview. To ensure that there will be no bias opinion coming from the surgical team members, a total of 10 surgeons, 10 anaesthesiologists, and 10 registered nurses who are working in Hong Kong-based operating rooms will be considered during the recruitment process. To increase the chances of finding healthcare professionals who are currently assigned to work inside the operating room, the proposed research study will make use of a combined referral and cluster sampling method. It means that the researcher will purposely select few local hospitals in Hong Kong that is situated in a specific geographical area (Houser, 2013, p. 170). In this case, cluster sampling will be conducted within the vicinity of ____ (Hi, kindly insert a specific geographical area in Hong Kong which you can do the research survey study). On the other hand, referral sampling means that the researcher will have to locate at least one (1) healthcare professional in a pre-selected hospital who can refer the researcher to 10 surgeons, 10 anaesthesiologists, and 10 registered nurses who are working in Hong Kong-based operating room departments. Discussion about the Instrument to Answer the Research Questions A research interview questionnaire will be used as an instrument in answering the research questions presented in this research proposal. To ensure that the researcher will be able to generate a successful research study, the type of research interview questions that will be use in the proposed research study should be aligned not only with the aims of the proposed study but also its main objective and sub-research objectives. Presented on Appendix I – Sample of Proposed Research Interview Questionnaire on page 11, the first research interview question aims to provide the researcher with information concerning the qualifications of each research interviewee. Since qualified research interviewee for the proposed research study include all Hong Kong-based surgeons, anaesthesiologists, and registered nurses who are currently working in the operating room departments of local-based hospitals in ____, Hong Kong (Hi, kindly insert a specific geographical area in Hong Kong which you can do the research survey study), asking each of the research interviewee about the number of years they have been working as a surgeon, anaesthesiologist or a registered nurse in an operating room can serve as a verification of their qualification to participate in the proposed research study. Research interview questions number 2 to 4 simply provides the researcher some idea about whether or not the local hospitals in Hong Kong practice some type of a surgical time-out policy, etc. Unlike research interview questions number 1 to 4, research interview questions number 5 to 7 was purposely designed using the PICO framework as discussed on page 4. In line with this, the fifth research interview question asked “In patients who have just received a surgery (“P”), what are the safety effects of using a checklist (“I”) in terms of reducing the risks of unconsciously leaving surgical items like cotton swabs, sponges, gauze, and needles inside the surgical site (“O”) as compared to not using a checklist (“C”)?” The sixth research interview question purposely asked “As compared to not using a checklist (“C”), would you consider the use of checklist (“I”) as the best strategy in terms of reducing the risks of unconsciously leaving surgical items like cotton swabs, sponges, gauze, and needles inside the surgical site (“O”) among the patients who have just received a surgery (“P”)? Why?” Basically, the main reason for asking “why” is to encourage each of the research interviewee to expound the reasons why they consider or not consider the use of checklist as the best strategy in terms of reducing the risks of unconsciously leaving surgical items like cotton swabs, sponges, gauze, and needles inside the surgical site. The seventh research interview question purposely asked “As compared to not using a checklist (“C”), would you strongly recommend the use of a checklist (“I”) when performing the surgical time-out procedure on patients who have just received a surgery (“P”)? Why?”. Eighth and ninth research interview questions were designed using open-ended questions. For instance, the eighth interview question aims to encourage each of the research interviewees to describe subjectively their past and current experiences or knowledge with regards to possible cases in Hong Kong wherein the surgeon had accidentally performed wrong surgical procedure on patients. On the other hand, the ninth research interview question aims to encourage the research survey respondents to describe subjectively their past and current experiences or knowledge with regards to possible cases in Hong Kong wherein the surgeon had accidentally performed surgery on wrong patient. Specifically the eighth and ninth research survey questions are aligned with second and third sub-research objectives. Issues on Reliability, Validity, Consistency, Transferability, and Conformability of the Proposed Research Study The reliability of the research study design is important since it will affect the accuracy of the research findings particularly when it comes to addressing the presented research questions (Connaway and Powell, 2010, p. 63). With regards to the consistency of the proposed research study, the research interview questionnaire used in obtaining primary data was purposely designed and aligned with the main purpose of the proposed research study as well as its main and sub-research objectives. In general, the term “transferability” is pertaining to the process wherein the researcher could somehow apply the research findings to other similar situations (Tappen, 2011, p. 160). Often times, transferability is all about being able to point out the similarity between the proposed research study and other similar studies made in the past (Eriksson and Kovalainen, 2008, p. 294). For example, the proposed research study is similar to the research study that was conducted by Pauniaho et al. (2009) in terms of analyzing how the use of surgical checklist can effectively incease the patients’ safety in Finland. The only difference between these two studies is that the proposed research study made use of PICO framework in creating the actual research interview questionnaire. Likewise, the proposed research study will be conducted in the operating room departments of local hospitals based in Hong Kong. Aside from the geographical differences, Pauniaho et al. (2009) conducted a systematic literature review using online databases. Confirmability is all about being able to maintain the objectivity of the research findings (Tappen, 2011, p. 161). To avoid bias research study conclusion, the findings of the proposed research study will be