Surgical/anaesthetic/maternity safety

This page is part of the wider ‘enduring standards that remain valid from previous patient safety alerts‘ set of webpages.

Enduring standards applicable to anaesthesia, surgical specialties, or maternity services, that remain valid from past alerts are:

  • WHO Surgical Safety Checklist: Ensure the checklist is completed for every patient undergoing a surgical procedure (including local anaesthesia), and that the use of the checklist is entered in the clinical notes or electronic record by a registered member of the team; for example, surgeon, anaesthetist, nurse, ODP. Note that although the alert is titled WHO Surgical Safety Checklist, it recognises that locally the checklist can be added to, adapted, and used in related areas eg electroconvulsive therapy.
  • Removal/flushing of lines:
    1. The Sign Out section of the Surgical Safety Checklist to include sections for confirming that, before a patient leaves the procedural area:
      1. all intravenous administration sets, and extension sets without active flow, have been removed
      2. any multi-lumen connector without active flow through all its arms is removed; or if this is not possible because a patient cannot tolerate even brief interruptions to essential drug or fluid delivery, that all arms have been adequately flushed
      3. all cannulae have been identified and either removed or adequately flushed.
    2. Local documentation for handover to recovery, and recovery to subsequent place of care, requires documented and verbal confirmation that lines not in active use have been removed and multi-lumen connectors and cannulae have been removed or flushed.
  • Throat packs: The anaesthetist or surgeon for each patient should justify the decision to use a throat pack, and assume responsibility for ensuring the chosen safety procedures are undertaken. At least one visually based and one documentary-based procedure is applied whenever a throat pack is deemed necessary.
  • Digital tourniquets: Removal of digital tourniquets should form part of the swab count procedure and the length of time a tourniquet is in place should be recorded. CE marked digital tourniquets, which are labelled and/or brightly coloured, should be used in accordance with manufacturer’s instructions.
  • Checking pregnancy status: Preoperative assessment policies require that pregnancy status is checked within the immediate preoperative period and the check should be recorded on preoperative documentation.
  • Use of reconstruction plates: In orthopaedic surgery, when using reconstruction plates and the use of tray systems:
    1. If continuing to use a tray system, remove all reconstruction plates from this and purchase reconstruction plates as individual sterilised packs that are clearly identified, stored separately from DC plates, and opened only when needed.
    2. If not using a tray system, ensure reconstruction plates in individual sterilised packs are clearly identified, stored separately from DC plates, and opened only when needed.
  • Swab count after vaginal birth: To reduce the risk of retained swabs after vaginal birth, have written procedures in place for swab counts at all births (including perineal suturing).
  • Dropped babies: Local guidance is required outlining the initial actions that should be taken if a baby is accidentally dropped in hospital. The reference resource, provided as part of the original alert, has subsequently been updated by the British Association of Perinatal Medicine.

These enduring standards should be considered in the context of broader advice on surgical and anaesthetic safety provided by the Royal College of Anaesthetists, Safe Anaesthetic Liaison Group and Royal College of Surgeons, and the National Safety Standards for Invasive Procedures (NatSSIPs), currently under review by the Centre for Perioperative Care.

The NatSSIPs document and the WHO Surgical Safety Checklist replace those elements of the Correct Site Surgery alert relating to pre-operative site marking and the pre-operative marking verification checklist that may have been considered as enduring standards.


Go back to the main  ‘enduring standards that remain valid from previous patient safety alerts‘ webpage