In evident need for immediate investigation and response.

In this study Operating team/ surgical team
means a team which includes surgeons, anesthesiologists, nurses, technicians
and other OR personnel.

The World Health Organization has
(WHO) given a detailed description and glossary on Patient safety Concepts and
References, 2009. As per the glossary, the following are the definitions:


culture – The safety culture of an
organization is the product of individual and group values, attitudes,
perceptions competencies, and patterns of behavior that determine the
commitment to, and the style and proficiency of, an organization’s health and
safety management.


An adverse event
– an injury that was caused by medical management or complication instead of
the underlying disease and that resulted in prolonged hospitalization or disability
at the time of discharge from medical care, or both OR An
injury that was caused by medical management and that results in measurable
disability OR An event that results in unintended harm to the patient by an act
of commission or omission rather than by the underlying disease or condition of
the patient



Services of health care professionals and their agents that are addressed at
(1) health promotion; (2) prevention of illness and injury; (3) monitoring of
health; (4) maintenance of health; and (5) treatment of diseases, disorders,
and injuries in order to obtain cure or, failing that, optimum comfort and
function (quality of life)


A near
miss – an event that almost happened or an
event that did happen but no one knows about. If the person involved in the
near miss does not come forward, no one may ever know it occurred OR An event
or situation that could have resulted in an accident, injury or illness, but
did not, either by chance or through timely intervention


A critical incident – An
incident resulting in serious harm… to the patient… when there is an evident
need for immediate investigation and response. OR any unintended event that occurs
when patients receive treatment in hospitals that
results in death, serious disability, injury, or harm, and does not result primarily from the patient’s underlying
condition or a known risk in providing treatment.


Medical error –
an adverse event that is preventable with the current state of medical


Sentinel event-
An unexpected occurrence involving death or serious physical or psychological
injury, or the risk thereof. Serious injury specifically includes loss of limb
or function. The phrase or risk thereof includes any process variation for
which a recurrence would carry a significant chance of a serious adverse
outcome. Such events are called ‘sentinel’ because they signal the need for
immediate investigation and response.


Adverse events can be classified in three categories
based on a study conducted by Joint Commission on sentinel events.

i. Communication- including communication with the
patient and among members of the surgical team; availability of information;
and operating room hierarchy;

ii. Patient management- such as preoperative
assessment of the patient;

iii. Clinical performance- including orientation and
training, the procedures used to verify the operative site, and distraction.
Alternatively, these areas could represent the clinical or management processes
that are associated with events without any judgments about root causes within
those processes.





The surgical safety checklist
is a series of events or task that a surgical team (surgeons, anesthetists,
clinician, and nurse etc. staff involved in the surgery) has to address during perioperative
period to improve the patient safety. Each task included in this checklist by
WHO is based on clinical evidence/ expert opinion from different field.

The ultimate goal of the
WHO Surgical Safety Checklist is to ensure that operating teams regularly
follow certain critical safety steps and therefore minimize the most common and
avoidable risks which can cause harm to lives and well-being of surgical

In order to implement the
checklist a single person must be responsible for checking the list, mostly
this task is given to a circulating nurse and the this person is known as the
checklist coordinator.