Evidenced Based Practice

An important part of an evidence based perioperative collaborative that focuses on patient

safety and quality are checklists. Part of this evidence based initiative is to implement checklists
that include elements to keep procedures standard for every health facility. With an estimated 234
million procedures per year worldwide, the chance of wrong site, wrong patient, or retained
objects has a significant chance of error. Evidence based practice has validated evidence-based
initiatives to decrease the chance of mistakes. Improved outcomes stem from awareness and
understanding that the same checklists are to be done on every patient, every time. Even though
the World Health Organization (WHO) surgical site checklist (SSC) is evidence-based, it is not
always understood and time restraints on the staff decrease the chances it will be executed. Its
difficult to have every facility execute an exact checklist, but if the minimal elements are
included in the checklist each individual facility can modify and adapt a checklist that
incorporates fundamental safety specifications. Evidence has shown that by using the uniform
WHO checklist, the rate of mortality and injury had decreased (Hitt, 2012). The Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) has three components that
are to be included in the checklist:
1. Preoperative verification includes confirming patient identity, correct site, and correct
procedure.
a) Timing (when this verification occurs) is under local control.
b) Location (where this verification occurs) is also under local control.
2. Marking the surgical site can be done by the following individuals:
a) Operating surgeon

b) Participating resident
c) Participating licensed practitioner (including physician assistant or nurse practitioner) with a
collaborative or supervisory agreement with the surgeon (determination of this application is
under local control.)
3. Only one time-out is required, just prior to the incision.
a) Local hospitals may require more than one time-out.
b) Time-out must be repeated with a new surgeon or procedure.
References
Hitt,E. (2012). Surgical Checklist From WHO Improves Safety and Outcomes. Medscape
Nurses, Retrieved from http://www.medscape.com/viewarticle/774277
Retrieved from http://www.jointcommission.org/facts_about_the_universal_protocol/
Retrieved from http://www.who.int/patientsafety/safesurgery/faq_introduction/en/