The World Health Organisation is a global tool to ensure safety in surgery. The principles and procedures are described for how to implement it in your organisation.

1. WHO Surgical Checklist
Mohamad Al-Gailani
Consultant Surgeon
Al Hammadi Hospital, Al Suwaidi
14th December 2015

2. Introduction
 Checklists have been used in aviation to standardize and increase the reliability of
systems.”
 Dramatically reduced aviation accidents and near misses.
 WHO adopted same principles to surgery.
 Established world wide
 Essential tool to minimise occurrence of wrong patient, wrong operation or wrong
side!
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3. Surgical risk, the scale
 The reported crude mortality rate after major surgery is 0.5-5%;
 Complications after inpatient operations occur in up to 25% of patients;
 In industrialized countries, nearly half of all adverse events in hospitalized patients
are related to surgical care;
 At least half of the cases in which surgery led to harm are considered preventable;
 Mortality from general anaesthesia alone is reported to be as high as one in 150 in
some parts of sub-Saharan Africa.
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4. Objectives
All important safety elements are reviewed by ALL OR
teams, for ALL patients, at ALL times
Promote teamwork and communication
Preparedness for the unexpected
Promotes an environment that allows anyone on the
team to speak up if patient safety is at risk.
Correct patient, operation and operative site
Safe Anesthesia and Resuscitation
Minimize the risk of infection
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6. Principles
 Deployable in an incremental fashion
 Supported by scientific evidence and expert
consensus
 Evaluated in diverse settings around the world
 Ensures adherence to established safety practices
 Minimal resources required to implement a far-
reaching safety intervention
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7. The 10 Principles
1. Operate on the correct patient at the correct site.
2. Use methods known to avoid harm from the administration of anesthesia, while
protecting the patient from pain.
3. Recognize and effectively prepare for life threatening loss of the patient’s airway
or respiratory function.
4. Recognize and effectively prepare for the possibility of high blood loss
5. Avoid inducing any allergic or adverse drug reaction known to be a significant
risk for the patient.
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8. 6. Consistently use methods known to minimize the possibility of surgical site
infection.
7. Work to avoid the inadvertent retention of instruments or sponges in surgical
wounds.
8. Secure and accurately identify all surgical specimens.
9. Effectively communicate and exchange critical patient information for the safe
conduct of the operation.
10. Hospitals and public health systems will establish routine surveillance of surgical
capacity, volume, and results.
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10. 1. Briefing
(before anaesthetic induction)
 Verbal confirmation with the patient:
 Identity using two patient identifiers;
 Consent for surgery;
 Type of procedure planned; and;
 Site (side and/or level of surgery).
 Site marked/not applicable
 Confirm surgeon performing the surgery has marked the surgical site according to Policy
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11. Briefing
Allergies/Precautions
 Does the patient have any known allergies? If so what are they?
Latex allergy precautions required.
 Is the patient on any specific infection control precautions? If so
what? MRSA?
VTE prophylaxis
 Is the patient receiving/to receive chemical VTE prophylaxis?
 Is the patient receiving/to receive mechanical VTE prophylaxis?
 Confirm TEDs/LMWH have or will be applied as per surgeon
request &/or hospital policy.
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13. 2. Time Out
(before knife to skin)
 Performed after induction, prepping/draping immediately prior to surgical
incision.
 Team members are identified
 Team members are identified by name and role.
 Team verbally confirms:
 Correct Patient;
 Correct Procedure; and
 Correct Site.
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14. Time Out
 Antibiotic prophylaxis given within the appropriate time frame.
 Confirm antibiotic prophylaxis has been given within 60minutes If not
given, give before incision;
 If administered, when is next dose due if any?
 Essential imaging displayed?
 Confirm essential imaging has been displayed and is displayed
correctly.
 Team communicates anticipated complications.
 Anticipated blood loss?
 Any unusual steps?
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15. 3. Debriefing
(before patient leaves theatre)
 Performed during or immediately after wound closure before the patient is transferred
from the operating room.
 Should be initiated when informing the surgeon that “Count is Correct”
 Nurse verbally confirms with the entire team
 Confirmation of procedure performed as stated by surgeon;
 Verbal confirmation of specimen details;
 Verbal confirmation of surgical count; and
 Identification of equipment problems.
 Procedure documented
 Surgeon reviews with the entire team
 Any concerns for recovery?
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16. Debriefing
 Anesthesiologist review with the entire team
 Recovery plans including concerns/issues related to postoperative care
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17. Success in Implementation
 Ongoing vigilance
 A champion (or better, champions) at all levels!
 Commitment from senior management and the
board
WHO Surgical Checklist
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18. WHO Surgical Checklist
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19. QUESTIONS?WHO Surgical Checklist
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