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IHI Surgical Safety Checklist

The Institute for Healthcare Improvement (IHI) supports the surgical safety checklist that the World Health Organization (WHO) has created to ensure and maintain patient safety in the operating room. The checklist was written in an effort to improve shared communication between the surgical team members to maximize the level of patient care and monitoring.

  1. Prior to Administering Anesthesia

    • The nurse and anesthetist must confirm the identity of the patient who must then acknowledge the surgical site. The patient should receive a description of the procedure and give his consent to have the procedure performed. The site must then be marked in applicable situations. The check of the machine and the medication must be completed and verified. The pulse oximeter must then be inspected to ensure its proper function and it must be on the patient at this point. Ask the patient a series of questions; find out if he has any known allergies to medications. Ascertain if he has or could potentially develop an airway or aspiration risk. Determine the potential risk of blood loss. If the amount of blood loss will be greater than 500 mL for adults or 7 mL for children, place two intravenous solutions or IVs where they can be centrally accessed. Have the fluids planned prior to inducing the anesthesia.

    Before Making Skin Incisions

    • Verify that all members of the surgical team have introduced themselves to the patient and that they have explained their roles on the team. Verify the name of the patient along with the surgical site and type of incision. If applicable, determine if the patient has received antibiotic prophylaxis in the last hour. The surgeon must conclude the amount of potential blood loss. The surgeon must then determine the time it will take to perform the procedure and all of the steps of the procedure. The anesthetist should provide details of any patient-related concerns and these concerns should then be addressed. The nursing team should confirm the sterility with the indicator results, and should address any issues with the surgical equipment on the field before its use. In applicable cases, check to make sure that the essential imaging is displayed.

    Clearing the Patient to Leave

    • The nurses must verbally confirm the name of the procedure with the patient and surgical team. A count of the needles, sponges and surgical equipment should be conducted. All specimen labels should be read aloud by the nurses, providing the patient's name. Correct any equipment problems or count discrepancies. The entire team should determine the key concerns for recovery of the patient and post-operative management.

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