The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.

1. DEPARTMENT OF SURGERY
BMSH
CLINICAL MEETING
TOPIC: SURGICAL SAFETY
PRESENTER: DR BATUBO ( TEAM E)

2. 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

3. 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
 Rate of mortality during general anaesthesia is reported to be
as high as 1 in 150 in parts of sub-Saharan Africa
 Avoidable surgical complications account for a large proportion
of preventable medical injuries and death
Countries Death rate Rate of major complication
Developed 0.4- 08% 3- 22
Developing 5- 10%

4. 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

5. Objective 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 drug
reaction for which the patient is known to be at significant risk.

6. 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.

7. 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.

8.  Circulating nurse is now covering two OR’s
 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 checklist was developed

10. 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 from the operating
room

11. Impact of checklist in the operating room
 New England journal of medicine (2009) by Save
Surgery Saves Lives
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 surgery
FINDINGS
Pre-checklist checklist P-value
# of patients 3733 3955
Mortality 1.5% 0.8% 1/2 0.003
Complication rate 11.0% 7.0% 3rd 0.001˂

12. 2nd
study in 2011 by John et al.
They put the operating team through several critical
operating room scenerio
½ a time they went in with a checklist
½ a time without a checklist
FINDINGS
critical management steps were adhere to
96% with checklist
76 without checklist
CHECKLISTS REMIND US TO DO
CRITICAL THINGS

13. 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 morbidity

14.  It is intended as a tool for use by clinicians interested
Safety of their operations
Reducing unnecessary surgical death &
complication

15. How To Run The Checklist: In detail
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

16. Sign in
 Take place in the theatre reception
 Safe to go back to the theatre
 Perform by
Preop nurse and circulator
Does not involve surgeon or
anaesthestist
 Pre- procedure preparation
 Relevant lab. Results, implant,
devices, special equipments
 DVT prophylaxis- assessment done
 Warming – warming device set up
in operating room if needed

17. Time out- safe to start the operation
 Perform by the entire surgical team
 Team introductions
 Pharmaceuticals e.g antibiotics and other
 Risk of blood loss
 Positioning/padding/straps- changes in
position, equipment
 Radiology – relevant images reviewed/
available
 Equipment e.g implant, anything special
anyone needs
 Fire risk assessment need to be done
heat and fuel( e.g alcohol-based prep, O2)
 60min procedure˃
 Expectected duration
 Antibiotic re-dosing plan
 Active warming
 DVT prophylaxis

18. Sign out
 Safe to end operation, safe to send
patient to next point of care
 Perform by the surgeon
 Opportunities for improvement
 Patient recovery and management
Postop expectation are discussed
Meds e.g antibiotics, pain
Tubes/ lines
Post-op studies ( labs, radiology)
Destination: ICU, HOME OR WARD
Key concern
 Operation note and orders

19. 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.

20. 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.
Barrier to implementation
time constraints duplication of existing processes
lack of communication between team members checklist too long to complete
some items did not fit in their operating room Could yes/no answer prevent moving on
to the next question

21. THE WAY FORWARD IN BMSH?

22. 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.

23. THANK YOU