The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [610]
The World Health Organization safety checklist is also completed at this point in the operating room which complies with the Safety First Campaign (NPSA 2009). The purpose of this safety checklist is to ensure that the correct procedure is performed on the correct patient, encourage team work and improve communication amongst the surgical teams from all disciplines. The safety checklist comprises three parts: sign in, time out and sign out (Tables 14.3, 14.4, 14.5). Sign in is completed in the anaesthetic room before the patient is induced. It has to be read out loud with the anaesthetist and the anaesthetic assistant present.
Table 14.3 Pre-theatre safety checklist (part 1)
Action Rationale
Has the patient confirmed his/her identity, site, procedure and consent?
□ Yes
This is the final point of confirming the details are correct
Is the surgical site marked?
□ Yes
To ensure surgery is performed at the correct site
Is the anaesthesia machine and medication check complete?
□ Yes
To ensure that the equipment and all necessary drugs are at hand and in working order to prevent complications arising during induction
Does the patient have a:
Known allergy?
□ No
□ Yes
To maintain patient’s safety and to be aware of any adverse reactions
Difficult airway/aspiration risk?
□ No
□ Yes
To ensure that the relevant equipment and drugs are in the room
Risk of >500 mL blood loss (7 mL/kg in children)?
□ No
□ Yes, and adequate IV access/fluids planned?
To ensure that the adequate IV fluids are planned and rapid administration of fluids is possible
Table 14.4 WHO checklist (part 2): time out (before the surgical intervention)
Action Rationale
Have all team members introduced themselves by name and role?
□ Yes
For all to understand and accept the roles and responsibilities. Also encourages confidence and team building
Surgeon, anaesthetist and registered practitioner verbally confirmed:
□ What is the patient’s name?
□ What procedure, site and position are planned?
This is to confirm the identity of the patient and the procedure to be performed and site to prevent wrong site surgery
Anticipated critical events
Surgeon:
□ How much blood loss is anticipated?
□ Are there any specific equipment requirements or special investigations?
□ Are there any critical or unexpected steps you want the team to know about?
To ensure that all necessary equipment is ready in theatre and there is no time delay in the procedure and to ensure that every eventuality is covered. Also, the surgeon is aware if there any problems with equipment at the start so that they are prepared
Anaesthetist:
□ Are there any patient-specific concerns?
□ What is the patient’s ASA grade?
□ What monitoring equipment and other specific levels of support are required, for example blood?
The ASA grade indicates patient’s suitability for anaesthesia
Nurse/ODP:
□ Has the sterility of the instrumentation been confirmed (including indicator results)?
□ Are there any equipment issues or concerns?
□ Levels of support required, for example blood?
Has the SSI bundle been undertaken?
□ Yes/Not applicable
□ Antibiotic prophylaxis within the last 60 minutes
□ Patient warming
□ Hair removal
□ Glycaemic control
This is to minimize the risk of postoperative infection which could lead to increased length of stay in hospital
Has VTE prophylaxis been undertaken?
□ Yes/Not applicable
To prevent development of DVT on the operating table
Is essential imaging displayed?
□ Yes/Not applicable
To support the surgeon during the procedure
Table 14.5 WHO checklist (part 3): sign out (before leaving the operating theatre)
Action Rationale
Registered practitioner verbally confirms with the team:
Has the name of the procedure been recorded?
Has it been confirmed that instruments, swabs and sharps counts are complete (or not applicable)?
Have the specimens been labelled (including patient’s name)?
Have any equipment problems been identified that need to be addressed?
This is to ensure that the correct information is recorded