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World Health Organization recommends checklist

Just as commercial pilots make a routine circuit through a basic checklist before taking lives into their hands, the WHO suggests that surgeons should mold a habit of confirming certain basic guidelines prior to embarking on surgery.  In reviewing this list, we find the kernel of several basic mistakes that have cost our clients' lives, long-term suffering and poor outcomes.

Among the WHO guidelines:  The surgical team should commence by identifying themselves,  and their role  and responsibilities, and confirming the patient and procedure to be undertaken.  The proper surgical cite should be marked in advance and confirmed.  An antibiotic should be given within 60 minutes of cutting the skin.  Drug allergies must be documented and confirmed. Two IV lines should be established where there may be substantial blood loss.  Foreign objects must be counted when inserted and counted when removed.  All foreign object should bear radiological markers.  

These guidelines were originally developed at Johns Hopkins and Harvard Medical School, and modeled on the aviation industry.  These guidelines were adopted on an experimental basis in a pilot study at eight hospitals and data from the first 1000 patients appears to show an improvement in adhering to the standard of care from 36 percent to 68 percent.  In some hospitals, the improvement was to near 100 percent; one wonders if this data can be correct:  going in, only one-third of the surgeries performed at these eight hospitals conformed to this basic standard of care?  Even after these guidelines were adopted, only 2/3 of the surgeries conformed?  No wonder negligence claims continue to arise.  Regardless of the level of "coaching" people still cut corners, still have bad days, still make mistakes.

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