1. Purpose
Most eye surgery is day surgery under local anaesthetic, with a high turnover of similar cases. That pattern is efficient, but it is exactly where a routine slip can cause harm. A surgical safety checklist makes the whole team pause and confirm the key facts together before each case. This policy sets out how the Service runs that checklist for ophthalmic day surgery, alongside the eye and lens checks in the correct patient, correct eye, correct lens policy.
The Service must verify this policy against the WHO Surgical Safety Checklist, the National Safety Standards for Invasive Procedures and Royal College of Ophthalmologists guidance before adoption.
2. Sources to verify before adoption
- WHO Surgical Safety Checklist (adapt the standard checklist for ophthalmic surgery): https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery
- National Safety Standards for Invasive Procedures (NatSSIPs): https://www.england.nhs.uk/patient-safety/natssips/
- Royal College of Ophthalmologists, Ophthalmic Services Guidance: https://www.rcophth.ac.uk/
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
- The Service's correct patient, correct eye, correct lens policy
3. Scope
This policy applies to:
- every surgical and invasive ophthalmic procedure, including cataract surgery, laser, and minor oculoplastic surgery
- the whole theatre team: surgeon, anaesthetist or sedationist where used, scrub and circulating staff, and recovery staff
- the day-surgery pathway from arrival to discharge
4. The team and the genuine pause
The checklist works only if the whole team stops and takes part. The Service expects:
- every member of the team to be present and listening for each check
- the checks to be read and answered aloud, not signed in advance or in retrospect
- any member of the team to raise a concern at any point, with that concern always welcomed and acted on before the case continues
5. The three phases of the checklist
The checklist is adapted from the WHO Surgical Safety Checklist for ophthalmic surgery and run at three points:
- Sign in (before the patient enters the operating area): identity confirmed; operative eye confirmed and marked (per the correct patient, correct eye, correct lens policy); consent confirmed; procedure and lens confirmed; allergies checked; anticoagulant and antiplatelet medicines reviewed; anaesthetic plan and any known difficulty confirmed; the required equipment and the correct intraocular lens confirmed as present.
- Time out (before the procedure starts): the team pauses; each member is known by name and role; identity, eye, procedure, consent and lens are confirmed against the record; the marked eye is confirmed as the eye prepared and draped; any anticipated problem is shared.
- Sign out (before the patient leaves the operating area): the procedure performed and the lens implanted are recorded (with power, model and serial or lot number); instrument, swab and sharps accounts are correct; any complication or change from plan is recorded; the recovery and discharge plan, including follow-up and who to contact, is confirmed.
6. Local anaesthetic and sedation safety
Because most cases use local anaesthetic, sometimes with sedation, the Service:
- confirms the anaesthetic plan and any allergy or contraindication at sign in
- monitors the patient appropriately during the procedure for the technique used
- keeps resuscitation equipment and trained staff immediately available, and follows the medical emergency and anaphylaxis arrangements
- where sedation is used, applies its sedation safety arrangements (assessment, monitoring, recovery and discharge)
7. Recovery and discharge
Day surgery is safe only if discharge is safe. Before the patient leaves the Service confirms:
- the patient meets the agreed discharge criteria and is accompanied where required
- the patient has clear written aftercare advice, including the eye drops to use, activity restrictions, the symptoms that need urgent help, and exactly how to reach urgent help, including out of hours
- the follow-up appointment and any onward arrangements are in place and recorded
8. When the checklist fails or a complication occurs
If a step is missed, a concern is overruled, or a complication occurs, the event is logged the same day as a patient-safety incident and runs through to a recorded outcome with completed actions. A Never Event (wrong eye, wrong implant, retained item) opens the duty of candour and the serious-incident process.
9. Training
Everyone in the theatre and recovery team is trained in the checklist, their role in it, and stop-the-line authority, at induction and on a refresher cadence the Service sets. The Service records completion and the next refresher date.
10. Audit cadence
The Service checks, on a stated cadence, that:
- the three-phase checklist was completed, in real time, for every case, with the whole team taking part
- anticoagulation, allergies and the anaesthetic plan were checked
- discharge criteria and written aftercare with an urgent route were met for every patient
- missed steps, overruled concerns and complications were reported and learned from
The Registered Manager and the lead surgeon review the results and record the improvement actions that follow.