Clinical procedure · WET-CHIR-03 · STD-03 · Operating theatre

Procedure checklist

Before an operation begins, the team goes through a checklist modelled on human surgery: patient identity, side of the procedure, equipment, drugs, a plan for complications. A routine that eliminates “obvious” errors.

STD-03 · Procedure checklist3 stages · 41 items

Process owner

The veterinarian responsible for the procedure

Participants

The surgeon, the veterinarian responsible for the anaesthetic, the technician/assistant, and a scrub nurse if one has been assigned

Purpose

Eliminating avoidable errors by jointly confirming the patient's identity, the procedure, the site of the procedure, the readiness of the team, the equipment, the drugs and the plan for responding to risk

Scope

All planned and urgent surgical and invasive procedures carried out in the operating theatre

Location

Operating theatre

Start

Preparing the patient for induction of anaesthesia

End

Handing the patient over to the recovery area or in-patient ward, after the “Sign out” part is complete

Documents

Procedure checklist, anaesthetic record, operation record, hospitalisation record, owner's consent

System records

Date and times of the three stages, team members, result of the check, discrepancies, decisions, interventions and the person who signed off

Procedure workflow

Procedure STD-03 · CHECKLIST (Procedure checklist) is intended for small animals. Its core is based on the “Sign in”, “Time out” and “Sign out” stages used in surgical safety checklists; a study in dogs and cats showed a significant reduction in the frequency and severity of complications after such a checklist was introduced.

Rules that apply

The checklist is completed for every patient undergoing a surgical or invasive procedure, regardless of the type of anaesthesia and the expected duration of the procedure.

The checklist is run by a designated coordinator, usually a technician/assistant or the person responsible for monitoring, who reads out each item aloud and confirms the answers.

At each item, active participation is required from the surgeon, the person responsible for the anaesthetic and the assisting staff. The aim is a shared safety pause, not merely ticking off a document.

If a critical confirmation is missing, the next stage is put on hold. The procedure can continue only once the discrepancy has been resolved, or the veterinarian's decision on how to proceed in an emergency has been documented.

Every member of the team can raise a concern or halt the start of the operation without fear of organisational consequences.

The checklist must not be completed retrospectively, except in an emergency; in that case the reason and the time it was completed must be recorded.

Stage 1: Sign in

When: before induction of anaesthesia or, in an emergency, as early as the patient's condition allows.

Led by: the designated checklist coordinator.

Patient identityOwner and consentProcedureSite and side of the procedureTests and imagingAnaesthetic assessmentAllergies and adverse reactionsVascular accessRespiratory riskBleeding riskAnaesthetic equipmentMonitoringDrugs and analgesiaInfection risk

Stage 2: Time out

When: after the patient has been prepared and positioned and the surgical field has been prepared and draped, immediately before the operation begins.

Led by: the whole team — everyone stops other tasks and responds out loud.

Team introductionsPatient identityProcedureSide and surgical fieldPatient positioningAsepsisSterility of instrumentsAntibiotic prophylaxisImplants and special equipmentImaging studiesSurgeon's planAnaesthetic planScrub nurse/assistant's planContingency planGo-ahead to begin

Stage 3: Sign out

When: after the wound has been closed, before the patient leaves the operating theatre or before handover for recovery begins.

Led by: the checklist coordinator, together with the surgeon and the person responsible for anaesthesia.

Name of the procedure performedCount of materialsImplantsBiological specimenWound checkEquipment problemsIntra-operative complicationsRecovery planHospitalisation planInformation for the ownerRecordsCompleting the checklist

Action in case of a discrepancy

Unconfirmed patient identityHalt induction or the start of the operation; compare the identifier, the records and the owner's details.

Discrepancy in procedure, side or fieldHalt the procedure immediately; verify the records, consent, imaging and field marking again.

No valid consentDo not perform an elective procedure; in a life-threatening situation, follow the rules for documenting emergency intervention.

Critical equipment missingDelay the start until the equipment is available, or change the procedure plan safely.

Sterility not confirmedDo not use the set; replace the instruments or prepare the field again.

Mismatch in the count of swabs, needles or instrumentsHalt completion of the procedure and search the field and the workstation; if the mismatch persists, carry out the appropriate diagnostics and documentation.

Sudden change in the patient's conditionStabilisation is the priority; once the situation is under control, complete the records and go through the relevant part of the checklist.

Breach of asepsisStop the task at the point of the breach, replace the contaminated item, assess the risk of infection and document the event.

The procedure describes the practice's standard of care; the details of the assessment of a particular patient are decided by the lead veterinarian.

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