The World Health Organisation is a global tool to ensure safety in surgery. The principles and procedures are described for how to implement it in your organisation.
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!
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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.
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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
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WHO Surgical Checklist
6. Principles
Deployable in an incremental fashion
Supported by scientific evidence and expert
consensus
Evaluated in diverse settings around the world
Ensures adherence to established safety practices
Minimal resources required to implement a far-
reaching safety intervention
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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.
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WHO Surgical Checklist
8. 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.
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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
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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.
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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.
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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?
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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?
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WHO Surgical Checklist
16. Debriefing
Anesthesiologist review with the entire team
Recovery plans including concerns/issues related to postoperative care
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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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