The surgical safety checklist in veterinary practice: why it matters and how to adopt it

A checklist is not there to remind professionals how to operate, it is there to protect the team from the predictable limits of human attention under load. In most avoidable incidents the knowledge was present: what was missing was the structured moment to stop, say it out loud and verify it together. That is exactly what a checklist imposes, turning implicit, memory dependent checks into explicit, shared steps.

• It makes explicit what often stays implicit: patient identity, planned procedure, correct side or site, known allergies and critical points.
• It spreads responsibility across the team instead of concentrating it on one person, and authorises anyone to flag a problem.
• It creates a moment of structured communication that reduces misunderstandings between surgeon, anaesthetist and theatre staff.
• It catches problems before the incision, when fixing them costs a minute, not afterwards, when they cost a complication.

The most widespread and robust model marks safety in three moments, each tied to a precise phase of the operative journey. Adapting them to veterinary medicine means keeping their logic, not copying the items to the letter.

The strength of the model lies in its simplicity and repeatability. It must not become a thirty item form that no one really reads: a few essential checks, done every time and out loud, are worth more than an exhaustive list filled in a hurry. The rule is that every item present is one that someone actually has the job of confirming.

Transferring the human model without adapting it breeds resistance and useless items. Veterinary medicine has specifics that must be acknowledged, otherwise the checklist looks alien to the real work and gets abandoned.

• Patient identification runs through the microchip, the record and the owner, and must be cross checked carefully when several similar animals are in the ward on the same day.
• Confirming the site and side is crucial in procedures such as spays in dogs with an uncertain history, orthopaedic or ophthalmic surgery, where operating on the wrong side is a real error.
• Up to date weight and dose calculations are a critical point precisely because they vary from patient to patient and species to species: an explicit check prevents order of magnitude errors.
• Anaesthetic management should be included explicitly, with checks of equipment, monitoring and the plan for complications, because in many practices one person covers several roles.
• The count of swabs and sharps should be adapted to the type of procedure, but planned for: retained material happens in veterinary surgery too.

Introducing a checklist is more a cultural than a documentary intervention. The difference between a tool that protects and a sheet someone signs reluctantly turns entirely on how it is introduced and sustained over time.

1. 1

   Involve the team in building it

   A checklist imposed from above breeds resistance. Building it together with surgeons, anaesthetists and theatre staff makes it fit the real work and turns sceptics into co responsible authors.

2. 2

   Start from a short version

   Better a few items always honoured than a long list half applied. It can be extended later, once the ritual of the three pauses has become habit and is no longer felt as a burden.

3. 3

   Assign who leads each moment

   Define who reads and leads the sign in, the time out and the sign out. Without a clear role, the pause dissolves into the rush. It often works well to give it to someone whose hands are not busy in the surgical field.

4. 4

   Authorise anyone to stop

   The checklist works if even the most junior person can say, without fear, that something does not add up. A culture where raising a doubt is seen as collaboration, not challenge, is the real barrier.

5. 5

   Review and improve on real cases

   Analyse near misses and events periodically, without hunting for culprits, and use what emerges to refine the items. A living checklist evolves with the practice, a dead one hangs on the wall.

Many implementations fail not because the tool is wrong, but because of recurring mistakes in adoption. Knowing them in advance helps avoid them.

1. Turning it into an overlong form, filled in a hurry and read by no one: length is the enemy of adherence.
2. Ticking the boxes without real verification, reducing the pause to a bureaucratic gesture without communication.
3. Imposing it without explanation, as a top down requirement, rather than sharing its purpose and the data that justify it.
4. Not assigning a leader, so that no one feels responsible for starting and completing each moment.
5. Using it to hunt for culprits after an error, destroying the trust needed for the team to report problems openly.
6. Leaving it unchanged for years, without updating it on the basis of real cases and new procedures introduced in the practice.

The common thread of these mistakes is forgetting that the checklist is a tool serving people, not an end. When it becomes again a structured conversation between professionals who trust one another, it regains its protective effect. Recording the completed verification in the record, briefly but traceably, closes the loop between safety and documentation.