DEPARTMENT OF SURGERY

BMSH
CLINICAL MEETING

TOPIC:

PRESENTER:

SURGICAL SAFETY

DR BATUBO ( TEAM E)

OUTLINE
INTRODUCTION
SAVE SURGERY SAVES LIVE OBJECTIVES
CASE SCENERIO
THE CHECKLIST
ADVANTAGES
HOW TO RUN THE CHECKLIST: In detail
Sign in
Time out
Sign out
MODIFICATION
IMPLEMENTATION
THE WAY FORWARD IN BMSH
CONCLUSION

INTRODUCTION
Surgery is regarded as a high risk and complex
industry
Complications of surgical care have become a major
cause of death and disability worldwide.

Studies done by Kable et al., 2002

Countries

Death rate

Rate of major
complication

Developed

0.4- 08%

3- 22

Developing 5- 10%

Rate of mortality during general anaesthesia is

reported to be as high as 1 in 150 in parts of subSaharan Africa
Avoidable surgical complications account for a large
proportion of preventable medical injuries and death

 Safety in surgery require the reliable

execution of multiple necessary steps in
care by health team working together for
the benefit of the patient
To minimize unnecessary loss of life, the
CHECKLIST was develop by the SAFE
SURGERY SAVES LIVES initiative of WHO
in 2008

OBJECTIVES OF SAFE SURGERY

1. The team will operate on the correct patient at the
correct site.
2. The team will use methods known to prevent harm
from
administration
of
anaesthetics,
while
protecting the patient from pain.
3. The team will recognize and effectively prepare for
life threatening loss of airway or respiratory
function.
4. The team will recognize and effectively prepare for
risk of high blood loss.
5. The team will avoid inducing an allergic or adverse

6. The team will consistently use methods known

to minimize the risk for surgical site infection.
7. The team will prevent inadvertent retention of
instruments and sponges in surgical wounds.
8. The team will secure and accurately identify all
surgical specimens.
9. The team will effectively communicate and
exchange critical information for the safe conduct
of the operation.
10.Hospitals and public health systems will establish
routine surveillance of surgical capacity, volume
and results.

The Case Scenario

45 year old with breast cancer.
Elective mastectomy.
Patient wants immediate reconstruction by plastic surgeon.
General surgeon does mastectomy.
Preference card is lost so instrument set not standard.
Scrub tech leaves because of family emergency.
Circulator becomes scrub nurse.

 Circulating nurse is now covering two ORs

Plastic surgeon comes into room early.
Wants to begin reconstruction before general
surgeons is finished
Plastic surgeon disruptive saying procedure
going too slow.
General surgeon insists on completing the
mastectomy first.
The breast specimen was lost.
Surgeons had never worked together before and
did not talk before procedure.
No plan for how surgery was to take place.
Nursing staff very stressed by level of workload.

Complete system breakdown

The check list was developed

The Surgical Checklist

The Checklist divides the operation into three
phases
OPERATION
(Sign In)
before induction of anaesthesia

(Time Out)
after induction and before surgical incision

(Sign Out)
Immediately after wound closure but before removing the patient

 Impact of checklist in the OR

New England journal of medicine (2009) by
SSSL
Hypothesis: 19 item surgical safety checklist
improve
1. Team communication and consistency of care
2. Reduce complications and deaths associated with
surgery

12 months ( 2007-2008)
Canada, India, Jordan, New Zealand, Philippines,
Tanzania, England, USA
16yr and older
Non- cardiac Presurgery checklist Pchecklist

value

FINDINGS3733
# of patients

3955

Mortality

0.8%
1/2

1.5%

0.003

2nd study in 2011 by John et al.

They put the operating team through
several critical operating room scenerio
a time they went in with a checklist
a time without a checklist
FINDINGS
critical management steps were adhere to
96% with checklist
76 without checklist
CHECKLISTS REMIND US
TO DO

Advantages of the Checklist

Check list can help
PREOP

Improve
1. Appropriate antibiotic administration
2. Prevention of hypothermia
REDOSING

3. Availability of equipment in operating room

4. COMMUNICATION, SAFETY CULTURE

Reduce
1. Specimen problems - - - loss, wrong test
2. Inaccuracies in documentation
3. Surgical related complications
4. Mortality and mobidity

 It is intended as a tool for use by clinicians

interested

Safety of their operations

death &

Reducing unnecessary surgical

HOW TO RUN THE CHECKLIST

IN 3 PARTS
Sign in
Before induction of anaesthesia
Ready to go back to the theatre

Time out
Before skin incision
Safe to start operation or
procedure

Sign out
Before patient leave operating
room
Safe to end operation and safe to
send patient to next point of care

Operating Room

Sign in- before induction of anaesthesia

Take place at the theatre
reception
Perform by
Preop nurse and
circulator
Does not involve surgeon
or anaesthestist
Pre- procedure preparation
Relevant lab. Results, implant,
devices, special equipments

DVT prophylaxisassessment done and place

TEDs/SCDs if needed
Warming warming device
set up in OR if needed

Time out- safe to start the operation

Perform by the entire surgical team

Team introductions
Pharmaceuticals e.g antibiotics
Risk of blood loss
Positioning/padding/straps- changes in
position, equipment
Radiology relevant images reviewed/
available
Equipement eg implant, anything
special anyone needs
Fire risk assessment need to be done
heat and fuel( e.g alcohol-based prep,
O2)
60min procedure

Expectec duration
Antibiotic redosing plan
Active warming
DVT prophylaxis

Sign out- safe to end operation, safe to send

patient to next
Perform by the surgeon

Opportunities for improvement

Patient recovery and
management
Postop expectation are discursed
Meds e.g antibiotics, pain
Tubes/ lines
Post-op studies ( labs, radiology)
Destination: ICU, HOME OR WARD
Key concern

Operation note and orders

Modification
The Checklist can be modified to account for
differences among
facilities with respect to their processes,
the culture of their operating rooms and
the degree of familiarity each team member has with each
other.

However, removing safety steps because they

cannot be accomplished in the existing environment
or circumstances is strongly discouraged.

Many of the steps on the Checklist are already

followed in operating rooms around the world;
few, however, follow all of them reliably.

Implementation
Requires adapting the Checklist to local routines
and expectations
With sincere commitment by hospital leaders
The heads of surgery, anaesthesia and nursing
departments must publicly embrace the belief that
safety is a priority and that use of the WHO
Surgical Safety Checklist can help make it a reality.
They should use the Checklist in their own cases
and regularly ask others how implementation is
proceeding

THE WAY FORWARD IN

BMSH

CONCLUSION
Checklists have been useful in many different
environments, including patient care settings.
This WHO Surgical Safety Checklist has been used
successfully in a diverse range of healthcare
facilities with a range of resource constraints.
Studies shows that with education, practice and
leadership, barriers to implementation can be
overcome.
With proper planning and commitment the
Checklist steps are easily accomplished and can
make a profound difference in the safety of surgical
care and reducing mortality and morbidity.

THANK YOU