Each year the Joint Commission, with input from practitioners, provider organizations, purchasers, consumer groups, and other stakeholders, determines patient safety issues that are the highest priority and creates National Patient Safety Goals (NPSG). NPSG were established in 2002 to help accredited organizations address specific areas of concern related to patient safety.

The Universal Protocol for preventing wrong site, wrong procedure, wrong person surgery is part of the National Patient Safety Goals. To decrease errors and adverse events and to increase teamwork and communication in surgery, the World Health Organization (WHO) also devised a surgical safety checklist after extensive consultation with stakeholders.

The Joint Commission checklist and the WHO checklist were created as a result of poor patient outcomes which were categorized as “Never Events” by the National Quality Forum (NQF). In 2008, the Centers for Medicare and Medicaid Services stated that they would no longer reimburse hospital systems for NQF defined “never events.”

In 2010, the Association of periOperative Registered Nurses (AORN) created the Comprehensive Surgical Checklist using color codes to signify items from the WHO checklist, the Joint Commission Universal Protocol, and areas where the two overlap. The Comprehensive Surgical checklist is an inexpensive way to decrease morbidity and mortality rates across the world in the surgical environment.

Association of periOperative Registered Nurses (AORN) recommends that a surgical checklist and the checklist implementation guidelines apply to all operative and other invasive procedures that expose patients to more than minimal risk. While the Joint Commission does not specifically define the term minimal risk, certain "minor" procedures such as venipuncture, peripheral intravenous line placement, insertion of a nasogastric tube or urinary bladder catheter, are not within the scope of the Protocol. However, examples of procedures such as PICC line and all central line insertion, chest tube insertion, blocks and other similar types of common procedures are included.

The Surgical Checklist is a guide for facilities to adapt into their own practice, and standardizing the process for implementation is important. High quality evidence exists and demonstrates that the use of standardized tools, protocols, and checklists improves the quality of information transfer and decreases communication breakdowns. The AORN Comprehensive Surgical Checklist provides four opportunities to ensure that correct surgical procedure is performed on the right site and person. These opportunities are as follows.

  1. Pre-procedure Check in
  2. Sign in
  3. Time-out
  4. Sign-out

By using a Comprehensive Surgical Checklist, your facility will provide an extra layer of safety to ensure your patients stay safe. Whichever checklist your facility uses, ensure the process is standardized, meaningful, and sustained.