Who Surgical Checklist: Principles and Procedures
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WHO Surgical Checklist Mohamad Al-Gailani Consultant Surgeon Al Hammadi Hospital, Al Suwaidi 14 th December 2015
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Transcript of Who Surgical Checklist: Principles and Procedures
WHO Surgical Checklist
Mohamad Al-GailaniConsultant Surgeon
Al Hammadi Hospital, Al Suwaidi14th December 2015
WHO Surgical Checklist
2 Introduction
Checklists have been used in aviation to standardize and increase the reliability of systems.”
Dramatically reduced aviation accidents and near misses. WHO adopted same principles to surgery. Established world wide Essential tool to minimise occurrence of wrong patient, wrong operation
or wrong side!
WHO Surgical Checklist
3 Surgical risk, the scale
The reported crude mortality rate after major surgery is 0.5-5%; Complications after inpatient operations occur in up to 25% of patients; In industrialized countries, nearly half of all adverse events in
hospitalized patients are related to surgical care; At least half of the cases in which surgery led to harm are considered
preventable; Mortality from general anaesthesia alone is reported to be as high as
one in 150 in some parts of sub-Saharan Africa.
WHO Surgical Checklist
4 Objectives
All important safety elements are reviewed by ALL OR teams, for ALL patients, at ALL times
Promote teamwork and communication Preparedness for the unexpected Promotes an environment that allows anyone on the
team to speak up if patient safety is at risk. Correct patient, operation and operative site Safe Anesthesia and Resuscitation Minimize the risk of infection
WHO Surgical Checklist
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WHO Surgical Checklist
6 Principles
Deployable in an incremental fashionSupported by scientific evidence and expert
consensusEvaluated in diverse settings around the worldEnsures adherence to established safety
practicesMinimal resources required to implement a
far-reaching safety intervention
WHO Surgical Checklist
7 The 10 Principles
1. Operate on the correct patient at the correct site.
2. Use methods known to avoid harm from the administration of anesthesia, while protecting the patient from pain.
3. Recognize and effectively prepare for life threatening loss of the patient’s airway or respiratory function.
4. Recognize and effectively prepare for the possibility of high blood loss
5. Avoid inducing any allergic or adverse drug reaction known to be a significant risk for the patient.
WHO Surgical Checklist
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6. Consistently use methods known to minimize the possibility of surgical site infection.
7. Work to avoid the inadvertent retention of instruments or sponges in surgical wounds.
8. Secure and accurately identify all surgical specimens.
9. Effectively communicate and exchange critical patient information for the safe conduct of the operation.
10. Hospitals and public health systems will establish routine surveillance of surgical capacity, volume, and results.
WHO Surgical Checklist
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WHO Surgical Checklist
10 1. Briefing (before anaesthetic induction) Verbal confirmation with the patient:
Identity using two patient identifiers; Consent for surgery; Type of procedure planned; and; Site (side and/or level of surgery).
Site marked/not applicable Confirm surgeon performing the surgery has marked the surgical site
according to Policy
WHO Surgical Checklist
11 Briefing
Allergies/Precautions Does the patient have any known allergies? If so what are
they? Latex allergy precautions required. Is the patient on any specific infection control precautions? If
so what? MRSA?
VTE prophylaxis Is the patient receiving/to receive chemical VTE prophylaxis? Is the patient receiving/to receive mechanical VTE prophylaxis? Confirm TEDs/LMWH have or will be applied as per surgeon
request &/or hospital policy.
WHO Surgical Checklist
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WHO Surgical Checklist
13 2. Time Out(before knife to skin)
Performed after induction, prepping/draping immediately prior to surgical incision.
Team members are identified Team members are identified by name and role.
Team verbally confirms: Correct Patient; Correct Procedure; and Correct Site.
WHO Surgical Checklist
14 Time Out
Antibiotic prophylaxis given within the appropriate time frame. Confirm antibiotic prophylaxis has been given within 60minutes If
not given, give before incision; If administered, when is next dose due if any?
Essential imaging displayed? Confirm essential imaging has been displayed and is displayed
correctly. Team communicates anticipated complications. Anticipated blood loss? Any unusual steps?
WHO Surgical Checklist
15 3. Debriefing(before patient leaves theatre) Performed during or immediately after wound closure before the patient is
transferred from the operating room.
Should be initiated when informing the surgeon that “Count is Correct”
Nurse verbally confirms with the entire team Confirmation of procedure performed as stated by surgeon; Verbal confirmation of specimen details; Verbal confirmation of surgical count; and Identification of equipment problems. Procedure documented
Surgeon reviews with the entire team Any concerns for recovery?
WHO Surgical Checklist
16 Debriefing
Anesthesiologist review with the entire team Recovery plans including concerns/issues related to
postoperative care
WHO Surgical Checklist
17 Success in Implementation
Ongoing vigilance
A champion (or better, champions) at all levels!
Commitment from senior management and the board
WHO Surgical Checklist
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WHO Surgical Checklist
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QUESTIONS?
