How many items are included in the WHO surgical safety checklist: SITOSO?

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

The World Health Organization (WHO) Surgical Safety Checklist is a standardized tool containing 19 distinct items.
It is structured into three phases to ensure critical safety checks are performed at key moments during a surgical procedure.
The three phases are: Sign In (before anesthesia), Time Out (before skin incision), and Sign Out (before the patient leaves the operating room).
The purpose is to improve team communication, minimize preventable errors, and reduce surgical complications and mortality.

Option A: 18 items is an incorrect count. While close, it omits one of the critical safety checks included in the standard WHO checklist.
Option C: 20 items is an incorrect count. This might result from miscounting the grouped discussion points within the 'Time Out' section as separate items.
Option D: 30 items is significantly higher than the actual number. The checklist is designed to be concise and efficient, and 30 items would make it too cumbersome for practical use in a busy operating room.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain WHO Surgical Safety Checklist items as background academic context rather than a clinical decision trigger.
For a nurse in the operating room (circulating or scrub nurse), knowing and actively participating in the checklist is a core responsibility for patient advocacy and safety.
Implementation of this checklist is a key performance indicator for hospital accreditation and quality improvement programs, including NABH in India.
What if? If the 'Sign Out' is skipped, there's a high risk of retained surgical items (like sponges or instruments) inside the patient, or mislabeled specimens, leading to severe patient harm and potential legal action.

How to Approach the Question

This is a factual recall question that tests your knowledge of a specific, globally recognized patient safety protocol.
Identify the keywords: 'WHO surgical safety checklist' and 'how many items'.
Recall the specific number associated with this standard checklist.
Associate the acronym SITOSO (Sign In, Time Out, Sign Out) with the structure of the checklist to reinforce your memory.
Eliminate options that are either too high (30) or very close but incorrect (18, 20), selecting the exact number established by the WHO.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 71-73

Practise the full Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

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