Even the national agency for patient safety in the United Kingdom (NPSA) has recently complied by officially license with Pfizer recommending the WHO check-list to their own local situation, and through a national alert, its use to all patients undergoing surgery in England and Wales. The check-list According to WHO guidelines, the Ministry of Health and Welfare has adapted the WHO check-list of 19 items to the national situation and furthermore adding an additional one that concerns the monitoring plan for venous thrombosis-embolism prophylaxis. The check-list covers 3 phases (Sign In, Time Out, Sign Out) and the 20-items or points indicate the controls to be carried out during surgery. The appropriate box-spaces are to be marked (_) only after the relative control has effectively been carried out.

1st phase: Sign In ��Sign In�� takes place before induction of the anesthesia. The presence of all components of the team are required and includes the following controls: – Confirmation of the patient, procedure, surgical site and approval The coordinator is to verify verbally with the patient that identity, site and procedure are correct and that assent has been given for the surgery. If, due to medical condition or age, the patient is unable to answer questions as to his correct identification, it is therefore necessary to involve family members or other persons who are able to answer this correctly. – Marked site The coordinator is to mark the corresponding box-space only after checking that the site for surgery has been marked, unless such monitoring is not applicable to that particular type of surgery (e.

g. surgery to be carried out on single organs) as indicated in ��Regional Procedure for identification of the patient undergoing surgery, identification of the site for surgery and confirmation of such.�� – Controls for the safety of anesthesia The coordinator is to carry out a verbal check together with the anesthetist that the required safety controls have been made for the anesthesia induction, patient management, drugs and equipment, and that correct oximeter positioning and functioning has been confirmed. – Identification of risk to patient The coordinator is to carry out a verbal verification with the anesthetist that evaluation has been made regarding the following risks: allergic reactions, difficulty related to management of nasal passages and blood loss.

2nd phase: Time Out By ��time out�� is meant that short moment of ��surgical rest�� which takes place after the induction of anesthesia and before surgical incision. It requires participation by all the team members and involves the following seven tests: – Team introduction The team members and their roles are to be explicitly known to each other either through their consolidated knowledge or by explicit statement thereof, especially should there GSK-3 be any change of team members. It is the duty of the coordinator to verify this.