Is the WHO checklist mandatory?

NHS England » Decade of improved outcomes for patients thanks to Surgical Safety Checklist Leading figures in health are celebrating ten years of a checklist for surgical teams which has saved countless lives and improved outcomes for patients in England and around the world.

The is a simple tool designed to improve communication and teamwork by bringing together the surgeons, anaesthesia providers and nurses involved in care to confirm that critical safety measures are performed before, during and after an operation. Launched by the (WHO) in June 2008, with substantial input from UK clinicians, the checklist was mandated for use in the NHS in January 2009.

It is now in standard use across the UK as well as worldwide.

A wide range of studies and evaluations since 2008 have shown the checklist to reduce the rate of deaths and surgical complications by as much as one-third in the facilities where it is used.Further improvements include cost savings and better communication between staff members, and similar checklists are now also in use in a range of other clinical areas, including childbirth, emergency departments, and intensive care units.The operating theatre is the most common site for adverse surgical incidents, with errors occurring in nearly 15% of all patients globally, and some international studies suggesting that surgery may be responsible for up to 1 million deaths every year, and an additional 7 million postoperative complications.

Thanks to funding provided by the U.K. during its EU Presidency in 2005, and with extensive involvement from UK clinicians, WHO started work to address this in 2006, producing the first ever global guidelines for safe surgery, which was then developed into the Surgical Safety Checklist, modelled on the pre-flight checklist pilots undertake.

Pauline Philip, National Director for Emergency and Elective Care for the NHS in England, was previously Director for Patient Safety at the World Health Organization where she led the development of the checklist, and she continues to help promote surgical safety around the world as honorary CEO of the international NGO Lifebox.

Pauline Philip said: “The safety of patients should always be the number one priority for the NHS, and for any health system around the world. It was a privilege to work with Lord Darzi and some of the country’s leading clinicians to develop this checklist to support safety in operating theatres around the world, and a source of pride that the NHS led the world in piloting and adopting it.” Between October 2007 and September 2008, the effect of the checklist was studied in eight hospitals in eight cities, including St Mary’s Hospital in Paddington, where the local lead was Lord Ara Darzi.

1. Those pilots found that use of the checklist reduced the rate of deaths and surgical complications by more than one-third across all eight pilot hospitals.
2. The rate of major inpatient complications dropped from 11% to 7%, and the inpatient death rate following major operations fell from 1.5% to 0.8%.

Speaking at an event organised by Lifebox and the Royal Society of Medicine in London to celebrate a decade of the checklist’s adoption in the NHS, Lord Darzi said: “10 years on from the introduction of the WHO Surgical Safety Checklist we have seen considerable improvements in the safety of patients undergoing surgery.

• The impact of this pivotal innovation extends well beyond the surgical domain, prompting positive changes in the wider global patient safety movement.
• We must not allow healthcare to become complacent – and in the coming decade, we need to adopt behavioural, digital and technological innovations, to ensure we fulfil our commitment to improving patient safety worldwide.” The checklist is a simple 19-item tool which addresses serious and avoidable surgical complications, by ensuring that critical steps outlined in the guidelines are done in every surgery, every time, everywhere.

It also serves as a critical communication tool for the operating theatre team. The checklist’s 3-pause point structure represents natural breaks in the surgical flow, and emphasises time points where changes can be made before it’s too late. Each item within these pause points serves either to trigger a process check of a critical safety step, or prompt a discussion to ensure a common understanding of the patient’s specific history, the surgical plan, and any potential problems that could arise during the procedure.

• The checklist was launched in June 2008, with pledges of support from leading health organisations including the Royal Colleges of Surgeons, Anaesthetists, Obstetricians and Nurses.
• Professor Derek Alderson, President of the Royal College of Surgeons said: “The WHO surgical safety checklist has demonstrated that even simple innovations can have profound patient safety benefits in healthcare.

Since its introduction, countless harmful incidents have been avoided and it has helped to create a safety first culture in the NHS. There is no excuse for surgical teams not to use it. “Over the next decade it will be vital to help spread its adoption in other parts of the world.

How many items are included in the WHO Surgical Safety Checklist?

