No more blame game: Kerala health department issues comprehensive guidelines to prevent surgical mishaps

THIRUVANANTHAPURAM: The Kerala Health Department has issued comprehensive guidelines clarifying the specific responsibilities of doctors and nurses to eliminate surgical errors in government hospitals. Aligned with World Health Organisation (WHO) standards, these protocols apply to all facilities, ranging from taluk hospitals to major medical colleges.

Key pre-operative requirements

To ensure patient safety, the following steps must be completed before a patient enters the operating suite:

• Identification: Patients must wear a wristband detailing their diagnosis and the specific surgery scheduled.
• Site Marking: The surgical site must be clearly marked in advance using a dedicated skin marker.
• Documentation: Ward doctors and nurses must complete and cross-check the patient’s IP number, unit details, and case records.
• Verification: The unit nurse and ward doctor must sign a pre-operative checklist. This must be reviewed and signed by the Operating Theatre (OT) Nursing Officer before the patient is admitted to the theatre.
• Digital Detox: The use of mobile phones within the operating theatre is strictly prohibited.

Three-stage safety check

The guidelines mandate a rigorous verification process to ensure "no-room-for-error" accountability. This process is broken down into three distinct phases:

• 1. Sign-In (Before Anaesthesia): This stage occurs before the patient is brought into the theatre or administered anaesthesia. Staff must confirm the patient's name, IP number, date of birth, and the specific surgical area. Information regarding infection control and drug allergies must be verified by cross-referencing the official case list before anaesthesia is given.
• 2. Time-Out (Before Incision): This is a final briefing where the surgeon, anaesthesia team, and nurses pause to communicate. They must re-verify the patient’s information and perform a final check of the patient's allergy profile and previous medication history to ensure everyone is on the same page before the procedure begins.
• 3. Sign-Out (Post-Surgery): Before the patient is transferred out of the theatre, the nursing staff must conduct a strict inventory. This includes counting all surgical instruments, discarded items, and blood-wiping cloths. The final count must match the initial tally recorded on the theatre whiteboard. Once verified, the checklist is signed and handed over to the concerned chief.

Accountability

The Health Department emphasised that these protocols are designed to foster a culture of collective responsibility. By requiring signatures at every transition of care, the guidelines ensure that if an error occurs, the point of failure can be identified, leaving no room for staff to shift blame onto others.