Our Surgical Safety Checklist 

You can never be too careful.

If there's one sentence that sums up the purpose of the province's new Surgical Safety Checklist initiative, that's it.

The Surgical Safety Checklist has evolved from a concept that was taken from the airline industry. Before a plane leaves the ground, pilots are taught to run through a pre-flight checklist, ensuring everything from instruments to the weather conditions have been monitored.

In an operating room, a good weather report isn't a factor, but good communication certainly is. That's why surgical teams are enhancing their own safety checks with a standard tool.

At RMH, staff in the OR had been using a system called "Pause for the Cause". Prior to a surgical procedure, the team stopped, checked the identification of the patient again, double-checked they were doing the right procedure in the right place, discussed any drug allergies the patient suffered from, and made sure the patient had received antibiotics.

By enhancing our existing surgical safety checklist by the new standard tool developed for all hospitals in Ontario, the RMH "Pause for the Cause" will be just one of three safety checks that teams are required to perform with each surgical procedure.

One of the biggest differences with the new checklist is that the first team discussion takes place before the patient goes to sleep. Each member of the surgical team is introduced to the patient; the patient confirms his or her identity, the procedure, and that it's being done with consent.

The entire team discusses with the patient the medical information on the chart, the laboratory and pathology reports, verifying that the information is correct and no important details are missing, such as a drug allergy. The team confirms that all of the equipment they will or may need is in the room and in good working condition. They explore what problems could arise and make sure they're prepared for possible complications.

When the patient goes under the anaesthetic, phase two begins. Now called a "Time Out", this phase resembles the RMH Pause for the Cause exactly. It's the last opportunity for the entire surgical team to go over the information on the patient's chart before an incision is made.

The third phase takes place before the patient leaves the Operating Room. Essentially, it's a debrief in which the team clarifies what was done and whether or not anything unexpected took place that will require special instructions before the patient goes into the Recovery Room or the Intensive Care Unit. Together, the team confirms that any specimens that were taken during the procedure are clearly and correctly labeled.

Perhaps the most important change is not that these steps are being done - because they were always part of the process, but that they're no longer the responsibility of individuals. Every member of the surgical team takes responsibility for the completion of each step. And by communicating the details during each phase of the checklist, the team ensures the safety standards are met and no errors are made inadvertently.

Hospitals throughout the province begin reporting their compliance to the new Surgical Safety Checklist on July 30th. The compliance is shown as a percentage where all three phases of the new Surgical Safety Checklist were performed for all surgical procedures. The information is available on the Ministry of Health website, and on each hospital's website, and updated every six months.

The Surgical Safety Checklist is the latest patient safety indicator to be included on the Ross Memorial's website, http://www.rmh.org/. Under "Quality & Patient Safety", you can learn more about our hospital's rates of healthcare acquired infections, hand hygiene compliance and wait times. You can also learn how to avoid the most common risks for patients: medicines, falls and infections.  

Because when it comes to your health - you can't be too careful.