World Alliance for Patient Safety. WHO surgical safety checklist and implementation manual 2008. Geneva: World Health Organization. Available at: http://www.who.int/patientsafety/safesurgery/ss_checklist/en/.
Patient Name: | ||
---|---|---|
Doctor Name: | ||
Date of Surgery: | ||
Number | Item | Check off |
A. Preoperative Checklist | ||
1. | Review and update changes to medical/dental history | |
2. | Signed prosthodontic treatment plan form | |
3. | a. Consent for oral anxiolysis (if needed) | |
b. Consent for tooth extractions (in immediate implant situations) | ||
c. Consent for implant surgery | ||
d. Consent for bone grafting (if needed) | ||
e. Consent for sinus membrane elevation (if needed) | ||
4. | Availability of prosthetic guide (“surgical guide”) | |
5. | Availability of updated radiographs/cone beam computed tomography (CBCT) images | |
6. | Preoperative photographs | |
7. | Blood pressure reading (with time of recording) | |
8. | Oral anxiolysis medication (if needed) | |
9. | Preoperative antibiotics | |
10. | Preoperative analgesics (if needed) | |
11. | Administer local anesthetics (long-duration and short-duration) | |
12. | Preoperative oral rinse with chlorhexidine | |
B. Intraoperative Checklist | ||
1. | Use of prosthetic guide (“surgical guide”) | |
2. | Bone resection and contouring (if needed) | |
3. | Use of implant guide pins for position and angulation check between drilling | |
4. | Intraoperative radiograph (if needed) | |
5. | Change drilling speed for expanding osteotomy (if needed) | |
6. | Collection of autogenous bone through slow-speed drilling (if needed) | |
7. | Use of countersink/profile drill (if needed) | |
8. | Use of tap drill in dense bone situations | |
9. | Final irrigation of implant osteotomy with chilled saline | |
10. | Intraoperative photographs (as needed) | |
11. | Change drilling speed to implant mode before implant placement | |
12. | Use of bone milling drill (in angled implant situations) | |
13. | Insert treatment abutment, healing abutment, or cover screw | |
If guided bone regeneration is required: | ||
a. | Collection of additional autogenous bone chips (if needed) | |
b. | Release of flap by dissection of periosteum | |
c. | Adequate hydration of bone graft particles with saline/blood/synthetic growth factors | |
d. | Trimming of membrane | |
e. | Immediate disposal of membrane trimming template (if any) | |
f. | Use of tenting screws and membrane tacks (if needed) | |
g. | Use of mattress sutures (horizontal and/or vertical) | |
14. | Attainment of hemostasis after complete suturing | |
C. Immediate Postoperative Checklist | ||
1. | Postoperative local anesthetics (long-duration/short-duration) | |
2. | Use of ice-pack extraorally to minimize swelling | |
3. | Postoperative radiograph | |
4. | Postoperative photographs | |
5. | Blood pressure reading (with time of recording) | |
6. | Postoperative analgesics/steroids (if needed) | |
7. | Prescriptions for antibiotics, analgesics, and antiseptic mouth rinse | |
8. | Video/verbal postoperative wound care patient instructions | |
9. | Written postoperative wound care patient instructions | |
10. | Recording patient’s updated mobile phone number for follow-up phone call | |
11. | Adjustment of interim fixed or removable partial denture or occlusal device (if necessary) | |
12. | Delivery of sterile gauze in the mouth and to take home to maintain hemostasis | |
13. | Scheduling patient’s follow-up appointment | |
14. | Entry of implant and bone graft material records into patient chart |
References
- Effectiveness of the surgical safety checklist in correcting errors: a literature review applying Reason’s Swiss cheese model.AORN J. 2014; 100: 65-79
- Surgical checklists: a systematic review of impacts and implementation.BMJ Qual Saf. 2014; 23: 299-318
World Alliance for Patient Safety. WHO surgical safety checklist and implementation manual 2008. Geneva: World Health Organization. Available at: http://www.who.int/patientsafety/safesurgery/ss_checklist/en/.
- Designing a safety checklist for dental implant placement: a Delphi study.J Am Dent Assoc. 2014; 145: 131-140
- Overview of medical errors and adverse events.Ann Intensive Care. 2012; 2: 2-9
- Oral implantology surgical procedures checklist.Quintessence Publishing, Hanover2012: 19