Reducing risks of tourniquets left on after finger and toe surgery: summary of a safety report from the National Patient Safety Agency.

What can we do? In the absence of evidence, the NPSA and the Royal C ollege of Surgeons consulted clinical experts to identify key actions to make practice safer: • Use only tourniquets with the CE marking (which indicates conformity with the European Union’s safety standards), which are labelled and/or brightly coloured to maximise visibility. Do not use gloves as tourniquets • Reconcile the number of tourniquets through swab counting procedures, and record the on/off time of tourniquets • Consider including tourniquets as part of the surgical safety checklist (tourniquet removal at “sign out” stage) • Once the tourniquet has been removed, check for adequate perfusion of finger or toe • Ensure that staff and patients know to look for later signs of tissue ischaemia, necrosis, and gangrene (skin discoloration or a pulseless, painful, paralysed, paraesthetic, and cold digit).