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Barriers and facilitators associated with the implementation of surgical safety checklists: a qualitative systematic review.

Paterson, Catherine; Mckie, A.; Turner, M.; Kaak, V.


Catherine Paterson

A. Mckie

M. Turner

V. Kaak


Despite the documented benefits of the World Health Organisation Patient Safety Checklist compliance rates with implementation continue to cause risk to patient safety. This qualitative systematic review aimed to explore the reported factors that impact compliance and implementation processes related to surgical safety checklists in perioperative settings. A qualitative systematic review. A systematic review using the Joanna Briggs Institute (JBI) approach to synthesize qualitative studies was conducted and reported according to PRISMA guidelines. Electronic databases were expansively searched using keywords and subject headings. Articles were assessed using a pre-selected eligibility criterion. Data extraction and quality appraisal was undertaken for all included studies and a meta-aggregation performed. The CINAHL, Medline and Scopus databases were searched in August 2022 and the search was repeated in June 2023. 34 studies were included. Following the synthesis of the findings there were multiple interrelating barriers to checklist compliance that impacted implementation. There were more barriers than enablers reported in existing studies. Enablers included effective leadership, education and training, timely use of audit and feedback, local champions, and the option for local modifications to the surgical checklist. Further research should focus on targeted interventions that improve observed compliance rates to optimize patient safety. This qualitative systematic review identified multiple key factors that influenced the uptake of the Surgical Safety Checklist in operating theatres. Surgeon participation, hierarchical culture, complacency, and duplication of existing safety processes were identified which impacted the use and completion of the checklist.


PATERSON, C., MCKIE, A., TURNER, M. and KAAK, V. 2023. Barriers and facilitators associated with the implementation of surgical safety checklists: a qualitative systematic review. Journal of nursing [online], Early View. Available from:

Journal Article Type Review
Acceptance Date Aug 23, 2023
Online Publication Date Sep 7, 2023
Deposit Date Sep 19, 2023
Publicly Available Date Sep 8, 2024
Journal Journal of advanced nursing
Print ISSN 0309-2402
Electronic ISSN 1365-2648
Publisher Wiley
Peer Reviewed Peer Reviewed
Keywords Barrier; Compliance; Facilitator; Implementation; Surgical safety checklists; WHO surgical safety checklists
Public URL
Additional Information This article has been published with separate supporting information. This supporting information has been incorporated into a single file on this repository and can be found at the end of the file associated with this output.


This file is under embargo until Sep 8, 2024 due to copyright reasons.

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