• VHA Directive 1039: “Ensuring Correct Surgery and Invasive procedures” (Veterans Health Administration)

    *See p.6 “For Ophthalmologic Intraocular Lens Implant Procedures”

    The Veterans Health Administration’s revised policy (2013) for ensuring correct patient/site/implant surgery, including the specific information elements that should be confirmed prior to implanting the lens.

    Wrong-Site, Wrong-IOL Checklist (AAO)

    A 1-page checklist for the pre-op area and operating room, developed as part of the American Academy of Ophthalmology’s 2014 Wrong Site Task Force. It offers an example “of how to document in the surgery chart that all the appropriate steps have been taken in preventing wrong-site/surgery. Surgeons and administration may wish to include something similar in their charts to ensure that steps are being followed appropriately for every patient.”

  • Ophthalmic Surgical Checklist (AAO, OMIC, ASCRS, ASORN, OOSS)

    An ophthalmic-specific checklist that was developed in 2012 by a taskforce of key national ophthalmic organizations. Created from the WHO’s general surgical checklist, it includes elements of the universal protocol and also specific items that should be covered in briefings from the surgeon, anesthesia provider, and nurse. Checklists are provided for 3 key points: before anesthesia (“sign in”), before incision (“time out”), and before leaving the OR (“sign out”). Designed by the American Academy of Ophthalmology, Ophthalmic Mutual Insurance Company, American Society for Cataract and Refractive Surgery, American Association of Ophthalmic Registered Nurses, and Outpatient Ophthalmic Surgery Society.

    Surgical Safety Checklist for Cataract Surgery (National Health Service, United Kingdom)

    A cataract surgery-specific safety checklist developed by the United Kingdom's National Patient Safety Agency (NPSA). It was adapted from the World Health Organization's Surgical Safety Checklist.

    Comprehensive Surgical Checklist (AORN)

    A surgical checklist created by the Association of periOperative Registered Nurses (AORN) to combine safety elements from both the World Health Organization's Surgical Safety Checklist and the Joint Commission's Universal Protocol, into a single, comprehensive checklist that may be used by a range of facility types. "Open-ended questions are also included to encourage active participation from all members of the surgical team." The document is available in an editable format (Word), and providers are encouraged to customize the checklist for their own practice settings.

    "Safe Surgery 2015" Checklist Templates (Ariadne Labs)

    “Safe Surgery 2015” is an initiative led by Ariadne Labs, a joint center of Brigham and Women’s Hospital and Harvard School of Public Health, focused on strengthening teamwork and communication by better use of the WHO surgical checklists. It was launched as a pilot in South Carolina in 2010. The initiative offers various different template surgical checklists based on the WHO Surgical Safety Checklist as well as an implementation guide. The group encourages “additions and modifications [to the documents] to fit local practice.”’

    Templates include:

    1. “Master” Safe Surgery Checklist (for Hospitals) — “Designed for all 3 sections performed in the OR: pre-anesthesia, pre-incision, and before patient leaves OR”
    2. Pre-op/OR Safe Surgery Checklist (2-page) — For organizations that administer anesthesia in pre-op area.
    3. Ambulatory Surgery Checklist Designed for low-risk procedures; it “omits items that are not applicable to the ASC environment.”
    4. Checklist with team briefing before induction — Includes introductions; “for use where the surgeon is always present at the time of induction.”
    5. Checklists (team already knows each other) — “Designed to be used in facilities where the OR teams are stable and everyone knows each other by name.”

    Ambulatory Surgical Checklist (SCOAP)

    A surgical checklist for ambulatory surgery developed by the Surgical Care and Outcomes Assessment Program (SCOAP), a clinician collaborative in Washington state that promotes data-driven quality improvement. The checklist was adapted from the WHO "Safe Surgery Saves Lives" campaign and the Washington Ambulatory Surgery Center Association/Proliance Surgeons Surgical Checklist.

    Instructional Videos on Surgical Safety Checklist Use (Safesurg.org)

    Instructional videos to help facilities correctly implement the World Health Organization’s Surgical Safety Checklist. Developed by Safesurg.org, a part of the “Safe Surgery Saves Lives Initiative”, these short (<5 minute) videos provide tips on how — and how not — to use the checklist to ensure patient safety.

  • Wrong-Site Taskforce Recommendations, 2014 (AAO)

    Recommendations from the American Academy of Ophthalmology’s Wrong-Site Task Force. Its introduction describes the report as a document that “ ... outlines the basic tenets to help all surgeons devise their procedures where appropriate. It is divided into three main sections: 1) steps taken prior to surgery day 2) steps taken on the day of surgery, and 3) procedures dependent upon pre-operative calculations.”

