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Safety
Surgical Safety? Check!
E. Dellinger
Publish Date: November 4, 2008   |  Tags:   Patient Safety

Would you be willing to board a plane if you knew its crew hadn't followed the aviation industry's standardized safety checklist? Didn't think so. Do you think undergoing a surgical procedure is safer than flying? Not likely. So why should safety precautions in the OR lag behind those taken on the tarmac? They shouldn't.

On the Web

Download a Surgical Safety Checklist courtesy of the University of Washington Medical Center

My hospital served as a pilot facility for the World Health Organization's new surgical safety checklist, and we've found that the systematic guide helped reduce pre-op safety oversights by half. Here's how we incorporated the checklist into our surgical routine and how you can do the same.

Understand it. The WHO's surgical checklist aims to improve case outcomes and reduce complications by reminding clinical staff about their role in and the importance of surgical safety, defining a minimum set of uniform safety measures that are applicable in all countries and surgical settings, incorporating those standards on an easy-to-use checklist and distributing checklists to facilities worldwide after completion of the pilot program.

Sell it. We all know instituting change in the OR is difficult. Your cause will be helped in this instance with the backing of the WHO and the credibility of a program being piloted in eight facilities worldwide.

This is not to say there won't be opposition. When first approached to implement the checklist, several nurses and surgeons at my facility said it was overkill and claimed it would take too long to complete before each case. Both are valid concerns, but you can address them by asking those opposed if taking the necessary steps to protect staff and patients is overkill. It'd be tough to say that it is. Also use the flight analogy in this article's opening paragraph. Trust me, it works.

With respect to wasting time, tell your surgeons and nurses that our clinical teams average a shade less than two minutes to complete the checklist, which includes the Joint Commission's mandated surgical timeout. That's not a long time to dedicate to OR safety.

Enlarge it. Make the checklist hard to ignore. We enlarged the single sheet into 3-foot by 4-foot laminated posters — 24 of them to be exact — for placement in each of our hospital's ORs. Hang them on OR walls using Velcro patches and fashion a hook at the top of the posters. That way your clinical team can pull the poster off the wall before surgery, hang it on an IV pole and wheel the pole next to the OR table for easy viewing and reference by the surgical team. Tear out or photocopy "Surgical Safety Checklist" on page 20.

Use it. The surgeon starts the checklist review after the patient is draped and anesthetized. All team members are asked to stop other activities and participate.

The surgeon confirms the patient's ID and surgical site, discusses unique challenges of the procedure, notifies the team of potential complications and the expected duration of the case, and identifies special instrumentation requirements. The anesthesia provider then raises potential airway management concerns, medication administration plans and steps that will be taken to ensure a safe emersion. Finally, nurses and techs review sterility concerns, locations of specialized equipment and instruments, sharps-passing protocols and other safety-related topics they deem important.

At the case's conclusion, the same groups reconvene to confirm that all instruments and sponges were removed from the patient (and counts are correct), discuss the procedure and the team's performance, address any equipment or instrument malfunctions, and agree on the management of the patient's post-op recovery, including concerns to pass along to the PACU staff.

Adapt it. The WHO's checklist is a valuable tool used to generate communication between anesthesia providers, surgeons and the nursing team. Following its core guidelines will improve your overall safety practices, but don't hesitate to expand the list with concerns specific to your facility. We added checkboxes for active patient warming, venous thrombembolism prophylaxis, re-dosing protocols for prophylactic antibiotic administration if the procedure lasts longer than the half-life of the prophylactic antibiotic and glucose checks for diabetic patients.

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