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Much of what we know about human‐based errors in veterinary medicine stems from an analysis of liability insurance claims. Surgical errors are overrepresented, including retained surgical tools [5, 37–45]. Because these errors have the potential to increase morbidity and mortality among patients, particularly when their diagnosis is delayed, measures ought to be taken to reduce the incidence.

Checklists in veterinary surgery are an appropriate tool to address surgical instrument retention, among other surgical errors. For instance, a surgical checklist should require a pre‐ and postoperative count of gauze squares, swabs, and sponges [37]. If these numbers are incongruent, then the surgery cannot be completed until all missing items are accounted for. Counting swabs and gauze squares is not immune from human error but it is an appropriate starting point prior to body cavity closure; in human healthcare, the sensitivity is 77% and specificity is 99% [46]. An additional safety measure would be the use of radiopaque swabs [47]. In the event that a discrepancy persists, radiographing the area of the body that was operated on should confirm accidental retention of the missing item within a body cavity.

In addition to surgical errors, medical errors may occur in veterinary practice (see 8.14 Appropriate Handling of Medical Errors). Among these, overdoses of medication and the administration of the wrong medication appear to be most common [5]. Checklists are also important aspects of convergence schedules, to ensure that client communication is managed appropriately (see 9.7 Continuum of Care and Convergence Schedules) and as preanesthetic safeguards (see 9.13 Preanesthetic Considerations).

Checklists are therefore advisable in veterinary healthcare for many reasons, all of which promote patient safety. There is currently no standard checklist to which all veterinary practices subscribe; however, a variety of formats are available in the popular press and can be custom‐fit to suit an individual practice's needs (see Table 2.4.1).

Table 2.4.1 Sample surgical safety checklist for use by veterinary practices as a tool to guard against human error. This checklist can be modified for completeness and to suit each individual hospital's needs

Surgical Safety Checklist
Procedure:
Attending Veterinarian:
CPR Code (Green / Red / Yellow)
Patient Identification	Client Information
Patient ID#:	Client Name:
Patient Name:	Client Phone Number:
Patient Signalment:	Client Emergency Contact:
Body Weight (Pounds):	Emergency Contact Number:
Body Weight (Kilograms):	Other Client or Patient‐Specific Notes:
Microchip Number:
Identifying Features: (Coat Color, Eye Color, etc.)
Patient Drop‐Off Procedures
Confirm patient's identity.
Confirm procedure to be performed, with client.
If sterilization surgery, confirm patient's sex.
Review procedure with client, including risks.
Obtain client contact information, including emergency contact.
Confirm the client's wishes concerning CPR code status for the patient in the event of an emergency.
Invite the client to ask questions or share concerns.
Make a plan with client concerning who from the practice will get in touch with them and when, relative to the end of the procedure.
Place identification (i.e., neck ID collar) on patient.
Weigh patient and record weight in pounds (lbs) and kilograms (kgs).
Record values for the patient's vital signs: T ______ / P _______ / R _________
Place patient in cage or kennel and label the housing appropriately.
Prior to Patient Induction
Confirm patient's identity
Review patient's chart:Are there any preexisting conditions that may complicate anesthesia, surgery, or recovery? If so, alert the attending clinician and create a plan for management of each condition.
Confirm procedure.
Confirm surgical site.
Perform physical examination.
Design patient's anesthetic protocol and confirm with the attending clinician:Include perioperative antibiotics (if necessary), analgesics, and other pre‐medications.Include calculations for induction agent and plans for maintaining anesthesia.
Check anesthetic machine and circuitry. Troubleshoot any potential problems.
Check monitoring equipment. Troubleshoot any potential problems.
Check patient warming devices. Troubleshoot any potential problems.
Patient Induction
Double‐check premedications, including route of administration.
Administer premedications.
Place intravenous catheter.
Double‐check induction agent.
Induce the patient.
Attach monitoring devices to the patient.
Prepare surgical site.
Transport patient into operating suite.
Prior to First Incision
Confirm patient, procedure, and incision site.
Confirm sterility of surgeon.
Complete patient prep, i.e., draping.
Counting of gauze squares, sponges, and swabs.
Surgeon to communicate with anesthetist about patient's vital signs prior to making the first incision.
During the Procedure
Patient's vital signs to be monitored and documented at predetermined intervals.
Prior to surgical wound closure, gauze squares, sponges, and swabs should be recounted. Compare this number to the presurgical count. If both numbers agree, then the patient can be closed.
After Surgery / During Patient Recovery from Surgery
Communication must take place between the OR surgeon/staff and those who will be tending to the patient in the postoperative period, including instructions concerning when to reassess patient and which medications to administer (how much? how often?)
Any samples that were taken intraoperatively need to be accounted for, labelled, stored appropriately, and/or submitted to the laboratory.
Surgeon to prepare surgical report. Any unexpected findings or complications should be documented in the patient's medical record.
Client communication should take place concerning the procedure.
Patient discharge instructions should be prepared.