Safe Surgical Checklist

SAN FRANCISCO - June 26, 2012

ASORN Partners with AAO, OMIC, ASCRS and OOSS to Create Sample Ophthalmic Surgical Checklist

Earlier this year the American Academy of Ophthalmology and OMIC approached the American Society of Ophthalmic Registered Nurses (ASORN) and other key ophthalmic societies to join them in developing a task force to devise an ophthalmic-specific surgical checklist. Other societies include the American Society for Cataract and Refractive Surgery (ASCRS) and the Outpatient Ophthalmic Surgery Society (OOSS). The task force produced a sample ophthalmic surgical checklist to meet the needs of patients having many kinds of procedures.


  • ASORN: Annquinetta F. Dansby-Kelly, RN, CRNO, Elethia C. Dean, RN, BSN, MBA, PhD, Deborah Ann Ehlers, RN, MSN, Nancy J. Haskell, RN, Diane M. LaRosa, RN, BSN, CRNO, Noreen E. Smith, RN, Mary Nehra Waldo, RN, BSN, CRNO

  • AAO: Flora Lum, MD, Cherie L. McNett, Kesley Kurth, William L. Rich, III, MD, Trexler M. Topping, MD

  • ASCRS: Samuel Masket, MD, Joyce D’Andrea, Paula Cooke, , Nancey McCann, Jenny Liljeberg

  • OMIC: Richard L. Abbott, MD, Steven V. L. Brown, MD, Hans Bruhn, MHS, Denise Chamblee, MD, Andrew P. Doan, MD, PhD, Tamara R. Fountain, MD, Ted V. J. Houle, MD, Anne M. Menke, RN, PhD, Ronald W. Pelton, MD, PhD, Steven I. Rosenfeld, MD, John W. Shore, MD , James B. Sprague, MD, Paul Weber, JD,  Harry Zink, MD

  • OOSS: Robert B. Nelson, PA-C, Lou Sheffler, MPS, Michael Romansky, JD

Surgical Team Briefings and Checklists Reduce Risk1

Communication breakdowns are the primary cause of 70% of serious adverse events reported to The Joint Commission (TJC).2 Nowhere is clear and consistent communication more important than in the Operating Room. To facilitate the exchange of critical information among surgical team members, the World Health Organization (WHO) introduced a basic surgical checklist in 2008, proposing it as a method to "help ensure that teams consistently follow a few critical safety steps and thereby minimize the most common and avoidable risks endangering the lives and well-being of surgical patients."3 The checklist divides surgical care into three phases: sign-in before anesthesia, time-out before incision, and sign-out before transfer from the OR to the post-anesthesia recovery room (PACU).

In addition to the elements of the universal protocol (identification of the patient, procedure, site, and side), the WHO time-out and sign-out include briefings from the surgeon, anesthesia provider, and nurse that—if consistently implemented - would prevent many malpractice claims reported to OMIC. The surgeon addresses critical or unexpected steps in the procedure, its planned duration, and the anticipated amount of blood loss. The anesthesia provider relates any patient-specific concerns such as cardiopulmonary diseases, arrhythmias, difficult airway, etc. The nurse confirms the sterility of the instruments and covers any equipment issues.

CMS Mandates the Use of a Surgical Checklist in Ambulatory Surgery Centers

In the 2012 ASC payment rule published last year, the Center for Medicare and Medicaid Services (CMS) outlined its requirements for a new ASC quality-reporting program. While the quality measure reporting requirements do not take effect until October 1, 2012, a requirement that all ASCs begin using a standard surgical checklist was implemented as of January 1 of this year and will be taken into account for determining whether the ASC will be subject to a 2 percent penalty in future years.  ASCs must attest later this year that they were using such a list.  CMS did not dictate any specific checklist but cited the WHO document as one example of a recommended list.  However, the lists suggested by CMS are designed for a broad spectrum of surgical procedures that require more comprehensive anesthesia and patient monitoring then is generally applicable for the ophthalmic ASC.

Please make any changes necessary to best address the type of patients, procedures, anesthesia, and facility you have. For example, ASCs whose only procedures are cataract surgery with topical anesthesia may not need many of the listed elements. Check with the physicians, anesthesia providers, nurses, and facility administrators to determine which elements are required under state licensing rules or by accreditation organizations.

Ophthalmic Safe Surgery Checklist (MS Word)

Ophthalmic Safe Surgery Checklist (PDF) 

1 Excerpted from Menke AM. Surgical Team Briefings Reduce Malpractice Risk. OMIC Digest, Fall 2011. Volume 21, Number 4.

2 JCAHO. Improving Handoff Communications: Meeting National Patient Safety Goal 2E. Joint Perspectives on Patient Safety. 2006; 6(8):9-15.

3 World Health Organization. World Alliance for Patient Safety. Implementation Manual. WHO Surgical Safety Checklist. First Edition. Accessed 10/31/11. This list was enhanced by the Association of PeriOperative Registered Nurses (AORN) to include a pre-procedure check-in that helps facilities comply with TJC universal protocol requirements and national patient safety goals.


Caitlin Nimmo
ASORN Program Manager
(415) 447-0287