Surgical safety

In June 2008 the World Health Organization's Surgical Safety Checklist was released globally as part of the Safe Surgery Saves Lives initiative.¹ The original pilot study demonstrated that with the use of a checklist, surgical complications were reduced by more than a third.¹

Over the last year, the local trust has been implementing a trial using an alternative suture company. It was soon noted that the change in suture was not being altered on the operation note and, at times, that it was not known to the operating surgeon. Examples included the transfer of Vicryl® (an absorbable suture produced by Ethicon Inc) to Polysorb™ (an alternative suture with similar properties manufactured by Covidien). Over a period of 4 weeks we looked at 48 day case and inpatient operations in a single centre. An observation of the requested and used suture was compared with the suture documented on the operation note.

Of the 28 cases of deep tissue closure, 19 were documented incorrectly, 6 were documented accurately and 3 not at all. Of the 45 cases of skin closure, 32 were documented inaccurately, 12 documented accurately and 1 not at all. The overall accuracy of documenting the suture was 28%.

The results were fed back to the surgical consultants at our trust audit meeting. They were then offered six sutures (Monosyn®, Monocryl®, Polysorb™, Vicryl®, Prolene® and Surgipro® II) and asked if they could tell the difference between the matching pairs. Around 50% were able to tell the difference accurately.

This observational study highlighted a couple of important points. First, Good Surgical Practice states that we should give details of our closure techniques, which should include the name of the suture.² Second, were we to have any problems with our sutures, would there be any litigation if the operation notes are not documented accurately? Shouldn't each suture pack come with a sticker for the notes?