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OT Check List
The document provides an operating theatre (OT) checklist to help ensure patient safety during surgical procedures. It lists several checks that the operating team should complete in the ward and theatre before surgery, including correctly identifying the patient, marking the intended surgical site, checking for allergies and previous medical history, and confirming critical patient information has been exchanged. The goal is for the team to operate on the right patient and site, take appropriate precautions, and communicate effectively to safely conduct the surgery and prevent errors.
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OT Check List
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- 4. OT CHECK LIST Aim and benefit of pu0ng a OT Check List in prac;ce • The team will operate on the correct pa0ent at the correct site • The team will use methods known to prevent harm from anaesthesia, while protec0ng the pa0ent from pain. • The team will recognize and effec0vely prepare for life threatening loss off airway & respiratory func0on • The team will recognize & effec0vely prepare for risk of blood loss • The team will avoid inducing any allergic or adverse drug reac0on known to be a risk for the pa0ent • The team will consistently use methods known to minimize risk of surgical site infec0on • The team will prevent inadvertent reten0on of instruments or swabs in surgical wounds • The team will secure and accurately iden0fy all surgical specimens • The team will communicate & exchange all cri0cal pa0ent informa0on for safe conduct of the surgery • Hospital will establish rou0ne surveillance of surgical capacity, volume & results.
- 5. OT CHECK LIST CHECK LIST WARD CHECK THEATRE CHECK ID bands in place & correct Yes No Yes No Consent form labelled signed & understood Yes No Yes No Thromboprophylaxis Risk Status Low Medium High Last food & Drink Food; Date: Time: Water; Date: Time: Confirm Food date/0me Confirm Water date/0me Allergies (food/latex/med ) correct arm band & label Yes No Type of allergy: Severity: Yes No Confirm type of allergy: Confirm Severity:
- 6. OT CHECK LIST Correct Notes with-‐ Drug chart, fluid chart & labels Yes No Yes No Most recent lab reports, Xrays, Scans etc Yes No Yes No Any previous surgery, metalwork, pacemaker Yes No N/A Yes No N/A Any property to accompany pa0ent Yes No Yes No Any medica0on to accompany pa0ent Yes No Yes No Glasses or Contact lenses Yes No N/A Yes No N/A Dentures removed Yes No N/A Yes No N/A Loose teeth, caps, crows Yes No N/ A Yes No N/A Jewellery removed or taped Yes No N/ A Yes No N/A
- 7. OT CHECK LIST Check List Ward Check Theatre Check Name Signature Band Name Signature Band COMMENTS
- 8. Operating team markingverification checklist Date Responsibility Signature to confirm check completed Check 1: Pre-‐op ward • Check the pt’s iden0ty • Check reliable documents &/ or images to ascertain intended surgical site • Mark the intended site with an arrow using an indelible pen The opera0ng surgeon or nominated assistant who will be present in the theatre at the 0me of the pa0ent’s procedure Signed: Print name: Check 2: Pre-‐op ward • Prior to leaving ward the mark is inspected and confirmed against the pa0ent’s suppor0ng documents Ward staff Signed : Print name:
- 9. DATE RESPONSIBILITY Signature to confirm check completed Check 3 Anaesthe;c Room • Prior to anaesthesia the mark is inspected and checked against the pa0ent’s suppor0ng documents • Re-‐check imaging studies accompanying the pa0ent or are available in the OT • Availability of the correct implant if that is applicable Opera0ng surgeon or senior member of the team Signed: Print name: Check 4 Theatre The surgical anaesthe0c and theatre team involved in the procedure, prior to commencement of surgery, should pause for verbal briefing, to confirm • Presence of the correct pa0ent • Marking of the correct site • Procedure to be performed Theatre staff directly involved in the opera0ve procedure Signed: Print Name:
- 10. WHO – OTSAFETY CHECK LIST • In 2008, The World Health Organiza0on (WHO), launched a second Global Pa0ent Safety Challenge, “Safe Surgery Saves Lives” to reduce the number of surgical deaths across the world. • A core set of safety checks has been iden0fied in the form of a ‘WHO Surgical safety OT Checklist’ for use in any OT environment. The checklist is a tool for the relevant clinical teams to improve the safety of surgery by reducing deaths and complica0ons. • A study of the checklist in nearly 8,000 surgical pa0ents, published in the New ‘England Journal of Medicine’ showed a reduc0on in deaths & complica0ons
- 11. SIGN IN (To be read out loud ) Before induc;on of anaesthesia Has the pa0ent confirmed his/her iden0ty, site, procedure & consent yes Is the surgical site marked yes Is the anaesthesia machine & medica0on check complete yes • Does the pa0ent have a known allergy • Does the pa0ent have a difficult airway/aspira0on risk (if yes then is equipment/assistance available) • Risk of > 500ml blood loss (if yes then adequate IV access fluid planned) Yes No Yes No Yes No
