Chapter 28: Pre-procedure Checklist

INTRODUCTION

The use of a pre-procedure checklist (briefing script) at a huddle, or briefing, provides the opportunity for the team to align to address any missing information and ensure preparation before starting an operation and has been associated with decreases in patient harm. A standardized briefing script can be used prior to entering the operating room to improve communication and enhance patient safety. Our script was revised multiple times based on clinical complications and near-misses. By using this script, we are able to identify latent errors prior to entering the operating room.

The briefing script supplements the intraoperative procedural verification (universal protocol, Time out) that occurs immediately before incision. The World Health Organization (WHO) and the Joint Commission (TJC) highly recommend the use of a procedural checklist for verification immediately before incision as a mandatory process.¹ The data from hospitals around the globe have successfully demonstrated that the use of a simple surgical checklist before major operations can help to reduce surgical complications and death.²

THE PROCESS OF PRE-PROCEDURE VERIFICATION

Before any invasive procedure, such as cesarean delivery, the surgical team members will gather together for the “Huddle.” The team members include:

• Obstetric attending

• Obstetric fellow/resident/physician assistant

• Anesthesia attending

• Anesthesia fellow/resident

• Labor and delivery nurse

• Operating room circulator nurse

• Surgical technician

The team members will start by introducing themselves by their first name and roles to help facilitate communication.

BRIEFING SCRIPT

The obstetric pre-procedure checklist is designed specifically for obstetrical patients and was based on identified latent errors that were discovered in our clinical practice. It can be customized to meet any institution’s needs.

The Joint Commission had identified our “Briefing Script” for invasive procedures on Labor and Delivery Unit at Beth Israel Deaconess Medical Center³ (Fig. 28-1) as a best practice during their site visit.

REFERENCES