GENERAL SAFETY CHECKLIST

(FOR SURGICAL TEAM)

Absolute prerequisites
 Use Standard Precautions with all patients.

Personal protective equipment􀁿appropriate choices

 Use adequate eye and face protection.
 Wear fluid-resistant or fluid-impervious gowns, as appropriate to expected
exposure risk (if available).
 Choose gloves appropriately (use double gloving,).
 Wear appropriate footwear (shoes not open toed or flip flops).

Personal protective equipment􀁿appropriate use

 Remove gloves carefully to avoid blood splatter.
 Wash hands with soap and clean water or use antiseptic hand scrub after removing
gloves.
 Remove eye protection last.
 Remove contaminated personal protective equipment (PPE) before leaving the
room.
 Carefully remove and discard mask following every procedure.

Safety techniques
 Wear examination gloves when handling surgical specimens.
 Wear eye protection if container is opened or splashing is anticipated.
 Apply dressings and handle drains or packs wearing clean new examination gloves.
 Avoid touching any surface with contaminated gloves.

Safety strategies
 Have extra PPE readily available should replacements be needed.
 Position sharps disposal containers at point of use.
 Have a plan for sharps management.
 Make sure all team members know the plan.
 Modify the plan as needed.
 Focus attention on sharps in use; be aware and alert.
 Alert other OR team members to possible hazards.
 Discourage unauthorized entry into the room.
 Keep extraneous conversation to a minimum.

Personal preparation
 Prepare your body and mind to function effectively and efficiently.
 Get enough sleep before surgery. If you are working a long shift on obstetrics or
trauma service, nap if and when you can.
 Avoid caffeine, which increases hand tremor.
 Avoid alcohol or other substances that impair perception, judgment or reflexes.
 Promote general good health. Exercise regularly and have an annual physical.
SAFE ASSISTING AND OPERATING CHECKLIST

 Use forceps to put scalpel blade on handle.

 Avoid handling suture needles manually.
 Never hold a scalpel, loaded needle holder, or any other sharp in the same hand
simultaneously with another instrument.
 Scalpels, loaded needle holders, and other sharps should be held in the hand only
during cutting, suturing, or for other specific tasks. At all other times, sharps should
be placed off the operative field.
 Properly employ a Safe Zone for the safe passing of sharps.
 Use verbal warnings to announce transfer of sharps.
 Before tying, either remove the needle from the suture and park the needle safely,
or protect the needle point with the needle holder.
 Avoid finger contact with tissue being sutured or cut.
 Use retractors rather than manual retracting whenever possible.
 Avoid reflex sponging of tissue, which may not be anticipated by the surgeon, when
a sharp is in use.
 Keep eyes on all sharps in use until they are returned to the Safe Zone.
 Pass long laparoscopic instruments, such as needle tip cautery and sharp-pointed
scissors, handle first and tip down.
 When doing repeat injections with hypodermic needle and syringe, stick needle in
rolled, sterile towel when not in use.
 Remove scalpel blade using forceps; place in sharps container.

OPERATING ROOM SAFETY CHECKLIST

PERSONAL PROTECTIVE EQUIPMENT
 Head wear that covers scalp hair
 Eye and face protection in place
 Appropriate gown
 Double gloves or glove liners as indicated
 Waterproof drapes (if available)

WORK PRACTICE CONTROLS

 Appropriate suture needle selection (blunt if applicable)
 Appropriate retractor selection (blunt if applicable)
 Disposable scalpels (if available)

SHARPS MANAGEMENT
 Sharps disposal container
DELIVERY ROOM SAFETY CHECKLIST

PERSONAL PROTECTIVE EQUIPMENT

 Head wear that covers scalp hair
 Eye and face protection in place
 Appropriate gown
 Double gloves, extended cuff gloves (gauntlet) or glove liners as indicated
 Waterproof drapes (if available)

WORK PRACTICE CONTROLS

 Appropriate suture needle selection (blunt if applicable for episiotomy)

 Appropriate retractor selection (blunt if applicable for cesarean section)

SHARPS MANAGEMENT
 Sharps disposal container

MINIMALLY INVASIVE SURGERY SAFETY CHECKLIST

 Pass sharps, needles, and other short-length sharps through a Safe Zone.
 Pass long laparoscopic instruments that don’t fit in the Safe Zone, such as needle-tip
cautery and sharp-pointed scissors, handle first and tip down.
 Place long-pointed cautery needles, hollow-bore needles or other long sharps into
sleeve ports, on request only, using two hands􀁿preferably one person’s hands􀁿and
then angle the handle toward the surgeon’s waiting hand.
 Blunt-tipped suture needles may be used effectively during laparoscopic
hysterectomy and are considered a safer option for patient and surgeon.
 Aspirate all gas, fluid, and blood from the abdomen prior to closing.

