Some safety practices are studied so thoroughly that skipping them is hard to defend. The surgical safety checklist and the surgical count are two of them — and the College of Physicians & Surgeons of Alberta (CPSA) standard requires both of every non-hospital surgical facility. They're the part of the Quality Management System that stands between a normal day and a never-event.
What CPSA expects
The standard sets two connected requirements — the checklist, and the count:
The surgical safety checklist (NHS.9.8) — a documented policy for a checklist the whole surgical team completes at three critical moments:
- A briefing before anesthesia is induced.
- A "time-out" before the skin incision that verifies the patient, the surgical side, and the surgical site — with active back-and-forth among the whole team. It's always started by one designated person and run fail-safe: the procedure doesn't begin until every question or concern raised has been resolved.
- A debrief before the patient leaves the operating room.
- Completion is documented, and adherence is monitored and evaluated at regular intervals.
The surgical count (NHS.9.9) — policies that guarantee a comprehensive set of count practices, including:
- The count is done by two health professionals, audibly and concurrently — each item spoken aloud and seen by both at the same time.
- Sponges, sharps, and miscellaneous items are counted in every procedure; an instrument count is done whenever an instrument could be retained.
- The count is recorded on a standardized count sheet, with radiopaque (X-ray-detectable) materials used and a neutral-zone / hands-free technique for passing sharps.
- Nothing leaves the room until the final count is complete and correct; items added after the initial count are counted immediately; a separate sheet is used for multiple set-ups or body cavities.
- Any discrepancy triggers a standardized investigation, and whatever is done is documented on the intraoperative record.
Why it's more than a form
- The checklist gets box-ticked. Treated as paperwork, it loses the one thing that makes it work — the fail-safe pause where the team actually stops until concerns are resolved. The standard is explicit that the procedure doesn't start until they are.
- The count goes quiet — or solo. A count done by one person, or silently, isn't the control the standard describes. It wants two people, out loud, looking together.
- Compliance isn't tracked. Without monitoring, checklist use quietly decays between assessments — which is exactly why the standard asks you to measure it.
What "getting it right" looks like
- A genuine time-out everyone takes part in, led by a designated person and run fail-safe — verifying patient, side, and site (the marking from your pre-service process).
- Two-person, audible, concurrent counts on a standardized sheet, with radiopaque materials and neutral-zone passing.
- A documented discrepancy procedure, and checklist compliance tracked as a quality indicator so it stays strong.
How Zosimos helps
We help facilities make the checklist and count real, not just present: the policies and standardized sheets the standard expects, and — crucially — the compliance monitoring that keeps them alive. The Accreditation Audit Tool and Compliance Tracker we're building on the Zosimos Enterprise hub — launching soon — are designed to track checklist adherence and count records as the quality indicators CPSA wants to see.
For non-surgical clinics: the count doesn't apply unless you open cavities or use items that can be retained — but the safety culture does. A pre-procedure time-out confirming identity, site, and procedure, run as a genuine fail-safe pause, belongs in any clinic doing invasive work.
See our CPSA NHSF accreditation support or get in touch if your checklist is filled in but never measured. Next in this series: intraoperative care & sterile technique.