World Health Organizations Surgical Safety Checklist

An international research team has shown that death and complication rates from surgery can be dramatically improved by using simple checklists to make sure that safety measures are taken before, during, and after each operation.

The research project involved nearly 8,000 patients at eight hospitals around the world and was done as part of the World Health Organization’s program called Safe Surgery Saves Lives. The results were published in January 2009 in the New England Journal of Medicine.

The surgical teams using checklists found that death rates were cut in half and non-fatal complications by one-third.

Items on the surgical safety checklist included basic items like verifying that the team has the correct patient and the correct surgical site, making sure the pulse oximeter (which measures oxygen in the blood) is working, making sure antibiotics have been given within one hour before the start of the surgery to prevent infection, and confirming that x-rays needed for the case are on display in the operating room. Another item on the checklist is to have all members of the surgical team introduce themselves by name and role; this is intended to give permission to lower-status team members to speak up at a later time if they notice something is wrong.

Listed below is the entire nineteen-item checklist from the World Health Organization:

    Before Induction of Anesthesia:

  1. Patient has confirmed
    • Identity
    • Site
    • Procedure
    • Consent
  2. Site Marked
  3. Anesthesia safety check completed
  4. Pulse oximeter on patient and functioning
  5. Does Patient have a:

  6. Known Allergy?
  7. Difficult airway/aspiration risk?
  8. Risk of more than 500 ML blood loss (7 ML/KG in children)?
  9. Before skincision:

  10. Confirm all team members have introduced themselves by name and role
  11. Surgeon, anesthesia professional, and nurse verbally confirm:
    • Patient
    • Site
    • Procedure
  12. Surgeon reviews: What are the critical or unexpected steps, operative duration, anticipated blood loss?
  13. Anesthesia team reviews: Are there any patient-specific concerns?
  14. Nursing team reviews: Has stability (including indicator results) been confirmed? Are there equipment issues or any concerns?
  15. Has antibiotic prophylaxis been given within the last 60 minutes?
  16. Is essential imaging displayed?
  17. Before Patient Leaves Operating Room
    Nurse verbally confirms with the team:

  18. The name of the procedure recorded
  19. The instrument, sponge and needle counts are correct (or not applicable)
  20. How the specimen is labeled
  21. Whether there are any equipment problems to be addressed
  22. Surgeon, anesthesia professional, and nurse review the key concerns for recovery and management of this patient.

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