WHO Surgical Safety Checklist

WHO Surgical Safety Checklist. It is essential that a single person leads the Checklist process. This designated Checklist coordinator, who is responsible for checking the boxes on the list, will often be a circulating nurse but can be any clinician participating in the operation. The Checklist divides the operation into three phases, each corresponding to a specific time period in the normal flow of a procedure: the period prior to induction of anaesthesia (Sign In), the period after induction and before surgical incision (Time Out), and the period during or immediately after wound closure (Sign Out). In each phase the Checklist coordinator must be permitted to confirm that the team has completed its tasks before it proceeds onward..

Before the induction of anesthesia. The Checklist coordinator will verbally confirm with the patient (when possible) his or her identity, the surgical site and the procedure, and that consent to operate has been obtained. The coordinator will visually confirm that the operative site has been marked (if appropriate) verbally review with the anaesthesia professional the patient’s risk of blood loss, airway difficulty and allergies, and also whether a safety check of the anaesthesia machine and medications has been completed. Ideally the surgeon will be present for 'Sign In', as the surgeon may have a clearer idea of the anticipated blood loss, allergies or other potential complicating factors. However the surgeon’s presence is not essential to complete this part of the Checklist..

omo zz 080. The team will pause immediately before the skin incision to confirm out aloud that the correct operation on the correct patient and site is being performed; All team members will then verbally review with one another, in turn, the critical elements of their plans for the operation, using the Checklist questions for guidance. They will also confirm that prophylactic antibiotics have been administered within the previous 60 minutes and that essential imaging is displayed as appropriate..

The team will review together the operation that was performed, completion of sponge and instrument counts and the labelling of any surgical specimens obtained. They will also review any equipment malfunctions or issues that need to be addressed. Finally the team will review key plans and concerns for postoperative management and recovery before moving the patient from the operating room..

Perioperative Bleeding Management. Goals: To accomplish preoperative identification by anamnesis (medical history) and laboratory testing of those patients for whom the perioperative bleeding risk may be increased To correct preoperative anaemia and stabilize the macro- and microcirculations to optimize the patient’s tolerance to bleeding To reduce the amount of bleeding, morbidity, mortality and costs.

Perioperative Bleeding Management: Guidelines. European Society of Anaesthesiology (2013) NICE (2020) National Blood Authority of Australia (2012) Australian Anaesthesia Perioperative Care Network and Surgical Services Taskforce (2016) American Society of Anesthesiologists Task Force on Perioperative Blood Management.

Good practice recommendations for clinical assessment procedures.

Clinical auditing structures and functions. Clinical audit/assessment as “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change”*.

Clinical auditing: Benefits. To evaluate and improve patient care To check compliance with international standards and applied protocols (national, local and internal) and documenting patient management To identify the areas of possible risk To create a culture of quality improvement in the clinical environment To enhance the satisfaction of health-care workers To provide the continuous training of health-care workers, in accordance with the applied standards of clinical practice To monitor the compliance of the health-care provider with standardized procedures and protocols, and can thus improve the quality and efficiency of health care.

Clinical auditing: System requirements. Aim: to identify the percentage of application and the deviations that can be managed effectively through continuous training and staff engagement. To ensure that the quality of the care provided meets the defined standards, and that all health-care worker teams apply the relevant pathways and guidelines  a comprehensive clinical auditing system is required Clinical auditing/assessment should be performed by properly trained professionals Specific resources are needed, including documented policies, procedures, protocols and instructions, based on which the health-care services are provided; registries and evidence on service outcomes; and documentation of patients’ administrative and clinical management (review of patient records, therapeutic and diagnostic records) among others.

Clinical auditing: Clinical auditing/assessment team.

Clinical auditing: Data Sources. Administrative databases (inpatient registries) Patient files (medical, nursing records) and data Prospective data collection, which involves collecting data specifically for qoc measurements purposes (such as patient incident reports) Data related to the audited processes: patient outcomes, clinical indicators, compliance rates, adverse events, near misses and other relevant data points. Interviews and consultations with health-care workers, other staff members and other relevant individuals involved in the audited processes  additional insights, clarify information and understand the perspectives of different stakeholders. On-site visits to observe the audited processes in action: physically visiting clinical areas, interacting with health-care providers and staff, and assessing compliance with established protocols and guidelines, collaborating with other committees and teams to share information, seek input, and work together to address issues identified during the assessment process.

Procedures for clinical assessment for the Health Quality Fund indicators.

Procedures for clinical assessment for the Health Quality Fund indicators.

Procedures for clinical assessment for the Health Quality Fund indicators.

Procedures for clinical assessment for the Health Quality Fund indicators.

Sampling methodology. For a clinical assessment to be effective, selection of a smaller sample of cases should ensure that the sample is representative of the entire patient or service population. The methodology for conducting any type of sampling analysis should be described in detail in the format of a standardized controlled document, with reference to relevant sources and with a specific reference to the applied rules. A minimum of 5% of the cases per variable denominator of each KPI under verification control should be registered under the clinical assessment process, depending on the volume of the treated cases in the hospital. This is a decision to be made by the hospital management and the clinical assessment team. The sample should be representative of all types of service within the scope of the indicator. The number per type/category of service should also be relative to the percentage of the volume of the service type..

Sampling methodology: Example. Generic process indicator (e.g. percentage of in-hospital patients assessed for fall risk) Among 1000 of the hospital’s inpatients 35% are internal medicine cases and 65% are surgical cases, the respective percentages should apply in the sampling procedure. Thus, of a total of 50 patient case records that should be processed by the clinical assessment team (5% of 1000), 17 files should be internal medicine cases and 33 should be surgical cases. This system should also be applied to related subspecialties: if general surgery cases make up 40% of the above 65% surgical cases, the number of general surgery cases to be assessed is 13 patient files..

Improvement measures to prevent patient safety incidents.

Take away messages. 20. Build a Quality Management System with standardized structures and procedures for KPI’s monitoring Apply data collection principles and tools, and verification methods to ensure transparency - accuracy of results.

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Thank you,. ANGELIKI KATSAPI, Consultant For more information, please contact: WHO EUROPE QUALITY OF CARE AND PATIENT SAFETY OFFICE.