Kerala Launches Strict Surgical Safety Rules to Cut Medical Errors

The order, issued under the authority of the Governor by IAS officer Rajan Namdev Khobragade, approves a detailed draft surgical protocol aligned with the safety guidelines of the World Health Organisation, with additional context-specific improvements tailored for Keralam's healthcare system.

Keralam, often cited as a model for other Indian states in healthcare indicators, has made significant advancements in surgical care, particularly through the integration of technology that enables complex procedures to be made accessible to the general public.

However, rising concerns over surgical errors, including wrong-site surgeries, retained foreign objects, and miscommunication, have prompted the government to strengthen regulatory mechanisms.

According to the guidelines, all hospitals, from primary health centres to tertiary care institutions, must strictly implement standardised surgical safety practices. The protocol mandates the adoption of preoperative checklists, WHO surgical safety checklists in operating theatres, and post-procedure verification systems.

Preoperative actions in wards have been made mandatory as a critical first step in preventing surgical errors. As per the protocol, ward doctors and nurses must complete a series of checks either on the night before surgery or early on the day of the procedure.

These include confirming the patient's identity using multiple identifiers, ensuring that properly informed and signed consent forms are in place, and applying colour-coded wristbands with complete patient and procedure details.

The guidelines also require clear marking of the surgical site on the patient's body using skin markers in the ward itself to prevent wrong-site surgeries.

A detailed preoperative checklist must be filled out and signed by the ward doctor and nurse, and later verified again by the preoperative nursing and anaesthesia teams before the patient is shifted to the operating theatre.

The document highlights that medical errors remain a major global concern. Citing data from the Centres for Disease Control and Prevention, it notes that medical errors are among the leading causes of death worldwide.

Surgical errors, in particular, are largely preventable through proper training, communication, and adherence to protocols.

The new framework introduces a three-stage verification process: Sign-In, Time-Out, and Sign-Out, ensuring correct patient identification, surgical site confirmation, and team coordination.

It also stresses the importance of informed consent, patient involvement, and clear documentation without abbreviations.

To address root causes such as human error, fatigue, miscommunication, and organisational gaps, the protocol calls for structured training, periodic audits, and the establishment of Root Cause Analysis (RCA) teams in all operating theatre complexes. Adverse events must be reported within 24 hours, with detailed analysis submitted within a month.

Additional measures include strict infection control, equipment audits, standardised case sheets, and a ban on distractions such as mobile phone usage inside operating theatres. The protocol also promotes a "culture of safety" with non-punitive reporting systems and team-based accountability.

The Directors of Medical Education and Health Services have been directed to ensure immediate implementation of the protocol across all institutions.

- ANI