Maria Jessica Nacional RN

Charge Nurse, Operating Room Makati Medical Center

Topic Outline
1. Surgical Safety background 2. Safety Surgical Checklist
Definition Benefits Content

3. Actual conduction of the Surgical Safety Checklist

Background
2008 Safe Surgery Saves Lives - Second Global Patient Safety Challenge.

Background
2011 International Patient Safety Goal (IPSG) IV
Ensure Correct-Site, CorrectProcedure, Correct-Patient Surgery.

What is the Surgical Safety Checklist?

GOAL: to help ensure that teams consistently follow a few critical safety steps and thereby minimize the most common and avoidable risks endangering the lives and well-being of surgical patients.

Surgical Safety Checklist

Sign In

Time out

Sign out

THE SIGN IN

SIGN-IN PHASE
With patient
Identification Procedure and site marking Consent

Site Marking
Done in case of laterality (left or right distinction) Surgeon marks site with his initials Use of a permanent marker Done when the patient is awake and aware Documented in a form

SIGN-IN PHASE
Review with Anesthesia
Pulse oximeter functioning Blood loss Pre-anesthesia assessment Airway difficulty Allergy/ allergic reaction

ANESTHESIA SAFETY CHECK

Ask the anesthesia professional
patients anesthetic risk anesthetic equipment medications

ABCDEs (availability and function)

Airway equipment, Breathing system suCtion, Drugs and devices Emergency medications

THE TIME OUT

TIME OUT
Each surgical team member introduces self by name and role Confirm and ensures
Correct patient Correct operation Correct site

TIME OUT
Surgeon Reviews:
Critical Steps Duration of Surgery Anticipated Blood Loss

Anesthesia Reviews:
Patient-Specific Concerns

TIME OUT
Prophylactic antibiotic Essential imaging
Orthopeadic, Neuro and Thoracic Surgeries

TIME OUT
Nursing Team Reviews:
Sterility should be verified Problems with Equipments and Other Preparations

THE SIGN OUT

SIGN OUT
Team confirms procedure performed
procedure may have changed or expanded during the operation.

Completion of sponge ,instrument and needle counts

SIGN OUT
Labeling of surgical specimen obtained

Equipment problems Issues that needs to be addressed PLANS and concerns re: post-operative management and recovery

Challenges
The operating room is a highly complex setting Time is of the essence Fast paced The traditional Hierarchal structure where the doctor is always right while nurse are sob servant followers

Action Steps
Empower nurses to assert and ensure compliance of the team Get the support and cooperation from the surgeons Consistency is the key!

To err is human, to cover up is unforgiveable and to fail to learn is inexcusable. Liam

Donaldson

References:
Pronovost, Peter , Joint Commission International: Safe Surgery Guide Institute for Healthcare Improvement World health Organization http://www.who.int/patientsafety/safesurgery/en/