analyzed together with the gathered literature review. In the process of analyzing the research findings with the findings of other similar studies, the researcher will be able to maintain objectivity throughout the entire research study. Ethical Considerations There are quite a lot of research ethics to be considered when conducting a primary research study. In line with this, one of the most important considerations that researchers should observe is the universal law on informed consent. Whether verbal or in writing, qualified research survey respondents should be properly informed of the main purpose of the research study before giving them the opportunity to decide whether or not to participate in the actual research interview process (Mertens and Ginsberg, 2009, p. 512; Marshall, 2007, p. 23). (See Appendix II – UOW Formatted Information Sheet and Consent Form on page 12) Aside from the need to maintain objectivity throughout the research study, another important ethical consideration is to observe the law of confidentiality. In line with this, the researcher is obliged to respect the research survey participants’ privacy by keeping all of their personal information anonymous throughout the completion of the proposed research study (Loue, 2000, p. 147). For this reason, the researcher will purposely omit mentioning anything that could reveal their personal identity in public (i.e. nick name, surname, contact number, home address, etc.). Instead of addressing each of the research interview participants using their first name, the researcher will make use of code such as research interviewee number 1, research interviewee number 2 or the first research interviewee, the second research interviewee, and so on. Conclusion The proposed research study can help educate and remind each member of the surgical team about the importance of adapting the practice of surgical time-out process before performing the actual surgery on patients. Therefore, completing the proposed research study is essential. Appendix I – Sample of Proposed Research Interview Questionnaire 1. Hi. Could you please tell me how many years have you been working as a ___ (i.e. surgeon, anaesthesiologist, and registered nurse) assigned to work in an operating room department? 2. Does the hospital you work for have some type of a surgical time-out policy? 3. Do you personally practice surgical time-out procedure before performing surgery on patients? 4. Do you agree that all healthcare professionals observe the adaptation of the surgical time-out policy? (Based on PICO Framework) 5. In patients who have just received a surgery (“P”), what are the safety effects of using a checklist (“I”) in terms of reducing the risks of unconsciously leaving surgical items like cotton swabs, sponges, gauze, and needles inside the surgical site (“O”) as compared to not using a checklist (“C”)? 6. As compared to not using a checklist (“C”), would you consider the use of checklist (“I”) as the best strategy in terms of reducing the risks of unconsciously leaving surgical items like cotton swabs, sponges, gauze, and needles inside the surgical site (“O”) among the patients who have just received a surgery (“P”)? Why? 7. As compared to not using a checklist (“C”), would you strongly recommend the use of a checklist (“I”) when performing the surgical time-out procedure on patients who have just received a surgery (“P”)? Why? 8. Are there cases in Hong Kong wherein the surgeon had accidentally performed wrong surgical procedure on patients? Kindly describe your previous experiences? 9. Are there cases in Hong Kong wherein the surgeon had accidentally performed surgery on wrong patient? *** Thank You! *** Appendix II – UOW Formatted Information Sheet and Consent Form References Conley, D., Singer, S., Edmondson, L., Berry, W. and Gawande, A. (2011). Effective Surgical Safety Checklist Implementation. Journal of the American College of Surgeons, 212(5), pp. 873-879. Connaway, L. and Powell, R. (2010). Basic Research Methods for Librarians. 5th Edition. CA: Greenwood Publishing Group. Eriksson, P. and Kovalainen, A. (2008). Qualitative Methods in Business Research. London: Sage Publications Ltd. Fry, H. (2008). Staff Education Tools for the National Patient Safety Goals: Curriculum. Oakbrook Terrace, IL: Joint Commission Resources, Inc. Gillespie, B., Chaboyer, W., Wallis, M. and Fenwick, C. (2010). Why isnt ‘time out’ being implemented? An exploratory study. BMJ Quality & Safety Health Care, 19, pp. 103-106. Halverson, A., Casey, J., Andersson, J., Anderson, K., Park, C., Rademaker, A., et al. (2011). Communication failure in the operating room. Surgery, 149(3), pp. 305-310. Hamlin, L., Richardson-Tench, M. and Davies, M. (2009). Perioperative Nursing: An Introductory Text. Chatswood: Elsevier. Holloway, I. (2005). Qualitative Research In Health Care. Berkshire: Open University Press. Holloway, I. and Wheeler, S. (2010). Qualitative Research in Nursing and Healthcare. 3rd Edition. West Sussex: Wiley-Blackwell. Houser, J. (2013). Nursing Research: Reading, Using and Creating Evidence. 3rd Edition. Burlington, MA: Jones & Bartlett Learning. Howlett, B., Rogo, E. and Shelton, T. (2014). Evidence-based Practice for Health Professionals: An Interprofessional Approach. Burlington, MA: Jones & Bartlett Learning. Kasatpibal, N., Senaratana, W., Chitreecheur, J., Chotirosniramit, N., Pakvipas, P. and Junthasopeepun, P. (2012). Implementation of the World Health Organization Surgical Safety Checklist at a University Hospital in Thailand. Surgical Infections, 13(1), pp. 50-56. Keegan, S. (2009). Qualitative Research: Good Decision Making Through Understanding People, Cultures, and Markets. London: Kogan Page. Little, T. (2013). The Oxford Handbook of Quantitative Methods in Psychology. Vol. 2. NY: Oxford University Press. Loue, S. (2000). Textbook of Research Ethics: Theory and Practice. London: Kluwer Academic/Plenum Publishers. Marshall, P. (2007). Ethical Challenges in Study Design and Informed Consent for Health Research in Resource - Poor Settings. OH: WHO. Mertens, D. and Ginsberg, P. (2009). The Handbook of Social Research Ethics. London: Sage Publications Ltd. Munhall, P. and Chenail, R. (2008). Qualitative Research Proposals and Reports: A Guide. London: Jones and Bartlett Publishers Inc. Pauniaho, S.-L., Lepojarvi, M., Peltomaa, K., Saario, I., Isojarvi, J., Malmivaara, A., et al. (2009). A surgical checklist increases patient safety. Suomen Lääkärilehti, 49(64), pp. 4249-4254. Tappen, R. (2011). Advanced Nursing Research. London: Jones & Bartlett Learning International. van Klei, W., Hoff, R., van Aarnhem, E., Simmermacher, R., Regli, L., Kappen, T., et al. (2012). Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality: A Cohort Study. Annals of Surgery, 255(1), pp. 44-49. Read More