Transcription of Checklist only:Layout 1 - WHO
1 PATIENT HAS CONFIRMED IDENTITY SITE PROCEDURE CONSENTSITE MARKED/NOT APPLICABLEANAESTHESIA SAFETY CHECK COMPLETEDPULSE OXIMETER ON PATIENT AND FUNCTIONINGDOES PATIENT HAVE A:KNOWN ALLERGY?NOYESDIFFICULT AIRWAY/ASPIRATION RISK?NOYES, AND EQUIPMENT/ASSISTANCE AVAILABLERISK OF >500ML BLOOD LOSS (7ML/KG IN CHILDREN)?NOYES, AND ADEQUATE INTRAVENOUS ACCESS AND FLUIDS PLANNEDNURSE VERBALLY CONFIRMS WITH THETEAM:THE NAME OF THE PROCEDURE RECORDEDTHAT INSTRUMENT, SPONGE AND NEEDLECOUNTS ARE CORRECT (OR NOTAPPLICABLE)HOW THE SPECIMEN IS LABELLED(INCLUDING PATIENT NAME)WHETHER THERE ARE ANY EQUIPMENTPROBLEMS TO BE ADDRESSEDSURGEON, ANAESTHESIA PROFESSIONALAND NURSE REVIEW THE KEY CONCERNSFOR RECOVERY AND MANAGEMENT OF THIS PATIENTSIGN INCONFIRM ALL TEAM MEMBERS HAVEINTRODUCED THEMSELVES BY NAME ANDROLESURGEON, ANAESTHESIA PROFESSIONALAND NURSE VERBALLY CONFIRM PATIENT SITE PROCEDUREANTICIPATED CRITICAL EVENTSSURGEON REVIEWS: WHAT ARE THECRITICAL OR UNEXPECTED STEPS,OPERATIVE DURATION, ANTICIPATEDBLOOD LOSS?
2 ANAESTHESIA TEAM REVIEWS: ARE THEREANY PATIENT-SPECIFIC CONCERNS?NURSING TEAM REVIEWS:HAS STERILITY(INCLUDING INDICATOR RESULTS) BEENCONFIRMED? ARE THERE EQUIPMENTISSUES OR ANY CONCERNS?HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVENWITHIN THE LAST 60 MINUTES?YESNOT APPLICABLEIS ESSENTIAL IMAGING DISPLAYED?YESNOT APPLICABLETIME OUTSIGN OUTB efore induction of anaesthesia Before skin incisionBefore patient leaves operating roomSURGICALSAFETYCHECKLIST(FIRSTEDITION )THIS Checklist IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE only:Layout 1 16/6/08 18:01 Page 1
