Orthopedic Surgery

Surgical Safety Checklist

The Children's Hospital of Philadelphia regularly assesses and updates its best practices to keep all children as safe as possible during surgery.

As we continue to work toward our goal of becoming the nation's safest children's hospital, we also want to be as transparent as possible.

We want you to know how we are going to keep your children safe in the operating room — when they are often at their most vulnerable.

Before the induction of anesthesia

  1. Sign in is initiated by the anesthesiologist
  2. The circulating nurse and anesthesiologist will verify the following:
    The patient’s identity (with two patient IDs)
       •   The patient’s weight
       •   The patient's physical status according to American Society of Anesthesiologists' classification system
       •   Any allergies the patient has
       •   The procedure(s) being done that day
       •   That the site of the procedure is marked
  3. When applicable, the circulating nurse and anesthesiologist will also address:
    Alternate induction technique (i.e. parental presence, rapid sequence, difficult airway/intubation)
       •   Pain management (regional or patient-controlled analgesia)
       •   Special catheter placement (central venous, arterial, urinary)
       •   Malignant hyperthermia risk
       •   Hypothermia risk
       •   The risk of deep-venous thrombosis (DVT) prophylaxis (if patient is 14 or older and the procedure is expected to last more than 45 minutes)
       •   Patient positioning
       •   Inpatient bed requirements

Before the procedure starts

  1. Appropriate patient positioning, with all bony prominences padded to minimize the risk of pressure ulcers
  2. A time-out is initiated by the surgeon or anesthesiologist 
  3. All team members are introduced by name and role
  4. For all procedures, the following information is reviewed:
       •   Patient's name
       •   Procedure(s) being done, site of the surgery, side of the body
       •   Matching signed consent forms
       •   Pertinent medical history, medications or implants
       •   Initial count of materials (sponges, needles and other instruments) 
       •   Fire risk (low, medium or high) 
       •   Medications and solutions are typed/labeled
       •   Equipment sterilization is confirmed
       •   Antibiotic prophylaxis (whether it is required or not required, the time given, and re-dosing schedule)
  5. The procedure team will additionally review the following when applicable to the patient's procedure:
       •   Relevant imaging/studies available
       •   Special equipment/implants available
       •   Expected case duration
       •   Critical events
       •   Estimated blood loss
       •   Blood product availability
  6. Then the team stops. This is a final check before the procedure starts. Are there any questions or concerns from anyone in the OR?

Before the patient leaves the OR

  1. Sign out is initiated by the circulating nurse.
  2. The circulating nurse verifies sign-out with the surgery and anesthesia teams.
  3. For all procedures, the following information is verified and recorded:
       •   Name of procedure(s) completed
       •   The patient's wound classification based on the size and depth of the incision
       •   Final sponge, needle and instrument counts are correct
       •   Any specimens collected for testing are correctly handled, labeled and documented
       •   The patient's status (i.e. critical, stable) and post-op destination (i.e. recovery room, ICU, patient room)
  4. For some procedures, additional details are necessary, must be recorded and reported to appropriate staff. These include: 
       •   Any problems with equipment before, during or after the procedure 
       •   The patient's fluid balance (i.e. fluids administered or lost during the procedure, urine output, estimated blood loss)
       •   Post-procedure management of the patient (i.e. transport equipment, surgical concerns, medical/anesthesia concerns, pain control)
       •   Post-operative imaging procedures (in some cases)

More information

Learn more about how CHOP prevents surgical site infections and keeps patients safe during orthopedic surgery

Reviewed by: Keith D. Baldwin, MD, MPH, MSPT, and John P. Dormans, MD, FACS
Date: May 2013

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