THE IMPLEMENTATION OF FIVE STEPS TO SAVE SURGERY PRACTICE IN IMPROVING THE CHECKLIST WRITING OBEDIENCE IN RSKB ANNUR YOGYAKARTA

Lucky Frannata 1 and Elsye Maria Rosa. 1. Master of hospital managemet post graduate studies, Universitas Muhammadiyah Yogyakarta. 2. Master of nursing science Universitas Muhammadiyah Yogyakarta. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

The aims of this research is to provide an overview about the checklist safer surgery writing obedience in RSKB ANNUR Yogyakarta. Quasi experiment is used in this research. The used-design experiment is onegroup pretest-posttest design where there should be pretest after treatment and posttest after treatment. There is a little deviation among mean, standard deviation, and standard eror. It can be concluded that the surgery team has been obedient in implementing pre and post safety surgery. The r correlation is 0.061 showing the contribution of checklist safety surgery socialization. The obedience level is 0.37% while the resr is caused by anotgher factor. The significant value is 0,709 (Sig. >0,05) showing that there is no correlation between socialization of pre and post checklist safety surgery and the surgery team obedience. The implementation of briefing with pre-Safety Surgery Checklist cannot be correlated since the standard error is 0.000. The sign-in implementation with in-Safety Surgery Checklist is more effective with Sig value (p) is 0,031 (p<0,050) where it means that Ho is denied. There is significant difference in pre and post safety surgery writing. The implementation of time out with Safety Surgery Checklist in surgery is ineffective with the Sig (p) value is 0,323 (p>0,050) where it means that Ho is accepted so there is not significant difference between checklist time out obedience and pre-post safety surgery implementation. The debriefing implementation with in-Safety Surgery Checklist is ineffective since the Sig (p) value is 0, 160 (p>0,050) where it means that Ho is accepted, so there is not significant difference between the obedience of checklist sign out writing before pre and post safety surgery implementation. The Five Steps To Safer Surgery implementation in RS ANNUR Yogyakarta is ineffective since the Sig (p) value is 0, 164 (p>0,050) where it means that Ho is accepted, so there is not significant differnce between surgery team's obedience and pre and post safety surgery implementation.

Int. J. Adv. Res. 5(4), 2001-2007
2002 operator, other medical staffs, operation theater, and operation tools. One of surgery room management is the use of a WHO surgical safety checklist that functions to equalize perception, communication, and cooperation among surgery team. WHO Surgical safety checklist is a way used by surgery team to improve surgery safety, decrease death rate and decrease surgery's disability. RSKB ANNUR Yogyakarta has performed higher enough surgery every month in 2012, more or less 60 surgery per month. RSKB ANNUR Yogyakarta has applied simple checklist safety surgery, consisting of sign in, time out dan sign out. It will revise checklist safety surgery by adopting NHS National Patient Safety Agency (2010) to improve its service quality in operation theater. There are 5 (five) steps to save in safety surgery namely briefing, sign in, time out, sign out, dan debriefing.

Methods:-
Quasi experiment is used in this research. The used-design experiment is one-group pretest-posttest design where there should be pretest after treatment and posttest after treatment. The subjects of this reserach are the hospital director, the surgeon, the anasthesist, and the surgery nurse. There are two objects in this research. First, qualitative objectsafe surgery, appropriate procedure, appropriate patient. Second, medical record history. The population in this research azre surgery team that consist of 4 surgeons, 2 anathesist, and 8 nurses. The samples are 14 people that consist of surgeons, anasthesists, and surgery nurse. It uses total sampling The independent variable is the implementation of five steps to safer surgeryThe dependent variable is the obedience of checklist writing. The data analysis in this research is using T-test to recognize the difference between pre and post socialization of safety surgery checklist.

