Who Surgical Checklist: Principles and Procedures

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.

1. WHO Surgical Checklist Mohamad Al- Gailani Consultant Surgeon Al Hammadi Hospital, Al Suwaidi 14 th December 2015

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! 2 WHO Surgical Checklist

3. Surgical risk, the scale T he reported crude mortality rate after major surgery is 0.5-5%; C omplications after inpatient operations occur in up to 25% of patients; I n industrialized countries, nearly half of all adverse events in hospitalized patients are related to surgical care; A t least half of the cases in which surgery led to harm are considered preventable; M ortality from general anaesthesia alone is reported to be as high as one in 150 in some parts of sub-Saharan Africa. 3 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 4 WHO Surgical Checklist

5. 5 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 6 WHO Surgical Checklist

7. The 10 Principles O perate on the correct patient at the correct site. U se methods known to avoid harm from the administration of anesthesia, while protecting the patient from pain. R ecognize and effectively prepare for life threatening loss of the patient’s airway or respiratory function. R ecognize and effectively prepare for the possibility of high blood loss A void inducing any allergic or adverse drug reaction known to be a significant risk for the patient. 7 WHO Surgical Checklist

8. C onsistently use methods known to minimize the possibility of surgical site infection . W ork to avoid the inadvertent retention of instruments or sponges in surgical wounds. S ecure and accurately identify all surgical specimens . E ffectively communicate and exchange critical patient information for the safe conduct of the operation. Hospitals and public health systems will establish routine surveillance of surgical capacity, volume, and results. 8 WHO Surgical Checklist

9. 9 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 10 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. 11 WHO Surgical Checklist

12. 12 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. 13 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? 14 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? 15 WHO Surgical Checklist

16. Debriefing Anesthesiologist review with the entire team Recovery plans including concerns/issues related to postoperative care 16 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 17

18. WHO Surgical Checklist 18

19. QUESTIONS? WHO Surgical Checklist 19