- 12. TIME OUT (Tobe read out loud) Before start of surgical interven;on (e.g. Skin incision ) Have all team members introduced themselves by name & role yes Surgeon, anaesthe;st & junior surgeon verbally confirm • What is the pa0ent’s name ? • What procedure, site and posi0on are planned ? An;cipated cri;cal events Surgeon • How much blood loss is an0cipated • Are there any specific equipment or special inves0ga0ons required • Are there any cri0cal or unexpected steps you want the team to know about Anaesthe.st • Are there any pa0ent specific concerns • What is the pa0ent’s ASA grade • What monitoring equipment, or other support required e.g. Blood
- 13. CONTINUED Nurse • Has the sterility of instruments been confirmed ( including indicator results) • Are there any equipment issues or concerns Has the surgical site infec;on (SSI) bundle been undertaken • An0bio0c prophylaxis within the last 60 minutes • Pa0ent warming • Hair removal • Glycaemic control Yes/ NA Has VTE prophylaxis been undertaken Yes / NA Is essen0al imaging displayed Yes / NA
- 14. SIGN OUT (Tobe read out loud) Before any member of the team leaves the opera;ng room Junior surgeon or the resident doctor verbally confirms with the team • Has the name of the procedure been recorded • Has it been confirmed that instruments, swabs and sharps count is complete (or not applicable) • Have the specimens been labelled (including pa0ent name) • Have any equipment problems been iden0fied that needs to be addressed Surgeon, Anaesthe;st and junior doctor: • What are the key concerns for recovery and management of this pa0ent
- 15. WHO, Surgical Safety,OT Checklist, for maternity cases ONLY
- 16. SIGN IN ( TO BE READ OUT LOUD AFTER THE ARRIVAL OF THE PATIENT AND THE OT SISTER OR RESIDENT DOCTOR IN THE OT ) • Has the woman confirmed her iden0ty , procedure and consent ? • C-‐Sec0on category ? 1 2 3 4 • Is the anaesthe0c machine and medica0on check complete ? • Does the woman have a known allergy ? • Is there any difficult airway risk ? • Are blood products available ? • Has the appropriate /recent antacid prophylaxis been given ? • Is the resuscita0ve checked and ready ? • Has the neonatal team been called and the neonatal resuscita0on trolley checked and ready ?
- 17. TIME OUT (To be said out loud before skin incision) • Have all the team members introduced themselves by name and role ? • What is the pa0ent’s name ? Obstetrician • What addi0onal procedure(s) are planned • Are there any cri0cal or unusual steps you want the team to know about ? • Are there any concerns about the placental site ? Anaesthe;st • Are there any specific concerns ? OT Assistant • Has the sterility of the instruments been confirmed ? • Are there any equipment issues or concerns ? OT Sister • Are cord blood samples needed ? • Is the urinary catheter draining ? • Has the FSE (Fetal Scalp Electrode) been removed ? • Has VTE prophylaxis been undertaken ?
- 18. SIGN OUT ( To be read out loud before the pa;ent leaves the theatre) Surgeon verbally confirms with the team • Has the name of the procedure or any addi0onal procedures been recorded ? • Has it been confirmed that instruments, swabs and sharps counts are correct ? • Have specimens been labelled ? • Has blood loss been recorded ? Obstetrician, Anaesthe;st, OT Sister • Have the key concerns for recovery & management been discussed ? • Has post opera0ve VTE prophylaxis been prescribed ? • Have An0bio0cs been given ? Anaesthe;st & Theatre Team • Have any equipment problems been iden0fied, that need to be addressed ? OT Sister • Has the baby/babies been labelled ? • Have relevant cord bloods been taken ? • Have cord gases been recorded, if required ?
- 19. Principals of crisismanagement
- 20. Principals of crisismanagement Know modify & op0mize the environment Establish protocols & procedures. Ensure room set up is conducive to crisis – layout, equipment etc An0cipate & plan for a crisis Pa0ent – procedure – equipment – drugs – personnel -‐ retrieval Ensure leadership & role clarity Assign a leader, who can have an overview of the situa0on. He decides, priori0ses & assigns tasks to the teams Communicate effec0vely Leadership aided by clear communica0on, eye contact, use names, clear instruc0ons, ensure understanding & report back Call for help or second opinion early Call for help early – even if not in a crisis. 2nd opinion may be reassurance enough or suggest alterna0ves. Avoid therapeu0c iner0a Allocate aoen0on & use available informa0on Fixa0on errors are common. Beware of situa0onal overload. If you are stressed you are likely to be missing something. Distribute workload & use available resources Maintain situa0onal awareness. Delegate tasks, use external resources, if all fails – improvise/ adapt/ overcome
- 21. COVER ABCD –A SWIFT OT CHECK LIST C Colour, circula;on, capnography O O2 supply & O2 analyser V Ven0la0on & vaporisers E ETT tube & Anaesthesia machine R Review – Monitors & equipment A Airway (face or laryngeal mask), me0culous aoen0on to ETT B Breathing (SV/IPPV) C Circula0on, I/V, blood loss, ECG D Drugs – consider all given & not given, check emergency drugs A Be -‐ AWARE of AIR & ALLERGY SWIFT CHECK Check Pa0ent, Surgeon & Responses
- 25. Conclusion • It should be a regular habit with all OT personnel to be familiar with the OT check list in whatever procedure is being performed. • A copy of the check list should be displayed in the OT • It will go a long way in reducing the morbidity and mortality associated with surgical procedures and also help in proper management of any cri0cal situa0on which may arise out of the situa0on.