This document provides an overview of the Surgical Safety Checklist (SSSL) version 2.0 used in Malaysian hospitals. It discusses the importance of surgical safety, the organizational structure for implementing the SSSL, and the objectives and strategies of the program. These include improving communication and teamwork, establishing operating theatre etiquette, and using the SSSL checklist which contains pre-operative, time-out, and sign-out components to verify procedures and prevent errors. The document emphasizes the role of surgeons in leading the safety culture and checklist process to minimize preventable adverse events and ensure patient safety.

1. Overview of Guideline and
Walk Through SSSL ver 2.0
SSSL Workshop Bil. 01/2019
20th April 2019
Chea Chan Hooi
Surgeon
Sibu Hospital

2. Content
• Surgical errors
• Introduction to SSSL
• Organisational structure
• Objectives
• OT etiquette
• Using the checklist

3. Examples of surgical errors

12. Yes, he had hemorrhoids :]

18. Introduction
• Adverse event in surgery is an important issue in which many are
preventable
• Surgical Safety Checklist introduced by the WHO in 2008
• In Malaysia, SSSL steering committee in 2008 and lauched Nov 2019
(Safer Surgery through Better Communication)
• Implemented in all MOH hospitals from 01/01/2010
• July 2018, 2nd edition of SSSL guidelines lauched

19. Organisational structure
• National level - Safe Surgery Steering Committee
• State level - Safe Surgery State Committee
• Hospital level
• To identify suitable Safe Surgery champions or potential champions in the hospital to be
members of the Safe Surgery Hospital Committee
• To lead and to drive the SSSL programme
• To plan the way forward of SSSL programme
• To promote and disseminate information on safe surgery and SSSL programme
• To monitor, evaluate the implementation and effectiveness of SSSL programme
• To further strengthen and enhance implementation of SSSL in the state
• To give feedback to the state and national committees regarding issues and challenges faced
in order to improve the SSSL programme
• To share and learn from patient safety incidents related to surgery
• To encourage innovative improvement of surgical safety

21. Objectives
• Improve surgical safety
• Prevent surgical adverse events

22. Strategies
• Improving communication and team work to ensure safer surgery
• OT etiquette
• Surgeons leadership in SSSL programme
• The use of “Surgical Safety Checklist” to improve the standards of
surgical safety
• Pre-operative checklist
• Operating team checklist
• Swab and instrument count form
• Pre-discharge check

23. OT etiquette
• Personal Protective Equipment (PPE)
• PPE is essential during surgery to protect the staff as well as the patient
• Wear clean PPE in operating theatre (OT)
• Surgical mask must be worn once the set of surgical instruments are opened.
• If the surgery might predispose the staff to ‘splashing hazard’ such as blood
and body fluid, eye protection is crucial
• Once scrubbed, maintain sterility
• If you are standing away from the operating field, clasp your hands together at the level
of your chest
• If you are standing at the OT table place your hands flat in the sterile area

24. • General matters:
• Avoid wearing watch, bracelet, ring or fake nails
• Avoid unnecessary traffic when surgery is ongoing
• Surgeons/assistants should never take instruments from the instrument
trolley/tray.
• Ask for the instrument and wait for it to be passed to you
• Blades and sharps are passed via a tray
• Return all instruments once you have used them
• Avoid unnecessary talk. Respond clearly with “yes” or “no”
• Answering phone calls should be kept to a minimum and not at all if possible
• Thank the team members before exiting a surgery

25. • For new healthcare personnel
• Introduce yourself to operation theatre manager/nursing sister, the surgeons,
the anaesthetist and clearly display your identification badge
• Obtain surgeon permission before scrubbing or observing the surgery
• If you are scrubbing for the case, know your patient well and the procedure

26. Surgeons leadership
• Team work involving multidisciplinary staff
• Demonstrate leadership skills and create safety culture
• Based on feedbacks, surgeons leadership still needs to be
further improved
• Check procedures are done before ticked
• Strive to involve all team members
• Lead and drive the SSSL programme
• Educate and motivate others outside OT

27. • Criteria of a good surgical leader
• Act with integrity
• Are honest, open and consistent
• Are accessible
• Are open to challenge and feedback
• Are decisive
• Are self aware and mindful of their impact on others
• Recognise their own responses to stress

28. Check list
Credit : Dato Dr Jamil

29. Pg 1

30. Pg 2

35. Pg 3

36. Pg 4

37. Patients with multiple surgeries performed by
multiple teams
• Patients with e.g. polytrauma, complex ENT or pelvic tumours
• Problems
• Prioritisation of procedures
• Underestimated EBL
• Prolonged GA
• Risk of SSI
• Retained FB
• Add in the Multidisciplinary Checklist (2 pages) for each additional
team
• Primary team uses the usual 4 page checklist

38. Pg 1
Allergies

39. Pg 2

41. Conclusion
• The majority of surgical adverse events are preventable
• SSSL is not new to us
• The goal is to cultivate a safety culture amongst OT members to
minimise surgical & anaesthetic adverse events to ensure patient
safety
• Improve communications, work as a team and adopt SSSL check list
will
• Monitoring and feedback mechanisms for quality assurance

42. Know your role and do it well

43. Thank you!
Questions?

44. SUSE 2.019