FIVE STEPS TO SAFER SURGERY
INTRODUCTION
With over 4.7m surgical admissions in the UK, Surgery is one of the most practiced
Healthcare interventions(HSCIC, 2014). In order to mitigate the thousands of deaths
which are related to surgery worldwide, the World Health Organization introduced a
safety checklist to bring down the mortality rate associated with surgical
procedures(WHO, 2009a). This checklist after implementation has reduced deaths
by 47% and in-hospital complications by 36% (Haynes, et al. 2009). Operating
Department Practitioners (hereafter referred to as ODP) are members of the range
of professionals involved in surgical operations. They play important roles and have
key responsibilities(NHS, No Date) especially in the fulfilment of safer surgeries. This
poster will highlight fundamental principles of safe and effective surgical practice as
well as the roles and responsibilities of ODPs.
FUNDAMENTAL PRINCIPLES OF SAFE AND EFFECTIVE
SURGICAL PRACTICE
The WHO set to the task of improving safety of surgical care by setting standards
around a core of four areas. These areas are in surgical site infection prevention,
safe surgical teams, safe anaesthesia and measurement of surgical services (WHO,
2009b). Thus the safety checklist was built around this core. This safety checklist
includes(AFPP 2020):
The Briefing; which is before the list or each patient: Involves designation of team
roles, list order as well as concerns relating to staff, equipment, etc
The Sign-in; which is before the induction of anaesthesia: Involves confirmation of
patient consent form, site marking, allergies, airway issues, pulse oximeter,
machine/medication check, anticipated blood loss check
The Timeout; which is before the start of the surgery: Involves member introduction
by name and role, verbal confirmation of patient information,
surgical/anesthetic/nursing issues, surgical site infection bundle,
thromboprophylaxis in the last hour, available imaging, instrument sterilisation,
equipment issues, etc
The Sign out; which is before the patient leaves the theatre: Involves confirmation
of the recording of the procedure, correct documentation of the instruments, swabs
and sharps, correctly labeled specimens, addressed equipment issues, post
operative management discussion
The Debriefing; which is at the end of the list. Involves List evaluation, incident
learning, problem remedying and sometimes the discussion of the whole five-step
process.
Sample of Surgical Safety Checklist
(WHO 2009a)
ROLES AND RESPONSIBILITIES OF THE ODP IN THE FIVE STEPS TO
SAFE SURGERY
The checklist outlined ensures the principles of safe surgery are adhered to. But as
each member of the surgical team is expected to play a role towards the fulfilment
of these guidelines, we will be focusing specifically on the roles & responsibilities of
an ODP either in the scrub or circulating practitioner position. An ODP is a
registered health professional who works with patients who undergo surgical
operations of all ages and at each section of operative procedures (Taylor, et al
2019). REFERENCES
-AFPP (2020) AFPP The Association for Perioperative Practice (AfPP) - Leading Perioperative Excellence
Standards and Guidance. Five Steps to Safer Surgery 2020
-ARC (No Date). “The Role of the Operating Department Practitioner - ARU.” Aru.ac.uk,
aru.ac.uk/health-education-medicine-and-social-care/allied-health/role-of-odp#:~:text=Scrubbed%20rol
e.
-Data from Health and Social Care Information Centre (HSCIC), Hospital Episode Statistics 2013/14.
-Haynes, Alex B., et al (2009). “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global
Population.” New England Journal of Medicine, vol. 360, no. 5, 29 Jan. 2009, pp. 491–499,
www.nejm.org/doi/full/10.1056/nejmsa0810119, https://doi.org/10.1056/nejmsa0810119.
-NHS, University Hospitals of Derby and Burton (No Date). “What Is an Operating Department Practitioner
(ODP)?” University Hospitals of Derby and Burton NHS,
www.uhdb.nhs.uk/operating-department-practitioner/#:~:text=In%20recovery%20the%20ODP%20will.
Image from Teeside University, Operating Department Practices Page For Undergraduate Nursing and Health
ROLES AND RESPONSIBILITIES AS A SCRUB PRACTITIONER
An ODP practicing in a scrub role will be a part of the sterile team performing
the operation on the patient. As a result of this they will don surgical gown
and gloves. They work closely with the surgeon(s) and serve as a link between
the sterile team and the rest of the theatre (ARC, No Date). Some of their
roles and responsibilities in line with the 5 step safety checklist;
-Checking the equipment and theatre preparation before the operating list
starts
-Donning surgical gloves and gowns to become ‘sterile’
-Preparing the patient’s skin and the use of sterile drapes to create a sterile
field
-Keeping track of all instruments, swabs and sharps used for the procedure
-Handing over of correctly labeled specimen
-Assisting in handing over of the patient’s surgical care to post-anesthesia care
unit
ROLES AND RESPONSIBILITIES AS A CIRCULATING
PRACTITIONER
An ODP practicing in a circulating role is also called a runner sometimes. Playing a
vital role in the surgical team, they provide a bridge between the theatre and the
rest of the hospital (ARC, No Date). Some of their roles and responsibilities in line
with the 5 step safety checklist;
-Checking the equipment and theatre preparation before the operating list starts
-Ensuring all necessary equipment is available, working and connected to the
patient such as the lighting, ventilation, anesthetic equipment, imaging
equipment, monitoring equipment, etc
-Serving as the second person during surgical counts
-Conveying labeled specimens to their appropriate destinations
-Liaising between the theatre team and the sterile team as well as with other
departments in the hospital as necessary during operations
CONCLUSION
In previous times, the main objectives of safe surgery were focused on the
technical aspect of procedures. With the WHO Safe Surgery Saves Lives campaign,
Implementation of safe surgical procedures occurred in line with the checklist and
this leads to reduction of the incidence of adverse events in the operating
room(Venneri, Francesco, et al 2021). This is by highlighting interpersonal
communication and non-technical skills to play a significant role in preventing
harm in a surgical setting. Thus the role of an Operating Department Practitioner
in achieving the 5 steps for safe surgery cannot be understated
-Taylor, Natasha, et al (2019). “Operating Department Practitioners and Adult Nurses: Interprofessional
Education Bedfellows or a Bridge Too Far?” BMJ Simulation and Technology Enhanced Learning, vol. 5, no.
4, 12 Aug. 2019, pp. 189–191, https://doi.org/10.1136/bmjstel-2019-000439.
-Venneri, Francesco, et al (2021). “Safe Surgery Saves Lives.” Textbook of Patient Safety and Clinical Risk
Management, 15 Dec. 2020, pp. 177–188, https://doi.org/10.1007/978-3-030-59403-9_14. Accessed 2
Dec. 2021.
-WHO, (2009a) World Health Organisation. “WHO Surgical Safety Checklist.” 2009,
www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery/tool-and-resources.
-WHO, (2009b) World Health Organisation. “Safe Surgery.” 2009,
www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery.