half and sometimes almost 100% of the surgical complications can be prevented by following simple rules. The release of ‘ WHO Surgical Safety Checklist’ has for the first time provided universally applicable surgical safety standards and aims to improve surgical safety, especially in underserved areas.
To provide high standrard of surgical care audit of 1000 patients from 8 pilot sites were undertaken. It was concluded that by using the checklist the chances of surgical complications can be halved. Margaret Chan, MD, director-general of WHO, said in a news release -. ‘Preventable surgical injuries and deaths are now a growing concern and using the Checklist is the best way to reduce surgical errors and improve patient safety."
The checklist covers 3 phases of a surgical procedure:
Before anesthesia is induced or "Sign In"
Before skin incision or "Time Out"
Before the patient leaves the operating room or “Sign Out".Before anesthesia - use mnemonic "Sign In"
Check to see if the patient has -
(1) Any known allergy e.g. antibiotics - If so, document it
(2) If anticipating an anatomically difficult airway to intubate or aspiration risk get additional equipment and assistance should be available.
(3) If there is a risk of losing more than more than 500-mL of blood in adults or 7 mL/kg in children – ensure that there is adequate intravenous access and fluids or reserve blood .
Before induction of anesthesia, key components of the checklist or "Sign In," are as follows:
1. Patient’s identity
- Check that the patient has confirmed their identity, the surgical site, and the procedure to be done and that the patient has given informed consent.
2. Surgical site
should be marked, if applicable.
3. Do Anesthesia Safety Checks
should be completed.
4. Place a Pulse oximeter
on the patient and ensure it is functioning.Before Incision or the checklist use the mnemonic "Time Out"
Introduction, familiarity with roles during surgery and anticipating critical events are the key components:
1. Ensure all team members have introduced themselves both by name and by their role on the surgical team.
2. The surgeon, anesthesia professional, and nurse should verbally confirm the patient's identity, surgical site, and procedure to be performed.
3. Anticipated critical events to be reviewed by the surgeon are any critical or unexpected steps, estimated operative duration, and anticipated blood loss.
4. Anticipated critical events to be reviewed by the anesthesia team are whether there are any patient-specific concerns.
5. Anticipated critical events to be reviewed by the nursing team are confirmation of sterility of the tools, supplies, and field (including indicator results);
a. documentation and discussion of any equipment issues or concerns;
b. whether antibiotic prophylaxis has been given within the last 60 minutes - if applicable
c. and whether essential imaging is displayed - if applicable. Before Patient Leaves Operating Room uses the mnemonic "Sign Out"
Check for the following components --
1. The nurse verbally confirms with the team the name of the procedure to be recorded
2. The nurse verifies instrument, sponge, and needle counts - if applicable
3. Labeling for the surgical specimen, including patient name
4. Whether there are any equipment problems to be addressed
5. The surgeon, anesthesia professional and nurse should review the key concerns regarding recovery and management of the specific patient.
"Surgical care has been an essential component of health systems worldwide for more than a century," says checklist co-author Atul Gawande, MD, MPH, a surgeon and professor at Harvard Medical School in Boston, Massachusetts. "Although there have been major improvements over the last few decades, the quality and safety of surgical care has been dismayingly variable in every part of the world. The Safe Surgery Saves Lives initiative aims to change this by raising the standards that patients anywhere can expect." Published in Lancet online - June 25, 2008.