In the wake of the mounting medical negligence allegations in Kerala, the state government has issued an order introducing a modified surgical protocol list. The new protocol, submitted by the Directorate of Medical Education, has been established based on the WHO surgical safety checklist.
What is the new protocol?
The directions issued through the order outline structured interventions across three stages:
*Preoperative actions
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*Use of the WHO surgical safety checklist in the operating room
*Additional measures in the surgical process
This list defines the specific roles and responsibilities of personnel involved in each stage of the operational procedures.
1 A consent form must be signed before the operation, and proper patient briefing and counselling must be undertaken.
2 Appropriate colour-coded identification wristbands are mandatory for all emergency and elective procedures to ensure accurate patient tracking and safety.
3 The unit's charge nurse and ward physician are responsible for completing and signing the preoperative checklist. Subsequently, the preoperative nursing officer and the assigned anaesthesia personnel will verify the patient’s credentials at the surgical table.
4 The preoperative checklist must be finalised and signed before the patient is transported to the operating suite. Once inside, the surgical team is responsible for ensuring the full implementation of the WHO Surgical Safety Checklist for all procedures—whether conducted under general, regional, or local anaesthesia.
5 Once the operation concludes, the scrub nurse must verify that all objects on the operating trolley are radio-opaque. The circulating nurse is tasked with supervising the transfer and accounting of all additional surgical instruments and disposables.
6 Instrument and sponge counts must be recorded on the operating room whiteboard and cross-checked by the scrub nurse upon the conclusion of the case.
7 The order also mandates the implementation of safety checklists for minor procedures performed under local anesthesia, particularly in settings where nursing staff may not be available to assist or document the process
“Since all checklists necessitate a two-point verification — one by the nurse and another by the doctor — it is crucial to ensure the availability of a nurse and nursing assistant in all procedure rooms where invasive procedures are performed," the order says.
In February, a surgical forcep was found inside the abdomen of an Alappuza native, who had undergone surgery at the Government Medical College Hospital in Vandanam five years ago.
Last year, two other cases of alleged medical negligence also raised controversies over surgical safety in the state's hospitals.
