Implementation of an Electronic Instrument Preparation Checklist

By IP Chi Ming Victor, RN, BN, MN, FHKAN
Operating Theatre Hong Kong Sanatorium & Hospital


The purpose of this project is to evaluate the impact of the implementation of an electronic instrument preparation checklist on operating theatre (OT) staff satisfaction.


Operating rooms in Hong Kong Sanatorium & Hospital are geographically separated into three locations on two hospital floors. Surgeons’ preferences for the same operation have historically been kept in a single preference book. This book may be in used by staff in different locations, with no back up copy, risking lost or missing pages. Traditionally, they have been transcribed by scrub nurses, with no designated person to update. Content is handwritten and may not be consistent, as it can be modified by anyone. All instruments have been packed by central preparation area (CPA) staff and are cross checked by the scrub nurse. Instrument location has not been recorded, making it time consuming to find and collect instruments, particularly for complicated operations.


A small test of change in one surgical specialty population was completed. Paper checklists for two orthopaedic operations (total joint replacement and anterior cruciate ligament reconstruction) were revised and entered as “read only” Excel files.

A pre-intervention survey addressing workflow and staff satisfaction was distributed to OT nurses, including CPA staff, scrub nurses, and circulating nurses (n=30). Those who participated in the pre-intervention survey were invited to participate in the post-intervention survey after the intervention was implemented, using the same tool (n=30). Data from both surveys were compared.


The survey focused on three aspects:  Accuracy, efficiency, and staff satisfaction. Thirty surveys were equally distributed to CPA staff, scrub nurses and circulating nurses. The return rate was 100%. Fifty percent of participants reported 5-10 years of experience, 24% had one to five years of experience and the remaining had either over 10 or less than one year of experience. Most staff (99%) agreed/strongly agreed that the checklist is more accurate, comprehensive, and up-to-date compared to the handwritten book. Ad-hoc item searching decreased by 28% with checklist implementation.


Most staff agreed that the revised checklist content is improved. All items on the instrument checklists have been packed correctly by CPA staff. Workflow efficiency improved since CPA staff did not need to locate the preference book. All staff found the checklist to be legible with transition to the online spreadsheet.


Adoption of an electronic instrument preparation checklist was successful in one surgical specialty population. Scrub nurses no longer need to cross check prepared instruments, improving efficiency. All nurses can read the surgeon’s preference via the printed checklist.

Instrument packing time has been shortened since instrument location is indicated. This has decreased the risk of extending operative time due to additional item searches. Overall satisfaction has improved with checklist use compared to the preference book.

A checklist will be created for every specialty in the same format as this pilot. The hand-written preference book will be sustained during transition to the computer-based system. Anticipated transition completion is February 2017, when the hand-written preference book will be retired.