Introduction – Operating room (OR) is a critical facility within the hospital where surgical operations are carried out in an aseptic yet stressful environment. This stress coupled with the performance of various surgical patterns is rarely admitted by the surgical community since accentuation of leadership and self- confidence is very exalted that stress is often realised as a stamp of weakness or failure,

Surgical team members highly contrive their efforts to attain their patients’ full care and safety. Culture of patient safety and infection control needs to be established first of all, especially in OR,, World Health Organization (WHO) published the surgical safety checklist which comprises 19 items that must be checked at 3 points all the time of surgery; sign in, time out and time out,

A mechanism needs to be developed for capturing data relating to knowledge of patient safety and patient safety practices,, Infection prevention and control(IPC) seizes an exquisite place in patient safety framework because it is universally pertinent to health workers and patients at whatsoever health-care station.

The conveyance of essential health services and the recovery phase of any health system should include IPC as a vital constituent, not just a response-specific intervention, If health care personnel (HCP) realise the evocation of infection control program, they will presumably carry out any exposure-control plan.

Congruity, proficiency, and applicable coordination of IPC activities can be attained through unmistakably written policies, procedures, and guidelines. Infection-control training should be received by HCP minimally three times; on the initial appointment when exposed to new tasks or procedures, and at a minimum, annually.

1. Occupational education and training should take hold of the assigned duties,,
2. Providing high-quality care should include organisational atmosphere cohesive to commended patient safety and infection control practices created by hospital administrators.
3. Sufficient resources and visible support in the form of continuous education programs must be provided by hospitals to reach this high-quality care concept,

This study aims to design and conduct an educational program of patient safety and infection control for operating rooms OR team at Port-Said general hospital and to assess their post-intervention knowledge and practices changes.

What is the sequence of the WHO Surgical Safety Checklist?

Discussion – The WHO checklist consists of three main parts, which are implemented at specific time-points during the surgery: The first part (Sign-in) is done before administering anesthesia to the patient; the second part (Time-out) is done before taking the surgical incision; and the third part (Sign-out) is done before shifting the patient to recovery room.

At each of these time-points, important information can be checked, communicated, and shared between all team members participating in the surgery. The WHO encourages modification of the checklist to suit local practices. In 2009, a modified version of the WHO checklist was introduced in the major OT in our hospital, a tertiary level cancer center in India.

Six elements/items were added to the original checklist according to the requirements in our hospital. Because there is no circulating nurse in our OTs, it was decided that the checklist would be implemented by one of the three OT team members (surgeons, anesthetist, or nurse).

• In addition, it was decided that the third part (Sign-out) would be done before the closure of the surgical incision.
• Surgery is an integral part of healthcare system all over the world.
• Literature has shown that at least half of the surgical complications are avoidable.
• Various studies conducted in the Western world have shown that introduction and implementation of the SSC has significantly reduced surgical complications and improved patient outcomes.

The use of the SSC not only improves patient safety but also introduces a safety culture among the OR team members. For a checklist to be effective, compliance is of vital importance. In a systematic review in 2012, Borchard et al, observed that the overall compliance to the checklist ranged between 12 and 100% (mean-75%) with maximum compliance of 90% during the Time-out part.

• In our study, the overall compliance to the checklist was 84.8%, but the maximum compliance was found during the Sign-in part, which was 100% in our study.
• The compliance rates for second (Time-out) and third part (Sign-out) were 78 and 76.5%, respectively.
• This reduced compliance for the third part of the checklist is consistent with the results from studies done in the Western world where the completeness of the checklist was lowest for the third part.

Our study results can be explained by the absence of a dedicated circulating nurse for implementation of the SSC. For the first part of the checklist, all three members of the operating team (surgeon, nurse, and anesthetist) are relatively unoccupied and free to perform the checklist, whereas during the remaining two parts, they are involved with clinical work.

In a retrospective study by Fourcade, the frequency of SSC items raising concern ranged from 1.5 to 1.9%, with common ones including forgotten administration of antibiotics, unexpectedly high risk of bleeding, incomplete preparation, and incomplete orders. In our study, 6% (131) of important items were identified only during the conduct of the checklist.

In terms of the individual items, the item that prompted an action maximum times was the “instrument count” done during the third part (23.5%) followed by specific instrument required for surgery, which is done in the first part (16%) and administration of antibiotic during the second part (12.2%).

This shows the importance of conducting the checklist, as these important items would have been forgotten if not for the checklist and that would have put the patient at risk. It is also worrying that the item prompting a change in behavior maximum times was in the third part of the checklist which had the lowest compliance.

