WHO Surgical Safety Checklist Mr Peter O’Leary 14/01/09

Introduction WHO Surgical Safety Guidelines was established by the World Alliance for patient safety to reduce the number of surgical deaths worldwide The aim of this initiative was to harness political commitment and clinical will to address important safety issues including Inadequate anaesthetic practices Avoidable surgical infection Poor communication between team members To assist operating teams to reduce the number of these events, the Alliance identified a set of 19 safety checks that could be performed in any operating theatre

Introduction Operating team is understood to comprise of surgeons, anaesthetics, nurses, technicians and other theatre personnel The checklist was designed for simplicity and brevity Each safety check has been included based on clinical evidence or expert opinion 8 pilot sites worldwide

How to run One designated person is responsible for checking the boxes A circulating nurse is suggested but any healthcare professional or clinician 3 phases Sign in – period before induction Time out – period after induction and before surgical incision Sign out – period after wound closure but before removing the patient from the theatre The checklist co-ordinator should prevent the team from progressing to the next phase of the operation until each step is completed

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population - New England Journal of Medicine Jan ‘09 Prospective study Between October ’07 and September ’08 Eight centres Toronto New Delhi Amman Auckland Manila Ifkara London Seattle 3955 patients enrolled Primary end point – rate of complications

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population - New England Journal of Medicine Jan ‘09 Results Rate of death prior to checklist introduction 1.5% Rate of death after checklist introduction 0.8% (p=0.003) Inpatient complications prior to checklist introduction 11% Inpatient complications after checklist introduction 7.0% (p<0.001)

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population - New England Journal of Medicine Jan ‘09 Conclusion Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among people over the age of sixteen and undergoing non-cardiac surgery

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