check list

1. OT CHECK
LIST
Dr kawita
Bapat

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 marking verification 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 – OT SAFETY 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 (To be 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 (To be 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 crisis management

20. Principals of crisis management
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.