NMH SURGICAL SAFETY CHECKLIST (Operating Room)

Takes place prior to the beginning of anesthetic administration. An attending physician (surgeon or anesthesiologist) must be present ►►►► Before skin incision, after draping

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Before surgeon leaves OR SIGN IN (Led by Anesthesia Provider) TIME OUT (Led by Circulating Nurse) SIGN OUT (Led by Circulating Nurse) SURGEON, ANESTHESIA PROVIDER, CIRCULATING NURSE AND SCRUB STAFF DISCUSS

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TEAM INTRODUCTIONS

 FIRST AND LAST NAME  ROLE   RESIDENT LEVEL

PRE-OP ASSESSMENT COMPLETE

IDENTITY  SITE  PROCEDURE  CONSENT   ALLERGIES

PROPHYLACTIC ANTIBIOTICS

GIVEN?

 TYPE AND DOSE □  DNR STATUS  DIFFICULT AIRWAY  A LINE  CENTRAL ACCESS  DISPOSITION POST OP □

ANESTHESIA PLAN SURGICAL PLAN

 MONITORING  EQUIPMENT/IMPLANTS  IMAGING SUPPORT  SPECIAL NEEDS  NON-OPTIMAL TIMES FOR STAFF TRANSITION  POSITIONING □  ESTIMATED BLOOD LOSS  AVAILABILITY  CELL SAVER □

BLOOD ACCOUNTABILITY STATEMENT OR VERSION: 2/12/09 SURGEON, ANESTHESIA PROVIDER AND CIRCULATING NURSE VERBALLY CONFIRM

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CORRECT PATIENT

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CORRECT PROCEDURE SIDE/SITE MARKING VISIBLE

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ALLERGIES PROPHYLACTIC ANTIBIOTICS INFUSED

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CONFIRM CORRECT PATIENT POSITION

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* MATERIALS/EQUIPMENT

 IMPLANTS/INSTRUMENTS  X-RAYS  BLOOD

* THESE ITEMS MAY BE CONFIRMED DURING THE TIME OUT IF DISCUSSED DURING SIGN IN CIRCULATING NURSE VERBALLY CONFIRMS WITH SURGEON:

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REVIEW SPECIMENS OBTAINED AND SENT

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THE NAME OF THE PROCEDURE RECORDED

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WOUND CLASS VERIFICATION

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PATIENT DISPOSITION POST OP

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ANY SUPPLY AND/OR EQUIPMENT THAT WAS MISSING THAT SHOULD BE INCLUDED IN FUTURE CASES?

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POST-OP CLOSING X-RAY ORDERED (IF APPLICABLE)