This document discusses the importance of using a surgical safety checklist. It notes that surgical errors can have serious consequences and that checklists are an effective way to reduce errors. The document outlines the components of the surgical safety checklist, which includes briefings before and after surgery and timeout periods. It also discusses implementation strategies, such as forming an implementation team, providing staff training, and having leadership support. Research showed that using the checklist reduced death rates after surgery from 1.5% to 0.8% and complications from 11.0% to 7.0%. With regular use, the checklist can become faster and more effective at improving safety.

1. Surgical Safety Checklist
Lt Col Md Rabiul Alam
MBBS, MCPS, FCPS
Classified Anaesthesiologist
Combined Military Hospital, Dhaka, Bangladesh

2. Checklist
• a list of items required
• things to be done
• points to be considered
• used as a reminder

3. • Canadian Adverse Events Study 2004: <50%
involved surgery
• The Healthcare Insurance Reciprocal of Canada
reports: 20 years
Claim types: 313
Retained foreign body - 210
Wrong body part - 94
Wrong patient - 9

4. 1. Correct patient, Correct site
2. Safe anesthesia, Proper analgesia
3. Difficult airway, Respiratory problem
4. Preparation for possibility of high blood loss
5. Avoid any allergic or adverse drug reaction

5. 6. Reduce surgical site infection
7. Prevent retention of instrument/gauze/mops
8. Accurate labelling of specimens
9. Communicate/exchange critical patient info
10. Surveillance of capacity, volume, and results

6. 1. Briefing : Planning, anticipation – all team members
2. Sign in : Before induction of anaesthesia
3. Time out : Before skin incision
4. Sign out : Before patient leaves operating room
5. Debriefing: Retrieving, criticism – all team members

7. • Any team member can lead the briefing
• Plan to implement the checklist in every case
• Everyone will introduce him/herself
• Clarification of own roles & responsibilities
• Having an overview of the checklist
• Highlighting any change, eqpt considerations
• Special requirements or safety concern

12. • At the end of op, before any member leaves OR
• Reflect on the checklist, Tasks: went well/didn’t
• Discussion of teamwork, theatre atmosphere
• Errors or near-misses
• Retrospective look at the briefing & use of SSC
throughout the day
• Registering successes, learning points, areas
that require change or escalation
• Things those can’t be discussed openly

14. Leadership Staff training

15. • Leaders will take patient safety as a priority
• Senior members should act as local champions
to support the junior staffs
• The champions should be:
• Approachable
• Accessible
• Skilled in negotiation and persuasion

16. • Leaders has to show their enthusiasm with the
staffs to implement the SSC…lead from the front
• By using evidence from experience of near
misses or adverse incidents, leaders can
encourage transparency and honesty
• Leaders will inspire the teams to see the values
of these routine works
• Administrative supports are to be sought out

17. • “Captain of the Ship” mentality
• Surgery team hierarchy
• Culture of blaming and punishment
• Compelling incentives for speed
• Little attention to near misses
• Failure to adopt “best practices”
• Litigation and confidentiality

18. • A local implementation team is to be formed
• This team will meet regularly to plan
introduction of the checklist
• Will lead staff training with in situ demos,
videos & coaching when they start to use the
checklist
• Training should be multi-professional,
incorporating to the whole team
• Raising awareness by posters, newsletters etc

19. • Very simple
• Widely applicable
• Measurable
• Addresses serious and avoidable surgical
complications
• Least costly
• No added manpower needed
• Zero harm from the checklist

20. • Between October 2007 and September 2008 – 1 year
• Eight hospitals in 8 cities (Toronto, Canada; New Delhi,
India; Amman, Jordan; Auckland, New Zealand; Manila,
Philippines; Ifakara, Tanzania; London, England; and
Seattle, WA)
• Outcomes of 3955 patients who were undergoing
noncardiac surgery
• After the introduction of the Surgical Safety Checklist

21. • The rate of death was 1.5% before the checklist
was introduced and declined to 0.8% afterward
(P=0.003).
• Inpatient complications occurred in 11.0% of
patients at baseline and in 7.0% after
introduction of the checklist (P<0.001).
Ref: N Engl J Med 2009;360:491-9.

24. With constant use, team members will become:
• Familiar to the checks
• Less embarrassed about using
• More time efficient
• Break down the barriers to success