    Speak Up: Universal Protocol Poster (The Joint Commission)

    A poster developed by the Joint Commission that outlines key steps for marking the procedure site, as well as pre-procedure verification and time-out. Content is adapted from the full Universal Protocol.

    Resources for Preventing Wrong-Site Surgery (Pennsylvania Patient Safety Authority)

    Over two dozen program and educational tools developed by the Pennsylvania Patient Safety Authority to prevent wrong-site surgery.

  • Sample Time-out Auditing Tool (Mass. Eye and Ear)

    Sample auditing tool and observer check list for surgical time-outs developed and shared with the Betsy Lehman Center by Massachusetts Eye and Ear. Includes both a surgical safety checklist audit form and a “circulator comparison form.”

    Team Performance Observation Tool (HRET, ISMP, MGA) *p.36-37

    A tool that supporting “documenting the behaviors that your team members should observe in each of the five key performance areas for patient safety.” For example, it may be used to structure improvement discussions at staff meetings or help individuals or units to define their goals. Developed by Health Research & Educational Trust, Institute for Safe Medication Practices, and Medical Group Management Association as part of the Pathways for Patient Safety modules.

    Gap Analysis and Action Plan to Prevent Wrong-Site Surgery (Pennsylvania Patient Safety Authority)

    A tool from the Pennsylvania Patient Safety Authority that “ ... provides surgical teams with the opportunity to identify potential practice gaps as compared with the 21 evidenced-based principles issued by the Authority.”

    Monitoring of Preoperative Information from Surgeon’s Office Available at First Encounter (Pennsylvania Patient Safety Authority)

    “This sample monitoring tool can be used to monitor 10 cases for availability of preoperative information during preadmission testing or preoperative admission. Specific instructions for use are included in the tool, which may be downloaded for electronic entry and automatic calculation or printed for handwritten entry." (Description from the Authority's website.)

    Self-Assessment Checklists for Program Elements Associated with Preventing: Wrong-Site Surgery and Wrong-Site Anesthesia (Pennsylvania Patient Safety Authority)

    “[These] checklist[s] can be used to evaluate and monitor facility programs for preventing wrong-site surgery [or anesthesia]. Specific instructions for use are included in the checklist[s], which may be downloaded for electronic entry or printed for handwritten entry.” (Description from the Authority's website.)

  • "Cataracts: Should I Have Surgery?" Decision Aid (Healthwise, Dartmouth-Hitchcock)

    An online tool developed by Healthwise to help patients makes decisions about cataract surgery. The interactive aid guides users through six screens: get the facts; compare options; your feelings; your decision; quiz yourself; your summary.

  • Credentialing Checklist: What to Check, Double-Check and Triple-Check to Achieve Compliance (Becker’s ASC Review)

    An article that reviews nine steps for complying with credentialing standards set by the three main accrediting bodies for Ambulatory Surgery Centers (ASCs). Steps include: designating a credentialing coordinator and establishing a “positive working relationship with the referring offices.” Published online by Becker’s ASC Review.

  • Surveys on Patient Safety Culture (AHRQ)

    Free surveys that organizations may use to ask staff about the culture of patient safety in their workplaces. Different versions are available for a range of facility types including hospitals and ASCs. Developed by the federal Agency for Healthcare Research and Quality (AHRQ).

    Action Planning Tool for the AHRQ Surveys on Patient Safety Culture (AHRQ)

    A tool to help facilities administer and analyze results from AHRQ’s Surveys on Patient Safety Culture. “It provides step-by-step guidance to help survey users develop an action plan to improve patient safety culture.” The PDF includes an “Action Plan Template” (pp.15-18) for facilities to use to “document goals, initiatives, needed resources, process and outcome measures, and timelines.”

    TeamSTEPPS 2.0 program (AHRQ)

    A comprehensive teamwork program for improving collaboration and communication within facilities. Materials include module curriculum, measurement tools, and specialty scenarios such as Ambulatory Care Specialty Scenarios. The system was developed by the federal Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense.

    TeamSTEPPS for Office-Based care program (AHRQ)

    A curriculum for practice facilitators to improve quality in their office-based care settings. Its resources include tools, videos and course materials developed by the federal Agency for Healthcare Research and Quality.

All resources listed above are either publicly available or generously shared with the Betsy Lehman Center by our partners. Several tools were originally listed in AHRQ's Resource List for Improving Patient Safety in Ambulatory Surgery Centers.