Precision in practice: Developing and validating a protocol and a checklist for standardization of ‘surgical counts’

Abstract

Background: The prevention of unintentional retention of surgical items (RSIs) inside a patient’s body is one of the primary responsibilities of operating room nurses. Surgical counting is a simple and efficient method that helps prevent this human error.

Aim: To develop and validate a standard operating protocol (SOP) and a checklist for surgical counts conducted during abdominal surgeries.

Methods and materials: A methodological study, divided into six phases (2021-2023), was conducted in the paediatric surgery operating theatre of a tertiary care centre in northern India. Initial observations (N = 30), focus group discussions (N = 20) and nurses' knowledge assessment (N = 24) were carried out to explore baseline knowledge and practices related to surgical counts. The first draft of the SOP and checklist was prepared. A three-round Delphi process involving nine experts was employed to ensure content validity. The reliability of the protocol was evaluated across 75 surgical procedures using Cronbach’s alpha coefficient and nurses' acceptance of the protocol was gauged through a structured questionnaire.

Results: Content validity was high, with a scale-level content validity index based on the average method (S-CVI/Ave) of 0.98 and a scale-level content validity index based on the universal-agreement method (S-CVI/UA) of 0.80. The mean item-level content validity index (I-CVI) was 0.90. The checklist comprised 37 items covering the key phases of surgery. Internal consistency was strong (Cronbach’s α = 0.82). Following implementation, surgical counting practices improved considerably, and nurses reported greater clarity and confidence.

Conclusion: The SOP and checklist were found to be valid, reliable and well accepted in this single-centre study; further multicentre validation is recommended.