Revised Statement on Safe Surgery Checklists, and Ensuring Correct Patient, Correct Site, and Correct Procedure Surgery

The following statement was revised by the American College of Surgeons (ACS) Committee on Perioperative Care and the revision was reviewed and approved by the ACS Board of Regents at its June 2016 meeting.

The ACS recognizes patient safety as an item of the highest priority and strongly urges individual hospitals and healthcare organizations to develop guidelines and checklists to ensure correct patient, correct site, and correct procedure surgery.

Therefore, the ACS recommends the following guidelines to eliminate wrong-site surgery:

• Verify that the correct patient is taken to the operating room (OR). This verification can be made with the patient or the patient’s designated representative if the patient is underage or unable to answer for him/herself.
• Verify that the correct procedure is on the OR schedule.
• Verify with the patient or the patient’s designated representative the procedure that is expected to be performed, as well as the anatomic location of the procedure.
• Confirm the submission of a consent form with the patient or the patient’s designated representative.
• In the case of a bilateral organ, limb, or anatomic site (for example, hernia location of melanoma), the surgeon and patient should be in agreement and the operating surgeon should mark the site before giving the patient narcotics, sedatives, or anesthesia. For spine cases, level should be verified.
• If the patient is scheduled for multiple procedures that will be performed by multiple surgeons, all the items on the surgical checklist must be verified for each procedure.
• Ensure that all relevant records, imaging studies, equipment, and implants are available as needed.
• Conduct a briefing prior to administering anesthesia and call for a final time out before skin incision. These two steps should include verification with members of the surgical team to confirm the correct patient, site, and procedure. If any verification process fails to confirm the correct site, all activities should be halted until verification is confirmed to be accurate by the surgeon and team.
• Conduct a debriefing prior to the patient leaving the OR; the debriefing should include verbal discussion of sponge and needle counts.
• In the event of an emergency, these steps may be modified according to local hospital guidelines.

Disclaimer

The ACS offers this statement for consideration by surgeons, their hospitals, and healthcare organizations. This statement is provided as general guidance. It does not constitute a standard of care and is not intended to replace the professional judgment of the surgeon or health care administrator. This statement may be reviewed and modified as necessary to conform with the laws of the applicable jurisdiction, the circumstances of the individual hospital and healthcare organization, and requirements of other allied and healthcare organizations.

Bibliography

The Joint Commission. Universal protocol for preventing wrong site, wrong procedure and wrong person surgery. Available at: www.jointcommission.org/standards_information/up.aspx. Accessed August 8, 2016.

World Health Organization. WHO Safe Surgery Checklist. Available at: www.who.int/patientsafety/safesurgery/ss_checklist/en/. Accessed August 8, 2016.