WA Health Surgical Safety Checklist

Why a Surgical Safety Checklist?

The Correct Patient, Correct Procedure, Correct Site Policy and Guidelines for WA Health Services (PDF 437KB) (C3 Policy) was implemented in 2005 and revised in 2006, based on the Ensuring Correct Patient, Correct Procedure, Correct Site Protocol (C3 Protocol) endorsed by Australian Health Ministers in 2004.

A 2008 national review found variation in implementation of, and compliance with the C3 Protocol. Locally, variation in compliance was also evident in the surgical setting following a 2009 audit at six metropolitan hospitals

In November 2009 Australian Health Ministers endorsed the World Health Organisation (WHO) Surgical Safety Checklist (PDF 93KB) as the national strategy for surgical safety in Australia, superseding the C3 Protocol. Ministers agreed that local versions of the Checklist be implemented in all jurisdictions by 1 July 2011.

The WA Health Surgical Safety Checklist (WA Health Checklist) was subsequently developed through extensive consultation across WA Health, the private hospital sector and relevant professional associations. It is to be implemented in all WA operating theatres and procedure rooms where invasive procedures requiring sedation/anaesthesia are performed by 30 June 2011.

For more detail refer to the Operational Directive (OD 0316/11).

Core Principles:

The WA Health Checklist is a minimum standard. Sites may adapt it to local requirements by adding extra elements. The following three principles are to be considered during adaptation:

The Checklist is a tool to improve VERBAL communication among the surgical team in the operating theatre.
The Checklist is the FINAL safety check before a procedure is commenced. It is not designed for planning or documenting treatment/care, and does not supplant other documentation of pre-surgical processes and procedures.
The Checklist should be SIMPLE, easy to follow and it should not take longer than one minute to complete each section.

NOTE: As its three-phase sequence is an important safety feature, adaptation must be limited to adding elements to the template without altering the configuration.

Resources

The WHO Website contains useful material and resources for implementation, including implementation guides and manuals, a starters’ kit and a PowerPoint presentation: www.who.int/patientsafety/safesurgery/tools_resources/en/index.html (external site).

Background

In 2008 the WHO developed the Surgical Safety Checklist (Checklist) as part of its global Safe Surgery Safes Lives (external site) campaign. The Checklist is a tool to reduce the rate of surgical error and complications. It includes a core set of safety checks for use in any operating theatre environment, and incorporates all steps of the C3 Protocol.

The Checklist was developed via a comprehensive iterative process and was subject to rigorous international piloting and study. A global trial (external site) of almost 8,000 surgical patients found that its use was associated with reductions in error, complications and mortality rates in both developing and developed countries. Evidence is also emerging that use of the Checklist enables better patient flow through theatre, improving efficiency of busy surgical wards, and that its use is cost-effective.

The Checklist is designed to improve safety by focussing on anaesthetic safety practice, ensuring correct site surgery, avoiding surgical site infection and venous thromboembolism. Most importantly the Checklist enhances communication within the surgical team, a critical factor in ensuring safety and quality of care. Its structure is based on the universally accepted sequence of surgical and other invasive procedures.

The Checklist has been widely adopted internationally and is supported by a range of learned Colleges and Associations, including the:

Royal Australasian College of Surgeons
Australian College of Operating Room Nurses
Australian and New Zealand College of Anaesthetists
Royal Australian College of Obstetricians and Gynaecologists
Australian and New Zealand College of Ophthalmologists

The C3 Policy is currently being revised and an updated version will be released in 2011. Until then, the C3 Policy remains current and should be used to augment the use of the WA Health Checklist. Once released, the updated C3 Policy will incorporate the WA Health Surgical Safety Checklist.

^I Haynes B et al. A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine 2009. 360; 491-9

^II Semel ME, Resch S, Haynes AB, Funk LM, Bader A, Berry WR, Weiser TG, Gawande AA. Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals. Health Affairs 2010. 29(9):1593-9.

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