In a retrospective study by Paugham-Burtz, adequate communication between the team members was found in only 4% of cases with no communication at all in 27%. In our study, all three staff members of the OT team (surgeons, anesthetists, and nurses) interacted with each other while implementing the checklist in 52% of the cases.

• In the rest of the cases, one or more of the team members did not participate in the checklist implementation.
• The interaction between all three members was highest (78%) during the second part of the checklist and lowest (24.5%) during the first part.
• The second part of the checklist is conducted just before the surgery starts.

Hence all the team members have their undivided and complete attention toward its implementation unlike in the last part of the checklist where they are busy in the clinical work. This could explain the highest interaction between all the team members for the second part.

• De Vries et al,
• Observed differences in compliance with completion of the checklist between surgeons and anesthetists, in which 77% of surgeons completed the checklist, whereas only 35% of anesthesiologists completed the checklist.
• Our results showed that the surgeons initiated the checklist in 83.5% of all the cases, whereas the anesthetists initiated it in 16.1% cases followed by nurses who initiated it in only 0.4% cases.

This is probably due to the OR culture in India, where nurses do not take a leading role. Equal participation of all the team members in the checklist is essential for the successful implementation of the checklist. Reduced initiation by anesthetists and nurses in our study strongly indicates a requirement of change in OR culture.

• Studies have shown that teamwork in surgery improves outcomes, with high-functioning teams achieving significantly reduced rates of adverse events.
• Lingard et al,
• Studied the effect of interprofessional checklist briefings in OR between the surgical team members and observed that these briefings reduced the number of communication failures in the OR and promoted team communication that was proactive and collaborative which helped in preventing errors.

Conley et al, undertook semi-structured interviews with implementation leaders and surgeons using the checklist. The results showed that for a highly effective implementation it is important that it is clearly communicated “why” and “how” the checklist should be used.

How” refers not only to actual checklist execution but also to checklist introduction and support. Key points to explaining “why” were, for example, providing a rationale for checklist implementation, highlighting values that aligned the institution with the checklist and surgical staff recognizing their own role in patient safety.

The success of the implementation of the checklist was much higher when it was led by a multidisciplinary team, which met regularly and spontaneously, than when the implementation was led and mandated by a single surgical staff member. Our study results indicate that appropriate measures are required to improve teamwork and communication between all the team members.

Explaining the importance of the checklist, educating, motivating, and training all the staff members included in conduct of checklist is the key to make it more effective. Our study has given us important inputs with respect to the compliance to the checklist and interaction between different team members after 5 years of the checklist implementation.

Though we have 100% compliance during the first part of the checklist, the compliance during the second and third part needs improvement. The level of interaction between all three members is poor during the first and third part of the checklist. The initiation of the checklist is done by surgeons in most of the cases.

In spite of the varied compliance, the percentage of change prompted by the items in checklist is 6%, which is significant. From the available literature in the past, it is proven that compliance to the checklist is paramount in increasing the effectiveness of the checklist and in bringing a safety culture to the OR.

Our study has provided us with an opportunity to take measures to further increase the compliance to our checklist, to encourage the interaction between the team members, and to be actively involved with greater participation and ownership of the process.

Several large studies have looked at the impact of the implementation of the SSC on patient outcomes such as infection rates, morbidity, and mortality. One of the chief limitations of our study is that we did not have the data to study the effect of the SSC on these outcomes. Also, as the observations were carried out by a research nurse, we had to limit the observations to those items which could be easily picked up by the nurse.

We did not look at hard outcomes such as infection, morbidity, and mortality. Also, we did not look at emergency cases. The compliance for the checklist is likely to be lower for emergency cases but more crucial at the same time, as more items are likely to be missed in an emergency situation.

The most important strength of our study is that all the operation theatre personnel were blinded to the audit. This is the first such study from the Indian. Because most hospitals in India do not have a circulating nurse, it is likely that our results will be representative of OTs across India. To improve the implementation of the checklist at our hospital, we have renewed our efforts by introducing mandatory department-wide training and reinforcement about the checklist and its benefits, involvement of multidisciplinary team to identify barriers in implementation, interactive sessions, immediate real-time feedback regarding the implementation of the checklist, and opinion from end-users.

We have also suggested that compliance with the checklist should be used as a performance indicator with different surgical specialties. In conclusion, though the SSC is an important tool for improving patient safety, the quality of its implementation was found to be suboptimal, with scope for improvement.

