Patient Safety Alert
UPDATE
26 January 2009
WHO Surgical Action for the NHS
Safety Checklist
For IMMEDIATE ACTION
by Chief Executive Officers:
Deadlines
• Action underway: 9 February 2009
In June 2008, the World Health Organization • Action plan to be agreed and
(WHO)1 launched a second Global Patient actions started: 1 June 2009
• All actions to be completed:
Safety Challenge, ‘Safe Surgery Saves Lives’ 1 February 2010
to reduce the number of surgical deaths Organisations are required to:
across the world. 1) Ensure an executive and a
The goal of the initiative is to strengthen the commitment of clinical staff clinical lead are identified
to address safety issues within the surgical setting. This includes improving in order to implement the
anaesthetic safety practices, ensuring correct site surgery, avoiding surgical site surgical safety checklist
infections and improving communication within the team. within the organisation.
A core set of safety checks has been identified in the form of a WHO Surgical 2) Ensure the checklist is completed
Safety Checklist for use in any operating theatre environment. The checklist is a for every patient undergoing a
tool for the relevant clinical teams to improve the safety of surgery by reducing surgical procedure (including
deaths and complications. local anaesthesia).
A study of the checklist in nearly 8,000 surgical patients, published in the New 3) Ensure that the use of the
England Journal of Medicine, showed a reduction in deaths and complications.2 checklist is entered in the clinical
notes or electronic record by
The National Patient Safety Agency (NPSA), in collaboration with a multi- a registered member of the
professional expert reference group, has adapted the checklist for use in
team, for example, Surgeon,
England and Wales (see overleaf). This checklist contains the core content
Anaesthetist, Nurse, ODP.
but can be adapted locally or for specific specialties through usual clinical
governance procedures.
In industrialised countries, major complications are reported to occur in 3–16%
of inpatient surgical procedures, with permanent disability or death rates of
approximately 0.4–0.8%.3 In England and Wales, 129,419 incidents relating to
surgical specialties were reported to the NPSA’s Reporting and Learning
System in 2007 with the following degrees of harm:
Degree of harm Number of reported incidents
No harm 90,368
Low harm 29,929 This Alert replaces
Moderate harm 7,746 the Correct Site
Surgery Alert
Severe harm 1,105 (2005)
Death 271
1 www.who.int/patientsafety/safesurgery/en/
2 http://content.nejm.org/cgi/reprint/NEJMsa0810119.pdf?resourcetype=HWCIT
3 www.who.int/entity/patientsafety/safesurgery/knowledge_base/SSSL_Brochure_finalJun08.pdf
WHO Surgical Safety Checklist
(adapted for England and Wales)
SIGN IN (To be read out loud) TIME OUT (To be read out loud) SIGN OUT (To be read out loud)
Before induction of anaesthesia Before start of surgical intervention Before any member of the team leaves
for example, skin incision the operating room
Has the patient confirmed his/her identity, site, procedure Have all team members introduced themselves by name and role? Registered Practitioner verbally confirms with the team:
and consent? Yes Has the name of the procedure been recorded?
Yes Has it been confirmed that instruments, swabs
Surgeon, Anaesthetist and Registered Practitioner
verbally confirm: and sharps counts are complete (or not applicable)?
Is the surgical site marked?
What is the patient’s name? Have the specimens been labelled
Yes/not applicable
(including patient name)?
What procedure, site and position are planned?
Is the anaesthesia machine and medication check complete? Have any equipment problems been identified that
Yes Anticipated critical events need to be addressed?
Surgeon: Surgeon, Anaesthetist and Registered Practitioner:
Does the patient have a:
How much blood loss is anticipated? What are the key concerns for recovery and
Known allergy? Are there any specific equipment requirements management of this patient?
No or special investigations?
Yes Are there any critical or unexpected steps you
Difficult airway/aspiration risk? want the team to know about?
No Anaesthetist:
Yes, and equipment/assistance available Are there any patient specific concerns?
What is the patient’s ASA grade?
Risk of >500ml blood loss (7ml/kg in children)?
What monitoring equipment and other specific
No levels of support are required, for example blood?
Yes, and adequate IV access/fluids planned
Nurse/ODP:
Has the sterility of the instrumentation been confirmed
(including indicator results)? This checklist contains the core
Are there any equipment issues or concerns? content for England and Wales
Has the surgical site infection (SSI) bundle been undertaken?
Yes/not applicable
• Antibiotic prophylaxis within the last 60 minutes
PATIENT DETAILS • Patient warming
• Hair removal
Last name: • Glycaemic control
First name: Has VTE prophylaxis been undertaken?
Yes/not applicable
Date of birth:
Is essential imaging displayed?
NHS Number: *
Yes/not applicable
www.npsa.nhs.uk/nrls
Procedure:
*If the NHS Number is not immediately available, a temporary number should be used until it is.
0861 January 2009
Patient Safety Alert
UPDATE
26 January 2009
The NPSA has informed:
NHS organisations, the Independent Sector, providers (direct and commissioned) of all NHS and Independent Sector care and
commissioners, regulators and professional bodies in England and Wales.
Supporting information
A supporting information document with more details on our findings, links to resources and the checklist is available from
http://www.npsa.nhs.uk/nrls/alerts-and-directives/alerts/safer-surgery-alert/
or contact Fran Watts, [email protected], 020 7927 9595
or Joan Russell, [email protected], 020 7927 9519.
Organisations endorsing WHO Surgical Safety Checklist:
The Royal College of Surgeons of England
The Royal College of
Ophthalmologists
© National Patient Safety Agency 2009. Copyright and other intellectual property rights in this National Patient Safety Agency
material belong to the NPSA and all rights are reserved. The NPSA authorises UK healthcare
organisations to reproduce this material for educational and non-commercial use. 4-8 Maple Street, London, W1T 5HD
NPSA Reference Number: NPSA/2009/PSA002/U1 T: 020 7927 9500 F: 020 7927 9501
Gateway Reference: 11146
www.npsa.nhs.uk
0861 January 2009