SAFE SHARPS DISPOSAL CHECKLIST

 Choose containers with built-in safety features, such as “see-through” (translucent)

boxes with a readily apparent three fourths and full level lines.
 Lids should allow the sharp to enter the container by gravity alone, without the need
for

 Install containers close to the point of use ideally within arm’s reach.
 Mount containers at a convenient height for use and service, in plain sight and free
from Obstructions.
 Do not leave containers freestanding on the floor on their side.
 Do not shake containers to avoid spillage or sharps sticking out.
 Schedule staff training and education for proper use of sharps containers.
 Assign responsibility for maintenance and service of sharps containers.
DUTIES AND RESPONSIBILITIES TO ENSURE SAFETY IN THE
OPERATING ROOM
Scrub Nurse/Technician

A. Preoperative

1. Checks the card file for surgeon's special needs/requests.

2. Opens sterile supplies.
3. Scrubs, gowns, and gloves and sets up sterile field. Obtains instruments from flash
autoclave if necessary. Checks for proper functioning of instruments/equipment.
4. Performs counts with circulator.

B. Preincisional

1. Completes the final preparation of sterile field.

2. Assists surgeon with gowning/gloving.
3. Assists surgeon with draping and passes off suction/cautery lines.

C. During the Procedure

1. Maintains orderly sterile field.

2. Anticipates the surgeon's needs (supplies/ equipment).
3. Maintains internal count of sponges, needles and instruments.
4. Verifies tissue specimen with surgeon, and passes off to circulator.

D. Closing Phase

1. Counts with circulator at proper intervals.

2. Organizes closing suture and dressings.
3. Begins clean-up of used instruments.
4. Applies sterile dressings.
5. Prepares for terminal cleaning of instruments and nondisposable supplies.
6. Reports to charge nurse for next assignment.
Circulating Nurse

A. Preoperative

1. Assists in assembling needed supplies.

2. Opens sterile supplies.
3. Assists scrub in gowning.
4. Performs and records counts.
5. Admits patient to surgical suite.

B. Pre-incisional

1. Transports patient to procedure room.

2. Assists with the positioning of the patient.
3. Assists anesthesia during induction.
4. Performs skin prep.
5. Assists with drapes; connects suction and cautery.

C. During the Procedure

1. Maintains orderly procedure room.

2. Anticipates needs of surgical team.
3. Maintains record of supplies added.
4. Receives specimen and labels it correctly.
5. Maintains charges and O.R. records.
6. Continually monitors aseptic technique and patients needs.

D. Closing Phase

1. Counts with scrub at proper intervals.

2. Finalizes records and charges.
3. Begins clean-up of procedure room.
4. Applies tape.
5. Assists anesthesia in preparing patient for transfer to PACU.
6. Takes patient to PACU with anesthesia and reports significant information to PACU
nurse.
7. Disposes of specimen and records.
8. Reports to charge nurse for next assignment.
SURGICAL AND INVASIVE PROCEDURE PROTOCOL

A. SCHEDULING
Scheduling must include:
1. Entire procedure, exact site, level, digit, and side/laterality (including spelling out
“Left”, “Right” and “Bilateral” – no abbreviations other than C-Cervical, T-Thoracic,
L-Lumbar, S-Sacral when identifying spinal levels – e.g. L4-5).
2. Specific information on implant/implant system and/or equipment.
3. Specific information on removal of device.
4. Information on harvest and donor sites.
5. The Operating Room (OR), or the person responsible for accepting requests to
schedule procedures, must verify the information provided by the
surgeon/physician. The information should be verified in a manner agreed to by
both the institution and physicians

B. CONSENT DOCUMENT
Consent documentation must include:
1. First and last name, date of birth of patient and medical record number of the patient.
2. Name and description of surgery or procedure in terms that are understandable to
the patient (correct site/side, level and digit with the side spelled out as “Left”,
“Right” or “Bilateral”).
3. No acronyms or abbreviations (except spinal levels noted).
4. Specific implant/implant system to be placed or device to be removed.
5. Patient/family/guardian/health care agent signature and date.
6. Witness signature and date.
7. Physician signature and date.
8. If the consent is altered or illegible it must be re-done and re-signed by all parties.

