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Surgical Safety Checklist

The document provides a surgical safety checklist that is to be used before induction of anesthesia, before skin incision, and before the patient leaves the operating room. The checklist includes verifying the patient's identity and procedure, equipment checks, confirming antibiotic administration, and addressing any concerns for recovery.

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Tarek Ali
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149 views1 page

Surgical Safety Checklist

The document provides a surgical safety checklist that is to be used before induction of anesthesia, before skin incision, and before the patient leaves the operating room. The checklist includes verifying the patient's identity and procedure, equipment checks, confirming antibiotic administration, and addressing any concerns for recovery.

Uploaded by

Tarek Ali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Patient Label

Surgical Safety Checklist

→
Before Induction Of Anesthesia Before Patient Leaves OR
→ Before Skin Incision
SIGN IN TIME OUT SIGN OUT

(before transfer to procedure area) (With nurse, surgeon & anesthetist) (With nurse, surgeon & anesthetist)
(With at least nurse & anesthetist) Nurse Verbally Confirms:
 Name of the procedure recorded
 Confirm all team members have
Patient has confirmed:  Identity introduced themselves by name and role.  Completion of instrument, sponge and needle
 Consent  Procedure  Site Confirm the patient’s counts are correct
 Site Marked  Not Applicable  Name
 Anesthesia machine & medication Check   Procedure  Specimen labeling (read specimen labels
Implants are present  Site of the incision aloud, including patient name)
 Yes  No Anticipated Critical Events
To Surgeon:  Any equipment problems to be addressed
 Pulse oximeter on the patient & functioning
 Critical or Un-Expected steps
 Operative Duration To Surgeon & Anesthetist :
 Anticipated blood loss  Are there any concerns for recovery and
To Anesthetist: management of this patient?
Does the patient have  Any patient-specific concerns  No
A Known ALLERGY? To Nursing Team:  Yes, Specify
 No  Yes  Sterility confirmed
Difficult airway or aspiration risk? Equipment issues or concerns
 No  Yes  No
 Yes, and equipment/assistance available Essential imaging displayed
Risk of >500ml blood loss (7ml/kg in children)?  Yes  Not applicable
 No Prophylactic antibiotic given
 Yes, and two IVs/central access and fluids planned  Yes  No

Anesthesiologist Name/ID/Stamp Circulating Nurse Name/ID/Stamp : Circulating Nurse Name/ID/Stamp :


……………………………………………………. …………………………………………………. ………………………………………
Nurse Name/ID/Stamp ……………………………………
Time:………:…………AM/PM Time:………:…………AM/PM Time:………:…………AM/PM

Date:………./………../………

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