Result and Discussion:-
In this study, the officer / operations team given surgery safety checklist that was made before explained how to fill in and benefit from the checklist to be tested to 40 patients were operated on within two weeks. Then the researchers socializing the benefits and how to fill out the checklist to the officer / operations team on Monday, April 1, 2013 with an invitation number 072A / RS-IN AN / IV / 2013. Next, the researchers asked the officer / operations teams perform surgery safety checklist The start of the briefing, sign in, time out, sign debriefing for use at 40 patients who underwent surgery. Obtained following studies: Univariate analysis:-   ,5%) 23 (57,5%) 4 (10%) 36 (90%) The show at the time pre and post implementation of safety surgery, the officer carrying out sign in and fill out a checklist on the 14-phase sign in for item replenishment confirm the name of the patient, confirm the patient's diagnosis, confirmed the operation plan, informed consent, anesthesia, medical history (allergies, asthma, diabetes , hypertension), the evaluation of the risk of airway and breathing each will perform surgery on 40 patients (100%). However, for the items in the marked site checklis charging operation pre and post implementation of the safety officer did not perform charging surgery checklist for 40 patients (100%), the clerk also only fill in the checklist item oximetry is installed and working as many as 37 (92.5%) before the application safety surgery and up to 40 (100%) after the implementation of safety surgery.
For marking the location of the operation in RSKB ANNUR Yogyakarta never done because the majority of its operating properties closed and in the case of urology location is certain and not arbitrary. Thus, no need for marking the location of the operation on every operation for the case of urology. Officers are still unsure on what action to do the marking and tagging need not be performed.
Officers had attended a workshop on hospital accreditation conducted by Hospital Accreditation Committee who explained that for any action on the surgery should do the marking on the location of the area of operation. However, until now there is still no agreement on marking the location of the area of operation in every operation in RSKB ANNUR Yogyakarta.
Charging checklist for dental amalgams item is only performed for 39 patients (97.5%) before the application of safety surgery and 40 patients (100%) after the application of safety surgery. To fill in the item checklist preparation operations and prevention of blood loss, before the application of safety required surgery, 17 patients (42.5%) and after the implementation of safety surgery 4 (10%).
Not being filled checklist on items oximetry is installed and working as many as three patients (7.5%) and the installation of dentures in 1 patient (2.5%) before being applied safety officer surgery because there is a chance missed when charging the checklist. According to information from the person in charge of the operating room, all patients undergoing surgery always performed installation oximetry. Most operations performed in RSKB ANNUR has closed nature although there are some cases of open surgery such as sectio alta, Neprectomy, laparotomy never was done in the hospital. Thus, not all the actions undertaken to prevent the risk of blood loss due to the risk of a small loss in surgery closed.  Rules of prophylactic antibiotics for surgery patients given ≤ 60 minutes before surgery. However, this can not be done in any patient who underwent surgery due to the condition of patients who come in the day before surgery with the case of Urinary Tract Infection (UTI), then antibiotics are given at the time of presentation. Thus, at the time of surgery, the patient did not receive prophylactic antibiotics ≤ 60 minutes before surgery. The Correlation (r) rate is 0.061. It means that there is 0.37% contribution of of checklist safety surgery socialization. The rest is caused by another factor. The significant value is 0.709 (Sig.>0,05). It means that thgere is no correlation between checklist safety surgey socialization and the staff's obedience pre and post safety surgery implementation. The deviation value pre and post safety surgery implementation is (0,175). The standard deviation in obedience of pre and post safety surgery implementation is (0,417) in interval ((-0,75) -0,425). It shows that there is a difference autonomy in trust for 95%. T-test shows that df is 39 with significant value(5% atau 0,05) and t An effective briefing is conducted in RSKB ANNUR to facilitate teamwork to perform surgery and to make the time more efficicent in creating the safety surgery. Lingard et al. (2005) in his research shows that thjere is a checklist used as a guideline in pre-surgery discussion around 1 to 6 minutes before surgery to make a better and efficient 2006 surgery. Paull, et al (2010) shows that pre-surgery briefing is related to the patient's safety. The obedience of prophylactic becomes higher after surgery checklist socialization.

Paired Samples Test
The implementation of sign in in surgery is effectively done in RSKB ANNUR . It is found that there is no fullmarked area in surgery because the surgery team is still doubt and not yet agree whether full-marked is need or not. From the workshop with KARS, it is suggested to mark area of surgery, but it is still a policy. Mis-site marking, mis-procedure, mis-operated patient are commonly caused by ineffective communication among surgery team, do not involve patient in site-marking, and no procedure to verify site-marking. Site-marking should be used consistantly in all hospitals it should be made by the one who performs surgery. It is also made when the patient is still awake and should be seen by patient until the patient is ready to be operated. ( Sign out implementation with Safety Surgery Checklist in surgery is effective conducted in RSKB ANNUR. The sign out is well-implemented in pre and post safety surgery chehecklist socialization where the staff considers how importance the sign out in implementing surgery. Gawande (2003) conducts a research that shows the impact of spons left in patient. As a result, re-operation is required here, one died. It can be concluded that strange things in pateint's body is really emergency condition that need seroius action. Debriefing implementation with Safety Surgery Checklist is ineffective in RSKB ANNUR

Conclusion:-
The Five Steps To Safer Surgery implementation in RS ANNUR Yogyakarta is ineffective since the Sig (p) value is 0, 164 (p>0,050) where it means that Ho is accepted, so there is not significant differnce between surgery team's obedience and pre and post safety surgery implementation. The suggestion is required a commitment between director and safety surgery checklist staff. It is required policy and hospital standard operational procedure in implementing surgery safety checklist WHO in surgery procedure in the hospital. It is required periodically routine evaluation to improve standard service using surgical safety checklist WHO in surgery. It is required in house training or re-socialization about the implementation of surgical safety checklist WHO to surgery team (surgeons, anasthesists, and anasthesist staffs). It is required to point a nurse as an operator in impkementing surgical safety checklist WHO.