What is the surgical safety checklist in OT?

1. Introduction – Surgical care is a crucial component of healthcare service delivery in all healthcare systems. Millions of surgical procedures are performed globally, most of them being undertaken in middle to high-expenditure countries, Considering the high burden of surgical services and complications that can arise during surgical procedures, surgical safety is a global public health concern.

A review of the in-hospital adverse events showed that most adverse events were operation-related, and roughly 43% were preventable, In response to the need for surgical safety, WHO launched Safe Surgery Saves Lives in 2006, which highlighted the essential objectives for safe surgical practice, and the WHO surgical safety checklist (SSC) was formulated as an effort to provide surgeons with a concise layout to follow these recommendations that ensure patient safety during surgical procedures,

The surgical safety checklist consists of three components: sign-in, performed before the induction of anesthesia; time-out, performed before skin incision; and sign-out, performed immediately after skin closure or before the patient leaves the operating theatre,

The checklist employs tactics to improve efficiency in the operating theatre and inculcates teamwork and good communication among the operating staff, all of them essentially working together to make the surgical environment safe for the patient. Implementation of the surgical safety checklist has shown to not only decrease operative morbidity and mortality but also foster a patient safety culture and enhances communication,

It has been established by many studies that the surgical safety checklist reduces morbidity and mortality, but implementing the checklist in diverse surgical settings throughout the world has been a challenge. A prospective observational study in Colorado revealed suboptimal compliance to the safety checklist and a significant difference in compliance among different surgical specialties,

Another survey from Ethiopia revealed a surgical safety checklist compliance rate of 39.7%, A review article highlighted that SSC compliance rates vary significantly among different centers, highly dependent on perceptions, teamwork, and efficient leadership, The role of the SSC in improving patient safety during surgical practice has been well established.

Implementing the SSC will require effective leadership, a delegation of responsibilities, and collaboration between the surgical staff, It is imperative to assess compliance to SSC in our hospital setting and explore the barriers to effective compliance, as this will help us implement SSC in our surgical environment and improve patient safety.

What does the WHO checklist do?

Reproduction of the WHO Surgical Safety Checklist – The WHO Surgical Safety Checklist can be reproduced in its entirety without any modifications or adaptations to layout or wording. This includes the WHO emblem as it appears as an integral part of this tool.

Copyright Translations Request for permission to reprint and reproduce the Checklist

Why is the WHO Surgical Safety Checklist important?

Background – The “WHO Surgical Safety Checklist” is used globally to ensure patient safety during surgery and has demonstrated potential to be effective at reducing surgical complication and mortality rates, The WHO checklist improves ‘patient safety and inter-discipline communication’ and prevents ‘avoidable complications by emphasising current safety procedures,

Despite widespread adoption, surgical “never events” and other OR related serious incidents still occur, which could be due to problems regarding compliance to the checklist, To successfully implement the checklist, it is imperative to have key team members in a supervisorial role. This facilitates team interaction regarding adjustment of checklists, and consideration of local contextual factors,

Adopting a stakeholder-driven approach while engaging all OR personnel (including surgeons, anesthesiologists, nurses, and technical staff) in a multifaceted intervention can significantly increase surgical safety checklist adherence,

What are the five steps to safer surgery checklist?

Overview – Worldwide, 45% of medical errors occur in the operating theatre and nearly half of these are preventable.2 Faced with evidence of avoidable harm, attitudes and practices need to change to promote safer healthcare. Five Steps to Safer Surgery is a surgical safety checklist.

How many types of checklist are there in safety?

Success in injury prevention often comes from having a good safety routine. Adopting a steady workplace operations schedule keeps everyone on task and working toward the same goals. Once a new routine is established, it will become a habit (and it can eliminate old bad habits that might have been formed).

• But what happens when you do everything right but overlook the smallest thing? In some professions, overlooking that little thing can be catastrophic.
• That’s why checklists are so important—they can help build new habits while making sure that small but essential tasks don’t fall through the cracks.
• And even the most basic checklist can improve effectiveness in any industry.

As Atul Gawande notes in his book The Checklist Manifesto: How to Get Things Right, knowledge has become more accessible over the last several decades. Where ignorance used to be an acceptable (and more forgivable) reason for failure, declining to correctly apply knowledge is simply unforgivable.

