Patient Safety Checklist
Spine Deformity Surgery Team Checklist (SDSTC) 2021
Preop Area
__Confirm postop bed availability (ICU, PICU)
__Surgical site marked with initials
__All piercings & jewelry removed
__Review TXA contraindication: clotting, stroke
__Malignant Hyperthermia risk?
__Allergies, and Latex Allergy?
__Patient and family questions answered.
__No skin infections. No Respiratory symptoms.
__Preop neurologic exam
__Presence implantable devices (pacemaker, vagal nerve stimulator, etc) & safety with neuro-monitoring
__Surgical/ post-surgical plan reviewed w patient/family
__Surgical and blood consent completed
__Family member names & mobile number. Intraop call frequency
__Chlorohexadine (CHG) wipe to surgical site
__Hospital admin tasks (H+P update, Admit & other orders)
Pre-Flight OR Team Briefing
__Visit OR and greet/welcome staff
__All team members on white board.
__Set room temp 69F/21C
__Review surgical plan with staff and positioning
__Neuromonitoring Tech: Type, Concerns, and ? Pre-Turn monitoring
__Anesthesia: Airway concerns?
__Anesthesia: TXA, Drugs Use/Don’t Use (Suf/Prop), MAP&BIS goals
__RM equip: light boxes, Lat X-Ray holder, lead shield,fluid warmers
__Confirm Cell saver ordered
__Confirm Imaging ordered
__Instrument layout photograph available
__Specials for Today. All equipment available?
__Give Circulator Saline:Betadine 3:1
__ Check OR Table pin position and test.
__Thigh foam pad and 3 pillows at foot
__Stool under table for X-Ray
__Put on under-body warmer on Jackson Table
__Sutures for the Field
__Bone Graft ordered
__Dural repair supplies in room
__Diamond and metal cutting bur available in room
__Prep table setup: Alcohol, 4x4’s, CHG, skin marker
__Any questions from team? Thank you for your help.
Before Turning
__Imaging up on wall or monitor, w proper orientation
__Confirm vertebral numbering / transitional anatomy
__Surgical implant “map” and other diagrams posted
__Warm Blankets On Patient
__Double-Check OR Table pad positions
__IV’s flowing normally, no infiltrate (compartment syndrome avoid)
__Foley placed with good urine flow
__Pneumatic boots applied and turned on
__Evoked Potential Wire Placement Done
__BIS Monitor on forehead
__Endo-Tracheal tube taped securely*
__Bite block x2 between molars*
__Stretcher and OR Table heights checked, tables locked
__Ensure all lines, foley, wires are free
__NM Tech: Identify Needle Locations (staff safety)
__Confirm grounding pad not over needles (burn risk)
__Verify Wrists hand needles wrapped w towel (staff safety)
Positioning
__Patient gently turned to prone, arms positioned
__ Eyes, nose, lips, ears protected w/o pressure *
__ ET Tube taped in securely*
__ Two bite blocks in place between molars*
__Chest roll is away from brachial plexus/airway*
__Reverse Trendelenburg 4 degrees (eyes & airway)
__Neck neutral position*
__For women, adjust breasts to minimize pressure
__Turn on warmers on high, warm blankets on
__Elbows/shoulders 90 degrees, no pressure ulnar n.
__ Arm boards out of way for surgeon
__ Ensure all IV/A-line connectors tight, no skin press
__Pneumatic boots on, plugged in and turned on.
__Add additional foam under iliac wings if needed
__Pelvis level, thighs on pads, knees no pressure
__Legs on pillows w knees flexed, strap on.
__Under Pt: Abdomen & G-Tubes / lines / ITB pumps free pressure
__Under Pt: Genitals free of pressure, not lying on foley valve
__Under Pt: Tape/Velcro up Foley /NM wires (C-Arm)
Prep and Drape
__ ? Shoulders/Buttock taped to prevent creasing.
__Upper and Lower Warm blankets applied
__4×4 sterile sponge alcohol wipe down entire back
__Confirm no alcohol pooling (fire risk)
__Surgical lights lined up over the surgical field
__Edge drapes away from planned incision (avoid drape creep)
__CHG Prep and Dry x3min
__Confirm no CHG pooling (fire risk)
__Skin incision and cross-hatches marked
__Large Sticky Drape, Splits, and edges sealed
__Red banner / Tape across main OR door
__Confirm patient stretcher location outside door & labeled
__Family name/phone number on white board
__Trip Hazard check: tape down all wires/tubes
__Foot pedals proper position.
__Bovie, Bipolar, Drill Settings set and tested
Pre-Incision Timeout
__SRG: Welcome & Team introductions name and role
__SRG: Patient/Family Intro & Surgical Plan, EBL
__SRG Reviews Preop Imaging: ID, levels, Transitional / Aberrant Anat.
__RN: Patient name, DOB confirmed with Anesthesia
__RN: Surgery consent read aloud, Confirm Site marking & Approach
__RN: Allergies / Latex Allergies
__RN: Positioning confirm legs/feet ok & strap on legs
__RN: Blood availability
__AN: Antibiotic given within 1 hour skin incision, & redose interval
__AN: Positioning confirm OK eyes, nose, mouth, bite
block, ears, neck, arms/shoulders
__AN: warm all fluids, warmers on high until PT 37c
__AN: minimize fresh gas flow to move bellows (1 liter - for normothermia)
__AN: TXA given and drip started (50mg/kg,5mg/kg/hr)
__AN: MAP in 70’s exposure, 80’s during rod insertion
__AN: q30m Verbally Report Eyes,ET Tube & Hands OK;
__AN: q30m Verbally Report: EBL, MAP, PPV, BIS, TEMP, Urine Output*
__RN: IF ARMS TUCKED, Verbal “Hands OK” q30m
__RN: Verbal “Legs OK” q30m
__Timers set for q30 min Anesth & foot/leg checks, 90m fam call, 2h glove
changes, and Antibiotic redose
