Cardiac Surgical Safety Checklist

December 12, 2009

Notes on the SCTS Cardiac Surgical Patient Safety Checklist, by S. C. Clark, Dec 2009.

Patient surgical safety checklists will become mandatory for all operations undertaken in the NHS from February 2010. Early versions of a surgical checklist trialled by the World Health Organisation in non-cardiac surgical patients have demonstrated significant reductions in mortality and post operative complications in many diverse health care settings. In aviation, the use of checklists as a means of error checking by crews during critical phases of flight are very well established and are an essential aid to safety. The existing WHO checklist (which was modified for use in the NHS last year) is not suitable for use in cardiac surgery and omits many necessary safety checks.The checklist we have devised covers all important safety checks necessary in cardiac surgery without omitting any of the original items from the NHS checklist. The checklist is evidence based and promotes established quality and safety practices. It has been approved for national use by both the Society for Cardiothoracic Surgery in Great Britain and Ireland and by the National Patient Safety Agency.

The checklist is divided into 3 parts – Sign in, Time out and Sign out.

Sign in

This section should be completed in the anaesthetic room before induction of anaesthesia. It should be completed by the Consultant surgeon (or his registrar) in conjunction with the anaesthetist present.
The checks are self explanatory but include confirmation of the patients identity, consent, operation site and type and that ward preparations have been completed satisfactorily.
There is a check that the patients MRSA status is known and that the team are aware of any patient allergies.
Anaesthesia preparation and safety checks are included with an assessment of the airway in case of difficulty. Plans for excessive bleeding are checked as being complete if necessary and a briefing with the anaesthesia team is included in this section.

Time Out

This section is performed before surgery actually commences. It could be done by a circulating nurse with the surgeons scrubbed in the theatre or by the surgeons before they scrub. It ensures that all personnel in the theatre are known to eachother and their roles defined and again checks the patient details and planned procedure.
A briefing with the theatre staff and perfusionist is done ensuring that the latter has checked the perfusion equipment for safety and is fully prepared. Instrument sterility is confirmed to the surgeon and a check that the surgical site infection bundle has been administered. The items listed here are evidence based and include existing standards of good practice. There is a check that relevant imaging has been reviewed by the surgeons or is displayed.

Sign Out

This part of the checklist is performed before the patient is transferred to the ITU. The instrument count is confirmed as being correct. The operation note is done and filed along with the relevant ICU documentation and drug charts. Any concerns for the recovery of the patient are recorded after discussion. A debriefing is undertaken with the operating team to address any deficiencies or problems identified during the case.

It is essential that the checklist is signed as being correct and complete by the surgeon, the anaesthetist and the scrub nurse. The checklist itself should then be filed in the notes. revalidation_checklist