Failures of ignorance we can forgive. If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort. But if the knowledge exists, and is not applied correctly, it is difficult not to be infuriated,” Gawande says. Creating structure in the work environment helps to ensure that everyone is following all of the prescribed functions of their job.

Once functions are performed enough times, they will become a habit, Habits can help workers complete tasks even when their minds aren’t on the task at hand, but like memory, habits aren’t infallible. Implementing a checklist, even for the most routine tasks, is the key to reducing (or eliminating) injuries and critical mistakes.

How effective is the WHO checklist?

The introduction of the checklist was found to have the following effects, independently of the socioeconomic characteristics of the hospitals (5): a statistically significant relative reduction of mortality in major surgery by 47%, from 56 in 3733 cases (1.5%) to 32 in 3955 cases (0.8%)

What are the three parts of the surgical safety checklist?

Introduction – The surgical safety checklist consists of three components: sign-in, performed before the induction of anesthesia; time-out, performed before skin incision; and sign-out, performed immediately after skin closure or before the patient leaves the operating theatre.

WHO guidelines on patient safety?

The global landscape of health care is changing with health systems operating in increasingly complex environments. While new treatments, technologies and care models can have therapeutic potential, they can also pose new threats to safe care. Patient safety is a fundamental principle of health care and is now being recognized as a large and growing global public health challenge.

Global efforts to reduce the burden of patient harm have not achieved substantial change over the past 15 years, despite pioneering work in some health care settings. Patient safety is a framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce its impact when it does occur.

Every point in the process of care-giving contains a certain degree of inherent unsafety. Clear policies, organizational leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients and families in the care process, are all needed to ensure sustainable and significant improvements in the safety of health care.

Patient safety in health care is an urgent and serious global public health concern. Patient harm exerts a very high burden on all health care systems across the world. Every year, an inadmissible number of patients suffer injuries or die because of unsafe and poor quality health care. Most of these injuries are avoidable.

The burden of unsafe care broadly highlights the magnitude and scale of the problem.

Patient harm due to adverse events is likely to be among the 10 leading causes of death and disability worldwide.Most of these deaths and injuries are avoidable.It is commonly reported that around 1 in 10 hospitalized patients experience harm, with at least 50% being preventable. Around two-thirds of all adverse events resulting from unsafe care, and the years lost to disability and death, occur in LMICs.

It is estimated that the cost of harm associated with the loss of life or permanent disability, which results in lost capacity and productivity of the affected patients and families, amounts to trillions of US dollars every year. Furthermore, the psychological cost to the patient and their family (associated with the loss or disabling of a loved one), is certainly significant, though more difficult to measure.

Recognizing the huge burden of patient harm in health care, the 72nd World Health Assembly, in May 2019, adopted a resolution (WHA72.6) on “Global action on patient safety”, which endorsed the establishment of World Patient Safety Day, to be observed every year on 17 September; and recognized “patient safety as a global health priority”.

The resolution urges Member States to recognize patient safety as a key priority in health sector policies and programmes, and requests the Director-General of WHO to emphasize patient safety as a key strategic priority in WHO’s work, especially within the universal health coverage (UHC) agenda.

The resolution also requests WHO’s Director-General “to formulate a global patient safety action plan in consultation with Member States, regional economic integration organizations and all relevant stakeholders, including in the private sector”. This plan will be based on the guiding principles of equity, sustainability and accountability.

The proposed action plan will seek inspiration and coherence with existing global action plans developed by WHO and other global health and development agencies. Responding to the unprecedented global patient safety movement, the need for very urgent and concerted action in this area, and aligning with the Sustainable Developmental Goals, WHO’s Director-General launched the WHO Flagship Initiative “A Decade of Patient Safety 2020-2030” in February 2020.

What are the 6 international patient safety goals?

Goal 1: Identify patients correctly. Goal 2: Improve effective communication. Goal 3: Improve the safety of high-alert medications. Goal 4: Ensure safe surgery.

What is pre operative checklist?

The Preoperative Checklist is completed by clinicians working within their scope of clinical practice and is designed to aid patient preparation prior to their transfer to theatre and support effective clinical handover when there is a transfer of professional responsibility and accountability.

WHO Surgical Safety Checklist prevents what type of error?

Abstract – Approximately 2,700 patients are harmed by wrong-site surgery each year. The World Health Organization created the surgical safety checklist to reduce the incidence of wrong-site surgery. A project team conducted a narrative review of the literature to determine the effectiveness of the surgical safety checklist in correcting and preventing errors in the OR.

