Definition
A Surgical Safety Checklist is a tool that helps a surgical team ensure patient safety by confirming identity, site, procedure, and consent before, during, and after surgery. The checklist is used by the entire surgical team—including surgeons, anesthesiologists, and nurses—at three critical junctures of an operation.

Key benefits of the Checklist

• Reduces complications and mortality: Studies have shown that consistent use of the checklist can significantly decrease the rate of surgical complications and deaths.
• Improves teamwork and communication: The checklist fosters a “safety-first” culture by encouraging verbal communication among the entire team, reducing reliance on individual memory.
• Standardizes safety: It establishes a standard, uniform approach to safety checks, which ensures critical steps are not missed, especially during high-stress moments.
• Empowers team members: It allows all members of the surgical team to voice concerns, helping to break down traditional hierarchies that can prevent safety issues from being raised.
• Error reduction: Minimizes preventable surgical complications and errors like operating on the wrong patient, site, or procedure.

The Three Phases

1. Sign-in (Before Anesthesia)

Performed by the anesthesia provider and nurse with the patient awake. Key checks include:

• Confirming the patient’s identity, the surgical site, the procedure, and that consent has been given.
• All team members introduced.
• Marking the surgical site, where applicable.
• Confirming that the anesthesia machine and medication checks are complete.
• Confirming the patient’s known allergies.
• Assessing the patient’s airway for any potential difficulties or aspiration risk.
• Confirming the risk of significant blood loss and preparing for it.
• Confirming that a pulse oximeter is on the patient and functioning.

2. Time-Out (Before Skin Incision)

A verbal confirmation involving the entire surgical team (surgeon, anesthetist, and nurse) just before the procedure begins. Key checks include:

• Confirming the patient’s identity, site, and procedure again.
• Reviewing anticipated critical events, including potential challenges, operative duration, and expected blood loss.
• Confirming that prophylactic antibiotics were administered within the last 60 minutes, if needed.
• Verifying that essential imaging results are properly displayed.
• Sterile field availability is confirmed.

3. Sign-Out (Before Patient Leaves OR)

Final review with the surgeon, anesthetist, and nurse before the patient is transferred. Key checks include:

• The nurse verbally confirming the name of the procedure.
• Confirming the completion of instrument, sponge, and needle counts.
• Reviewing whether any equipment issues or concerns need to be addressed.
• Verifying that specimens are correctly labeled with the patient’s name.
• Discussing the key concerns for the patient’s recovery and management.

Implementation and Challenges

For the checklist to be effective, it must be treated as a tool for communication rather than a “tick-box” exercise. Challenges to proper implementation can include:

• Lack of awareness among staff.
• Reluctance from senior staff.
• Perception that it is too time-consuming.

Compiled By:

Dr. Rafaa Islam

Contributors :

1. Prof Fawzia Hossain
2. Prof Farhana Dewan
3. Prof Laila Arjuman Banu
4. Dr Sumaiya Binte Asif
5. Dr Maniza Khan
6. Dr Taslima Akter Tithi
7. Dr Jannat Ara Rifat
8. Dr Naznin Akter
9. Dr Sharani Laskar
10. Dr Nipa Ghosh