World Health Organization Surgical Safety Checklist

Authored by Open Medicine, published on 2026-09-04 18:27:31.0

This algorithm is broadly aligned with the WHO Surgical Safety Checklist framework (Sign In/Time Out/Sign Out) and with contemporary perioperative patient-safety standards emphasizing team communication, correct patient/site/procedure verification, timely antibiotic prophylaxis, and reliable counts/specimen labeling. Evidence supports checklist implementation reducing perioperative complications and mortality, though effect size varies by setting and implementation quality. The content is consistent with WHO guidance and widely adopted safety recommendations, but some items (e.g., specific antibiotic timing windows) may require local protocol alignment by procedure and antimicrobial agent.Adapted from WHO Surgical Safety Checklist (copyright WHO, 2009). The checklist is intended for local adaptation.

Before induction checklist (with at least nurse and anaesthetist)

Team "Sign-In" phase: Has the patient confirmed identity, site, procedure, and consent? (Yes) Is the site marked? (Yes / Not applicable) Anaesthesia machine & medication check complete? (Yes) Pulse oximeter on patient and functioning? (Yes) Does the patient have: Known allergy? (No / Yes) Difficult airway or aspiration risk? (No / Yes, equipment/assistance available) Risk of >500ml blood loss (7ml/kg in children)? (No / Yes, two IVs/central access & fluids planned)
- Has the patient confirmed identity, site, procedure, and consent? (Yes)
  - Is the site marked? (Yes / Not applicable)
    - Anaesthesia machine & medication check complete? (Yes)
      - Pulse oximeter on patient and functioning? (Yes)
        
        Does the patient have: Known allergy? (No / Yes)
        
        Difficult airway or aspiration risk? (No / Yes, equipment/assistance available)
        
        Pre-induction airway risk assessment and ensuring availability of appropriate equipment and help are consistent with major difficult-airway guidance to reduce failed airway events and aspiration-related complications. Possible airways specific issue e.g. Double Lumen Tube (DLT) vs Bronchial Blocker (BB)?
        
        Risk of >500ml blood loss (7ml/kg in children)? (No / Yes, two IVs/central access & fluids planned)
        
        While the exact thresholds and access strategy may vary by procedure and patient factors, perioperative guidance supports preoperative hemorrhage risk assessment and preparation (vascular access, blood products/fluids) to reduce morbidity from major bleeding. Does the team have any arterial line concerns?
        
        Before skin incision (with nurse, anaesthetist and surgeon)
        
        Team "Time-Out" phase: Confirm all team members introduced themselves by name and role Confirm patient's name, procedure, and where incision will be made Antibiotic prophylaxis within last 60 minutes? (Yes / Not applicable) Anticipated Critical Events: - To Surgeon: critical/non-routine steps; how long; anticipated blood loss - To Anaesthetist: patient-specific concerns - To Nursing Team: sterility confirmed? equipment issues/concerns? Essential imaging displayed? (Yes / Not applicable)
        
        Confirm all team members introduced themselves by name and role
        
        Confirm patient's name, procedure, and where incision will be made
        
        Antibiotic prophylaxis within last 60 minutes? (Yes / Not applicable)
        
        Discuss Anticipated Critical Events (Select "Details" to View Events by Role)
        
        Anticipated Critical Events: To Surgeon: critical/non-routine steps; how long/planned OR time; anticipated blood loss To Anaesthetist: patient-specific concerns To Nursing Team: sterility confirmed? equipment issues/concerns? Are procedure and patient specific equipment available? e.g. Ensure surgical mesh, critical tools or prosthesis are available.
        
        Essential imaging displayed? (Yes / Not applicable)
        
        Essential imaging should displayed and reviewed by the operator.
        
        Before patient leaves operating room (with nurse, anaesthetist and surgeon)
        
        Team "Sign Out" phase: Procedure confirmation, counts, specimen labeling, equipment issues, and recovery/management concerns Key processes to prevent retained surgical items, diagnostic errors, and handoff failures
        
        Nurse verbally confirms: name of procedure, completion of instrument/sponge/needle counts, specimen labelling (read labels aloud incl. patient name), equipment problems to be addressed
        
        This step is directly aligned with WHO Sign Out and is also supported by retained surgical item prevention guidance emphasizing standardized counts and reconciliation processes; evidence is largely observational and consensus-based rather than RCT-driven for individual elements.
        
        To Surgeon, Anaesthetist and Nurse: key concerns for recovery and management?

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