C. PRE-OPERATIVE/PRE-PROCEDURAL VERIFICATION PROCESS

Verification of the correct person, procedure site and side must occur (as
applicable):
1. At the time the surgery or invasive procedure is scheduled.
2. at the time of admission or entry into the facility.
3. with the patient involved, awake and aware, if possible.
4. Anytime the responsibility for care of the patient is transferred to another caregiver
or location in the pre-operative or pre-procedural process.
5. before the patient leaves the pre-operative area or enters the procedure/surgical
room.
D. MARKING THE OPERATIVE/PROCEDURAL SITE
1. The physician doing the procedure must do the site marking using his/her own
initials. Site marking must be legible and unambiguous.
2. All sites involving laterality (e.g. brain) and/or paired organs, multiple structures
(fingers, toes, hernias, lesions) or multiple levels (spine). Make the mark at or near
the incision site(s) so that it/they will be visible when the patient is draped
3. For hand and foot surgery, the surgeon must mark the surface(s) of the digit to be
operated on, anterior, posterior or both.
4. The appropriate site must be verified before any cast is split. For relevant orthopedic
cases, the skin/site should be marked immediately after cast/splint is removed.
5. For surgery of the spine, pre-operative skin marking is required to indicate laterality,
when appropriate. A second time out must be performed when the intra-operative
imaging is done to confirm the level.
6. When the site or level is not visually identifiable, the surgeon must obtain an intra-
operative image, using markers that will not move, to confirm the exact level/site.
7. Do NOT mark any non-operative site(s).
8. The mark must be visible in the operative field after the patient is prepped and
draped.
9. Adhesive site markers should not be used as the sole means of marking the site.
10. In the event of multiple surgical procedures by different surgeons, all relevant
surgical sites must be marked prior to the first surgery. The surgeon marking the
site(s) must be present for and participate in the “time out” performed for each
procedure he/she marks.
11. Marking must take place with the patient/family involved, awake and aware, if
possible.
12. If a smaller mark is necessary, such as near the eye cases, a dot near the eye
constitutes the site marking. A special purpose wristband is also an option.
14. Final verification of the site mark must take place during the "time out".
Surgeon’s Team Briefing
(before surgery)

Patient’s name

The Surgeon will state the patients name aloud. The name must coincide with the name
previously confirmed by Anesthetists the Nurses prior to induction.

Procedure, site and site marked

The Surgeon will state aloud the procedure to be performed, identify the site and state that
the site is marked or that site marking is not required.

If site marking is required and has not been marked, it will be marked prior to continuing
with the briefing.

General overview of the procedure and duration

The Surgeon will give a general overview of the procedure to be completed and state the
anticipated duration.

Required Equipment, Instruments, imaging, implants

The Surgeon will discuss with the team all necessary requirements with regards to
equipment, Instruments, imaging, implants etc.

Patient positioning, warming, DVT and antibiotics (re-dose)

The Surgeon will discuss the requirements with regards to Patient positioning, warming
devices, and antibiotic prophylaxis including possible re-dose of drugs.

Anticipated Critical Events:

Surgeon Review:

The Surgeon will discuss with the team all specific patient concerns, blood loss, critical
steps, staffing, special equipment and any other issues affecting patient safety.

Anesthesia Review:

The Anesthetist will discuss with the team any specific patient concerns, resuscitation plan,
medications, and any other issues affecting patient safety

Nursing Review:

The Nurses will discuss with the team all specific patient concerns, equipment, implants,
supplies, staffing, and any other issues affecting patient safety
Introduction and role of all team members

The Surgeon may introduce all team members or may choose to have team members
introduce themselves. The role of each team members should also be discussed.
Note: If the team is together for several cases during the day, introductions are only
required for the first case of the day, or when new clinicians join the team and change in
roles.

Surgeon’s Team Debriefing

To be completed by the Surgeon prior to the patient leaving the room

The Surgeon will verbally confirm the following with the team

Instrument, sponge and needle count

The Surgeon shall confirm with the nursing team that the count is complete and accurate.

The circulating and scrub nurses should verbally confirm the completeness of final sponge
and needle counts. In cases with an open cavity, instrument counts should also be
confirmed as complete

Specimen labeling

The Surgeon shall confirm with the nursing team that all labeling is complete and accurate.

The circulating nurse confirms the correct labeling of any specimens obtained during the
procedure by reading out loud the patient’s name, the specimen description, and any
orienting marks or sutures.

The management/handling and labeling of all specimens must be completed before the
surgical procedure setup is dismantled.

Incorrect labeling of specimens is potentially disastrous for a patient and has been shown
to be a frequent source of laboratory error.

Refer to policies and procedures for handling of specimens.

Procedure performed and unplanned events

The Surgeon shall state the procedure performed and discuss any unplanned events.

The circulating nurse will document the procedure(s) on the operative record.

The purpose of this step is to have complete and accurate documentation and transfer of
critical information to the recovery room team.
Patient recovery concerns and management plan / destination

The surgeon, anesthesiologist and nurse should review the post-operative recovery and
management plan, focusing in particular on intra operative or anesthetic issues that might
affect the patient.
Events that present a specific risk to the patient during recovery and that may not be
evident to all involved are especially pertinent.

Equipment shortages / malfunctions reviewed

The team will discuss equipment shortages or malfunctions and document if necessary
Equipment problems are universal in operating rooms. Accurately identifying the sources
of failure and instruments or equipment that have malfunctioned is important in
preventing devices from being recycled back into the room.

The circulating nurse should ensure that equipment problems arising during a case are
identified by the team.
The teams concerns will be communicated to the applicable departments involved in
resolving problems identified

Surgical wound classification

The surgical wound classification will be determined and documented.

The surgeon and the circulating nurse will review the classification of the surgical wound.
- If the wound classification was downgraded during the procedure due to
contamination, the circulating nurse will change the classification and
document on the nurse’s notes why this was done.

The circulating nurse will also document any reprocessing (flashing) of instruments and
the reason why this was done

Could anything have been done to make this case safer or more efficient?

The Surgeon will ask the team if anything could have been done differently or if anyone has
suggestions or concerns.