• Team members used Swiss cheese model of error by Reason to analyze the findings.
• Analysis of results indicated the effectiveness of the surgical checklist in reducing the incidence of wrong-site surgeries and other medical errors; however, checklists alone will not prevent all errors.
• Successful implementation requires perioperative stakeholders to understand the nature of errors, recognize the complex dynamic between systems and individuals, and create a just culture that encourages a shared vision of patient safety.

Keywords: OR safety; Swiss cheese model; checklists; error prevention; just culture; medical errors; patient safety; preventable adverse events; surgical safety checklist; teamwork. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

What is the purpose of checklist assessment?

Assessment Checklists – A checklist is an assessment tool that lists the specific criteria for the skills, behaviors, or attitudes that participants should demonstrate to show successful learning from training. Checklists usually feature statements or questions about the participant’s performance of each criteria.

What is a process checklist?

WHAT IS A PROCESS CHECKLIST? – A process checklist is a process that include a step-by-step mandatory method application. These processes are usually paper sheets, books, or memorised lists that workers must validate while executing their operations. The checklists are executed by field operators, and, frequently include a specific workflow per process. The Process Checklist procedure

Who created the 5 steps to safer surgery?

WHO Surgical Safety Checklist The World Health Organisation (WHO) first published their Surgical Safety Checklist in 2010. It’s a series of five critical steps that surgical teams should perform before and after surgical procedures to reduce the risk of certain adverse events.

What are the effects of the introduction of the WHO Surgical Safety Checklist on in hospital mortality?

Abstract – Objective: To evaluate the effect of implementation of the WHO’s Surgical Safety Checklist on mortality and to determine to what extent the potential effect was related to checklist compliance. Background: Marked reductions in postoperative complications after implementation of a surgical checklist have been reported.

• As compliance to the checklists was reported to be incomplete, it remains unclear whether the benefits obtained were through actual completion of a checklist or from an increase in overall awareness of patient safety issues.
• Methods: This retrospective cohort study included 25,513 adult patients undergoing non-day case surgery in a tertiary university hospital.

Hospital administrative data and electronic patient records were used to obtain data. In-hospital mortality within 30 days after surgery was the main outcome and effect estimates were adjusted for patient characteristics, surgical specialty and comorbidity.

• Results: After checklist implementation, crude mortality decreased from 3.13% to 2.85% (P = 0.19).
• After adjustment for baseline differences, mortality was significantly decreased after checklist implementation (odds ratio 0.85; 95% CI, 0.73-0.98).
• This effect was strongly related to checklist compliance: the OR for the association between full checklist completion and outcome was 0.44 (95% CI, 0.28-0.70), compared to 1.09 (95% CI, 0.78-1.52) and 1.16 (95% CI, 0.86-1.56) for partial or noncompliance, respectively.

Conclusions: Implementation of the WHO Surgical Checklist reduced in-hospital 30-day mortality. Although the impact on outcome was smaller than previously reported, the effect depended crucially upon checklist compliance.

Why do we need safety inspection checklist?

Daily Safety Inspection Checklist – A daily safety inspection checklist enables to evaluate key workplace health and safety issues that have the potential of cropping up on a daily basis. This checklist helps you keep a constant vigil on daily work conditions, incidents and safety compliance of people, processes and machinery.

How effective is the WHO checklist?

The introduction of the checklist was found to have the following effects, independently of the socioeconomic characteristics of the hospitals (5): a statistically significant relative reduction of mortality in major surgery by 47%, from 56 in 3733 cases (1.5%) to 32 in 3955 cases (0.8%)

Why was the WHO checklist introduced?

History of the WHO Surgical Safety Checklist – In 2002 the World Health Assembly urged countries to improve the safety of health care and monitoring systems. They requested that the WHO set global standards of care and provided support for countries to improve patient safety.

As a result, WHO Patient Safety was formed, and focussed its energy on campaigns named Global Patient Safety Challenges. Following their first challenge, ‘Clean Care is Safer Care’, WHO launched ‘Safe Surgery Saves Lives’ and led by Professor Atul Gawande, published WHO Guidelines for Safe Surgery 4,

This set out 10 essential objectives for safe surgery from which the Surgical Safety Checklist was derived. (Figure 1) The aim of this ‘WHO checklist’ was to give teams a simple, efficient set of priority checks to improve effective teamwork and communication and encourage active consideration of patient safety for every operation performed.

