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Is the Use of Surgical

Checklists Thriving in
Your OR?

J une is a time for us to celebrate the tremendous progress

that has been made in implementing the time out for
surgery. Newer perioperative nurses may not remember
a time when there was not the expected pause before surgery.
We are still learning about what variables affect team strength,
and some of our knowledge about teams comes from sports. I
have been fortunate to play team sports, and I currently play
As awareness of wrong-site, wrong-patient, wrong-procedure on a co-ed recreational softball team that has a core group of
surgical events grew, the time-out process was established as players who have been together for more than 20 years.
a means to perform a final review of key pieces of information Although we often play against younger teams, the strength we
(eg, patient, procedure, site) immediately before surgery. In have in knowing our teammates gives us some advantages that
2004, AORN initiated National Time Out Day as an aware- newer, younger teams do not have. We have a high level of
ness campaign for the public and a call to action for all surgical trust in each other’s intentions and preparation, and we have
team members to improve patient safety. National Time Out the knowledge of how best to use each other’s skills. Of course,
Day, recognized June 10 this year, is supported by The Joint this is a fun, recreational example, so the analogy only goes so
Commission and the World Health Organization as a strategy far. However, in the high-stakes arena of surgery, knowledge of
to increase awareness of key patient safety practices associated each surgical team member is an asset; thus, introductions
with the time out. have become an important part of the surgical check-
list process.
Tremendous strides have been made by the World Health
Organization in recent years to improve surgical safety Name familiarity has been shown to improve the ability to
worldwide through the use of surgical safety checklists. Atul speak up, which is a hallmark of a safety culture, and clarity of
Gawande, MD, MPH, a surgeon, writer, and public health roles and responsibilities also helps make a team strong.
researcher who practices general and endocrine surgery at Because surgical teams can change from surgery to surgery and
Brigham and Women’s Hospital, Boston, drew additional even within surgeries, making assumptions that all members
attention by publishing his 2009 book, The Checklist Manifesto: know each other and each other’s roles can be dangerous. The
How to Get Things Right.1 These gains have helped surgical checklist directs us to consider the unique contribu-
established the use of a surgical safety checklist that tions and observations of each person to add to the shared
includes the key elements of the surgical time out as the knowledge and awareness of the entire teamdwhether it is
new, higher standard for surgical safety.2 Much has been about one team member’s fatigue, items from the preoperative
written about the effects of surgical checklist use on assessment that have arisen, or a delay in the arrival of a specific
improving teamwork, communication, and safety.3 It is item for the surgery. Hearing each team member’s voice is a
time to celebrate our progress as teams and consider what means to acknowledge the value of each team member’s
work lies ahead of us. contributions.
ª AORN, Inc, 2015 AORN Journal j 597
e June 2015, Volume 101, No. 6

A great team looks for ways to help each other improve, so that an intentional deep breath as a tool to reconnect the body and
the combined strengths are greater than any individual the braindperhaps we should add “deep breath in/out” as the
contribution. Building a strong, effective surgical team requires first step of the surgical safety checklist as a way to make sure
fostering trust and safety in all interactions with team members everyone is where their feet are!
and ensuring clear communication and leadership.4 In sports,
there are teams that have a superstar, and the fate of the team is CONCLUSION
often dependent on that individual’s skills; however, most Celebrating the time out and the use of surgical safety
winning teams espouse a philosophy of all members checklists is an effort to help the public understand the gains
succeeding together by drawing on each other’s strengths. It that have been made in surgical safety. However, there is more
has been said that “there is no ‘I’ in team.” We strive to to do. AORN continues to collaborate with The Joint
align this philosophy with the safety work of the surgical Commission and the Council on Surgical and Perioperative
team, who may be meeting each other for the first time Safety to emphasize the importance of surgical checklists. This
before surgery begins. The time out allows us to establish month, we emphasize the value of the time out for patient
the “we” or the team identity. It is similar to a team huddle safety. The first issue of the “AORN Quality & Safety Special
before the start of a game. Report” will be sent to all AORN members via e-mail in June
and will focus on the prevention of wrong-patient, wrong-site,
Knowing each other, understanding each other’s roles, valuing
wrong-procedure events, which represent the second most
each other’s contributions, and making sure the time-out
commonly reported sentinel event category.5 Watch for this
process supports the value of each team member continue to
special report and take time to review the articles in this
be important elements of making our ORs a safe place to
month’s AORN Journal that focus on preventing surgical
practice and receive care. It is important to continually assess

errors and making use of the surgical checklist. Our patients
our own practice to see if our actions are in alignment with
depend on us to be vigilant!
evidence-based practices. Do we model the importance of
listening to team members by taking time to listen to a hand-
over report and confirm there are no questions, even when we References
are anxious to finish our shift? Do we seek the perspective of 1. Gawande A. The Checklist Manifesto: How to Get Things Right. New
each team member when there is an adverse event or a York, NY: Metropolitan Books; 2009.
problem? Do we audit surgical checklist use to ensure that, 2. Surgical Safety Checklist. World Health Organization. http://whqlibdoc
over time, it is still being followed consistently? Are new sur-
gical team members informed and coached on how to actively Updated January 2009. Accessed March 30, 2015.
3. Lyons VE, Popejoy LL. Meta-analysis of surgical safety checklist
participate? Are we sharing the latest evidence about the
effects on teamwork, communication, morbidity, mortality, and
importance of the time out and the safety checklist? Are we safety. West J Nurs Res. 2014;36(2):245-261.
actively reviewing and updating the checklist to meet the 4. Shuhaiber J. The quest for safe surgical care: are we missing the
unique needs of the populations at our own sites? obvious? Bull Am Coll Surg. 2014;99(2):42-45. http://bulletin
It is important for surgical team members to be fully engaged -the-obvious/#. Accessed March 30, 2015.
and present when participating in the checklist and to respect 5. Sentinel event data e general information (1995-2014). The Joint
the process. At my organization, we have been discussing Commission.
situational awareness and mindfulness and what it means to be Information_1995-2Q_2014.pdf. Accessed April 16, 2015.
fully present. I once heard a football coach use the phrase “be
where your feet are,” and I thought it had application to what
Renae N. Battie
perioperative team members do. It is easy to multitask or
is the AORN President and the associate vice president,
become distracted by work or personal issues. During the time Perioperative Services, at CHI Franciscan Health, Tacoma,
out and completion of the surgical safety checklist, it is Washington. Ms Batti e has no declared affiliation that
important to be where your feet aredfully present, fully could be perceived as posing a potential conflict of
engaged, and listening. I heard a speaker recently discuss using interest in the publication of this article.

598 j AORN Journal