Surgical checklists increase patient safety
A recent study shows that hospitals using operating room checklists have lower post-surgical death rates
When people consent to have a surgery, they do so because it will likely fix a problem or sickness that they are experiencing.
Even though every surgery carries certain risks, few people expect that they will be ones to experience a new illness, complication, or even death from the procedure. Some of these potential complications are unavoidable risks of surgery, but others can be avoided if the surgeons, nurses, and operating room team pay a little more attention.
Experts recommend operating room checklists
In our day-to-day lives, our brains function on auto-pilot more than we may realize.
Think about your routine of getting ready every morning. Can you remember what you did, in order, before you got to your workplace? The same can be true for routine tasks that we do at work.
While surgery is a distressing and unique situation from the patient’s perspective, for surgeons, nurses, and operating room staff, it is a routine occurrence that they see every day. That means that surgical healthcare providers need to find a way to overcome the risk of skipping over safety steps because they are working, at least to some degree, on auto-pilot.
The World Health Organization (WHO) published a guide called “Patient Safety: Safe Surgery” that contains some frightening facts:
- Complications after inpatient operations occur in up to 25% of patients.
- In industralized countries, nearly half of all adverse events in hospitalized patients are related to surgical care.
- At least half of the cases in which surgery led to harm are considered preventable.
Patient safety is a big topic of concern, considering that the number of surgeries continues to increase, to address traumatic injuries, cancers, cardiovascular disease, and other health problems, as well as elective surgeries, like cosmetic and plastic surgery.
WHO concludes that one way to make surgery safer is for operating room staff to use a surgical safety checklist.
The WHO checklist includes steps to check off in three stages: before anesthesia, before skin incision, and before the patient leaves the operating room.
The checklist for before anesthesia says that at least the operating room nurse and anesthesia provider should have the patient confirm his or her identify, site, procedure, and consent. They should then mark the site. Believe it or not, as an experienced Houston medical malpractice lawyer, I have seen cases where a surgical team operated on the wrong leg of a patient. Next, they should check the anesthesia machine, and medication. After that, the nurse and anesthesiologist or anesthetist should check to make sure that the pulse oximeter is on the patient and working right. That device measures oxygen saturation during the procedure. Finally, the checklist recommends that the nurse and anesthesia provider note whether the patient has a known allergy, difficulty airway, aspiration risk, or risk of significant blood loss.
The checklist for before skin incision starts with all surgical team members introducing themselves by name and role, and then confirming the patient’s name, procedure, and where the incision will be made. Next, the surgical nurse, anesthesia provider, and surgeon should note whether antibiotics were given, if necessary, within an hour before the surgery. After that, the checklist focuses on anticipated critical events. The surgeon needs to think about and check off any critical or non-routine steps, how long the surgery will take, and how much blood loss is expected. The anesthesiologist or needs anesthetist should think about and document any particular concerns specific to the patient. At the same time, the operating room nurses should confirm that the surgical site and equipment are sterile, and identify any equipment issued. The final recommended item on this checklist is whether any necessary radiology imaging is being displayed properly.
The final checklist that WHO recommends focuses on before the patient leaves the operating room. The nurse should confirm the name of the procedure, and then complete counting of surgical instruments, sponges and needles, to make sure that nothing was accidentally left inside the patient. The nurse should also label any specimens, including reading the specimen and patient names out load, and then identify any equipment problems that need to be fixed. Finally, the surgeon, anesthesia provider, and nursing staff need to discuss any key concerns for recovery and management of the patient.
Do surgical checklists make a difference?
The results of a five-year study in South Carolina on the WHO surgical checklist were published in the Annals of Surgery in April 2017. Almost all hospitals in the Palmetto State adopted the checklist after the study began in 2010.
The results of the study are attention-grabbing. There was a 22-percent different in the mortality (death) rate in the hospitals that best implemented the surgical checklists, as compared to hospitals that did not use the checklists.
How can you use the checklists to improve your surgical safety?
While the WHO checklists are designed for operating room personnel, they are also educational and helpful for patients and family members.
Remember, not all hospitals have implemented the checklists. It we be nice to know if yours uses checklists or not.
One of the ways to help keep surgeons, doctors, and nurses from going into an auto-pilot mode is to ask polite, open-ended questions, even focusing on items in the WHO checklists.
I recommend asking your surgeon or nurses if the hospital, surgical facility, or operating room team use a safety checklist or surgical time-out before starting the surgery. If so, ask what is involved in their procedures.
When it comes to anesthesia, it is a good idea to ask a number of detailed questions to make sure that the anesthesiologist or anesthesia provider has thought through your particular case. For example, ask if they see any particular risk because of your health condition, weight, or any other factor.
Prepare in advance for after the procedure by having a loved one available to receive for post-operative instructions. A lot of information is given at a time when patients are still groggy from anesthesia and the toll of surgery itself.
Surgery malpractice lawyers are here to help
If you or someone you care for has been seriously injured in the operating room, call 281-580-8800 for a free consultation with the Texas medical malpractice lawyers at Painter Law Firm.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine [...]read more
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