__ASSISTANT: be aware spinal “RED ZONE” L1 & above - sucker/cord safety
__NM: Neuromon being performed & baselines
__NM: NM Emergency Checklist Available
__Malignant Hyperthermia Risk & cart location
__Fire Safety Review: no alcohol/CHG pooling.
__Safety zone & sharps awareness – pass blunt end
__Keep light handles 10 cm above highest head
__Floor clear trip hazards, cables/tubes taped down.
__Verify bed location and label in case of emergency
__Make sure everyone is double gloved
__Minimize trips going in and out of room unless necessary.
__Sit down immediately if light-headed and notify staff.
__Keep talking to minimum to maximize communication.
__Use verbal “read-backs” to ensure accurate communication
__SRG: ”What safety concerns does everyone have?”
__SRG: “I encourage all team members to to speak up during surgery”
__SRG: “All Agree with Timeout and OK to proceed?”
__All team members reply with verbal “Aye”
Prep and Drape
__ ? Shoulders/Buttock taped to prevent creasing.
__Upper and Lower Warm blankets applied
__4×4 sterile sponge alcohol wipe down entire back
__Confirm no alcohol pooling (fire risk)
__Surgical lights lined up over the surgical field
__Edge drapes away from planned incision (avoid drape creep)
__CHG Prep and Dry x3min
__Confirm no CHG pooling (fire risk)
__Skin incision and cross-hatches marked
__Large Sticky Drape, Splits, and edges sealed
__Red banner / Tape across main OR door
__Confirm patient stretcher location outside door & labeled
__Family name/phone number on white board
__Trip Hazard check: tape down all wires/tubes
__Foot pedals proper position.
__Bovie, Bipolar, Drill Settings set and tested
Intra-Op
__RN calls family for first phone call, marked on board
__Metal marker over transverse process or in bone for level confirmation
__Betadine sponge in wound, towel covering for X-Ray
__AP/Lat Fluoro/X-Ray: confirm marker position with 2+ team members*
__Permanent mark with bur made on bone prior to marker removal.
__Marked Level written on white board
__Hemostasis check completed left side
__Vancomycin powder 1gm rubbed into muscle left side
__Hemostasis check completed right side
__Vancomycin powder 1gm rubbed into muscle right side
__Pedicle screw placement safety subroutine (include link/video)
__Each step called out verbally as completed
__Betadine sponge in wound, towel covering for X-Ray
__Flouroscopic/X-Ray/3D imaging confirmation screw position
__XR: harmonious screw cascade
__XR: screw lengths good on lateral
__Possible screw impedance check
__Confirm MAP raised to 80+ with AN. Turn off Sufenta.
__Rods inserted bilaterally
__Adequate rod sticking out each end, no muscle entrapment.
__Betadine sponge in wound, towel covering for X-Ray
__X-rays: good coronal/sagittal balance, LIV tilt, rod lengths, no screw plow
__XR: no pneumothorax.
Before Closure
__Screw caps locked double check by surgeon/asst.
__Valsalva maneuver done to confirm no spinal fluid leak.
__Irrigate wound copiously with saline
__Complete posterolateral decortication
__Place bone graft mixed w 2g Vancomycin.
__Meticulous hemostasis confirmed
__Drain placement if needed.
Closure
__Fascia closure at distal and proximal ends first
__Great care to ensure drain not sutured in
__Push down on wound to test for water-tight closure?
__Running water-tight fascial suture
__Confirm body weight, then Inject 0.5% Marcaine w/ epi
__Dermabond / Steri-Strips applied
__Confirm Evoked potential monitoring normal
__Remove ALL non-disposables (bipolar, clips, cables)
__Pre-turn check all lines/foley & drains. Loosen Foley from table.
Turn to Supine
__Turn supine onto bed gently, watching foley and drains
__All NM needles removed and counted.
__Inspect face, arms, hands, chest, pelvis & extremities
__Patient moved bilateral lower extremities.
__Extubated
__Tongue check: no laceration
__Extubated and moving lower extremities (wakeup done)
Legend/Notes
*Confirm with 2 team members
SRG: surgeon
RN: circulating nurse
AN: Anesthesiologist / CRNA
NM: Neuromonitoring Tech
PreOp Team Email Welcome & Training Example
For information on training and access to
Electronic checklist web app, see:
https://careguard.org/spine-surgery-checklist
Or email drlloydhey@gmail.com
http://www.srs.org/safety&value (future)
Legend/Notes
*Confirm with 2 team members
SRG: surgeon
RN: circulating nurse
AN: Anesthesiologist / CRNA
NM: Neuromonitoring Tech
PreOp Team Email Welcome & Training Example
For information on training and access to
Electronic checklist web app, see:
https://careguard.org/spine-surgery-checklist
Or email drlloydhey@gmail.com
http://www.srs.org/safety&value (future)
Download PDF File Version
The Development and Implementation of a Spine Surgery Team Checklist v20200915 LA Hey
Scoliosis Research Society Safety & Value Committee Delphi Technique / Checklist Refinement
