New Guidelines Based on WHO Checklist Aim to Eliminate Surgical Errors
In response to recent incidents of surgical lapses in government hospitals, the Kerala Health Department has introduced a comprehensive surgical safety protocol to enhance patient safety and minimise procedural errors across the state.
Mandatory Pre-Operative Checks and Patient Identification
As per the order issued on April 15, the new guidelines make it compulsory for healthcare institutions to follow strict pre-operative verification processes, including accurate patient identification and detailed documentation. The protocol has been developed by the Directorate of Medical Education based on the globally recognised World Health Organization surgical safety checklist.
Wristbands and Surgical Site Marking Made Compulsory
To prevent wrong-site surgeries, patients will now be required to wear wristbands containing complete surgical details. Additionally, the exact surgical site must be clearly marked in advance before the procedure begins.
Restrictions in Operation Theatres to Reduce Distractions
The guidelines impose strict restrictions on phone calls and non-essential communication inside operation theatres (OTs), aiming to reduce distractions and ensure full concentration of medical staff during surgeries.
Multi-Level Verification Before Surgery
Doctors and nurses must complete all patient details, including IP numbers and case records, prior to surgery. A pre-operative checklist must be filled and signed by the ward doctor and nurse-in-charge, followed by verification from the OT nursing officer before shifting the patient to the operation theatre.
Strict Instrument Count and Documentation Protocol
To avoid critical errors such as retained surgical items, the protocol mandates precise counting and documentation of all instruments and materials. Details must be recorded on a whiteboard before surgery and rechecked after the procedure, with reports submitted to relevant authorities.
Emphasis on Patient Communication and Consent
The new guidelines stress clear communication with patients and their families. Hospitals must inform patients about procedures, risks, and benefits, and obtain separate consents for anaesthesia, surgery, and blood transfusion. Institutions are also directed to strengthen counselling systems and keep relatives regularly updated.
Focus on Safety Culture and Accountability
To build a strong “culture of safety,” the department has encouraged hospitals to promote error reporting without blame, enhance teamwork, and conduct regular training sessions and mock drills for OT staff.
Mandatory Root Cause Analysis of Adverse Events
The protocol includes measures to prevent retained foreign objects, equipment-related errors, and miscommunication. It also mandates conducting a root cause analysis (RCA) within 24 hours of any adverse event to ensure accountability and corrective action.
Immediate Implementation Across All Institutions
Authorities have directed both the Director of Medical Education and the Director of Health Services to ensure immediate implementation of the protocol across all healthcare institutions in Kerala.
The initiative aligns Kerala’s healthcare practices with global safety standards while incorporating local improvements. The move is expected to reinforce the state’s reputation for a robust public healthcare system by ensuring safer, standardised, and transparent surgical care.
