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Surgical Safety Checklist - Canadian Version

The checklists below are Word documents with identical content. They are provided in portrait and landscape versions for easier integration into patient files or postings. If your organization is interested in measuring compliance, use the versions with a scorecard. We encourage you to adapt them for use in your organization.

Surgical Safety Checklists - Scorecard

Surgical Safety Checklists - No Scorecard

 
 

 

Links

World Health Organization Safe Surgery Saves Lives

Reference Articles

  • Impact of using the checklist at the eight WHO pilot sites
    Haynes AB, Weiser TG, Berry WB, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine. 2009 Jan 14; [Epub ahead of print]. Retrieved from: http://content.nejm.org/cgi/content/full/NEJMsa0810119
  • The Canadian Adverse Events Study
    Baker GR, Norton P, Flintoft V, et al. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004; 170 (11): 1678 - 1686. Retrieved from: http://www.cmaj.ca/cgi/content/full/170/11/1678
  • Team behavior (information sharing during preoperative phases, briefing and information sharing during handoff) impacts the rate of surgical complications and death.
    Mazzocco K, Petitti D, Fong K, et al. Surgical team behaviors and patient outcomes. The American Journal of Surgery. 2009, Volume 197, Issue 5, Pages 678-685.
  • Preoperative briefings have the potential to increase OR efficiency and thereby improve quality of care and reduce cost.
    Nundy S, Mukherjee A, Sexton BJ, et al. Impact of preoperative briefings on operating room delays: a preliminary report . Arch Surg. 2008 Nov;143(11):1068-72.
  • Team debriefings best practices and tips
    Salas E, Klein C, King H, et al. Debriefing medical teams: 12 evidence-based best practices and tips. The Joint Commission Journal on Quality and Patient Safety. 2008 Sep;34(9):518-27.
  • Adapting the surgical checklist – requirements and implementation tips

    • Verdaasdonk EGG, Stassen LPS, Widhiasmara PP, Dankelman J. Requirements for the design and implementation of checklists for surgical processes. Surg Endosc. 2009, 23: 715-726

  • Prototype surgical checklist development and validation (the Netherlands)
    De Vries EN, Hollmann MW, Smorenburg SM, et al. Development and validation of the SURgical Patient Safety Sustem (SURPASS) Checklist. Qual Saf Health Care. 2009, 18: 121-126
  • Interprofessional checklist briefings reduce the number of communication failures, promote proactive and collaborative team communication, and identifies patient safety problems.
    Lingard L, Regehr G, Orser B, et al. Evaluation of a Preoperative Checklist and Team Briefing Among Surgeons, Nurses, and Anesthesiologists to Reduce Failures in Communication. Arch Surg. 2008;143(1):12-17.
  • Large and sustained reduction of the catheter-related infections through an intervention program using a checklist
    Pronovost P, Needham D, Berenholtz S, et al. An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU. N Engl J Med 2006 355: 2725-2732.​​​​