• WHO also wanted to ensure consistency in patient safety in surgery and introduce (or maintain) a culture that values patient safety 5,
• In a pilot study of the WHO checklist implementation, Professor Gawande’s team prospectively observed over 3000 patients prior to the introduction of the checklist and nearly 4000 patients after checklist implementation, and measured the rate of surgical complication or mortality up to 30 days after surgery or until discharge 6,

The study included four hospitals in low- and middle-income countries and four hospitals in high-income countries and found the overall rate of death prior to introduction of the checklist was 1.5% and after checklist implementation fell to 0.8%. Inpatient complications were also reduced, from 11% pre checklist to 7% after the checklist was introduced.

1. As a measure of adherence to the checklist, they identified 6 safety indicators, such as pre-incision antibiotics, swab counts and routine anaesthetic checks, and saw an increase in performance of these from 34.2% pre checklist to 56.7% post checklist.
2. It is interesting that even with only 56% completing these 6 indicators, significant reductions in complications and death rates were seen.

The checklist implementation team used team introductions, briefings and debriefings as part of the safety routine, which has also been formalised as part of the checklist strategy in the UK (see below). By September 2014, the WHO team had identified 4132 institutions who had expressed an interest in using the checklist and 1790 institutions who were actively using the checklist in at least one operating theatre 7,

Why is the pre op checklist important?

The Preoperative Checklist is completed by clinicians working within their scope of clinical practice and is designed to aid patient preparation prior to their transfer to theatre and support effective clinical handover when there is a transfer of professional responsibility and accountability.

WHO guidelines on patient safety?

The global landscape of health care is changing with health systems operating in increasingly complex environments. While new treatments, technologies and care models can have therapeutic potential, they can also pose new threats to safe care. Patient safety is a fundamental principle of health care and is now being recognized as a large and growing global public health challenge.

Global efforts to reduce the burden of patient harm have not achieved substantial change over the past 15 years, despite pioneering work in some health care settings. Patient safety is a framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce its impact when it does occur.

Every point in the process of care-giving contains a certain degree of inherent unsafety. Clear policies, organizational leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients and families in the care process, are all needed to ensure sustainable and significant improvements in the safety of health care.

• Patient safety in health care is an urgent and serious global public health concern.
• Patient harm exerts a very high burden on all health care systems across the world.
• Every year, an inadmissible number of patients suffer injuries or die because of unsafe and poor quality health care.
• Most of these injuries are avoidable.

The burden of unsafe care broadly highlights the magnitude and scale of the problem.

Patient harm due to adverse events is likely to be among the 10 leading causes of death and disability worldwide.Most of these deaths and injuries are avoidable.It is commonly reported that around 1 in 10 hospitalized patients experience harm, with at least 50% being preventable. Around two-thirds of all adverse events resulting from unsafe care, and the years lost to disability and death, occur in LMICs.

It is estimated that the cost of harm associated with the loss of life or permanent disability, which results in lost capacity and productivity of the affected patients and families, amounts to trillions of US dollars every year. Furthermore, the psychological cost to the patient and their family (associated with the loss or disabling of a loved one), is certainly significant, though more difficult to measure.

Recognizing the huge burden of patient harm in health care, the 72nd World Health Assembly, in May 2019, adopted a resolution (WHA72.6) on “Global action on patient safety”, which endorsed the establishment of World Patient Safety Day, to be observed every year on 17 September; and recognized “patient safety as a global health priority”.

The resolution urges Member States to recognize patient safety as a key priority in health sector policies and programmes, and requests the Director-General of WHO to emphasize patient safety as a key strategic priority in WHO’s work, especially within the universal health coverage (UHC) agenda.

• The resolution also requests WHO’s Director-General “to formulate a global patient safety action plan in consultation with Member States, regional economic integration organizations and all relevant stakeholders, including in the private sector”.
• This plan will be based on the guiding principles of equity, sustainability and accountability.

The proposed action plan will seek inspiration and coherence with existing global action plans developed by WHO and other global health and development agencies. Responding to the unprecedented global patient safety movement, the need for very urgent and concerted action in this area, and aligning with the Sustainable Developmental Goals, WHO’s Director-General launched the WHO Flagship Initiative “A Decade of Patient Safety 2020-2030” in February 2020.

Jack Gloop