SURGICAL SAFETY CHECKLIST (FIRST EDITION)

BEFORE INDUCTION OF ANAESTHESIA BEFORE SKIN INCISION BEFORE PATIENT LEAVES OPERATING ROOM

SIGN IN TIME OUT SIGN OUT

‰ PATIENT HAS CONFIRMED ‰ CONFIRM ALL TEAM MEMBERS HAVE NURSE VERBALLY CONFIRMS WITH THE TEAM:
• IDENTITY INTRODUCED THEMSELVES BY NAME AND ROLE
‰ THE NAME OF THE PROCEDURE RECORDED
• SITE ‰ SURGEON, ANAESTHESIA PROFESSIONAL AND
• PROCEDURE ‰ THAT INSTRUMENT, SPONGE AND NEEDLE
NURSE VERBALLY CONFIRM
COUNTS ARE CORRECT (OR NOT
• CONSENT • PATIENT APPLICABLE)
• SITE
‰ SITE MARKED/NOT APPLICABLE ‰ HOW THE SPECIMEN IS LABELLED
• PROCEDURE
(INCLUDING PATIENT NAME)
‰ ANAESTHESIA SAFETY CHECK COMPLETED ANTICIPATED CRITICAL EVENTS
‰ WHETHER THERE ARE ANY EQUIPMENT
‰ PULSE OXIMETER ON PATIENT AND ‰ SURGEON REVIEWS: WHAT ARE THE CRITICAL PROBLEMS TO BE ADDRESSED
FUNCTIONING OR UNEXPECTED STEPS, OPERATIVE DURATION,
ANTICIPATED BLOOD LOSS?
DOES PATIENT HAVE A: ‰ SURGEON, ANAESTHESIA PROFESSIONAL AND
‰ ANAESTHESIA TEAM REVIEWS: ARE THERE ANY
KNOWN ALLERGY? PATIENT-SPECIFIC CONCERNS? NURSE REVIEW THE KEY CONCERNS FOR
RECOVERY AND MANAGEMENT OF THIS
‰ NO ‰ NURSING TEAM REVIEWS: HAS STERILITY PATIENT
‰ YES (INCLUDING INDICATOR RESULTS) BEEN
CONFIRMED? ARE THERE EQUIPMENT ISSUES OR
DIFFICULT AIRWAY/ASPIRATION RISK? ANY CONCERNS?
‰ NO
HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN WITHIN
‰ YES, AND EQUIPMENT/ASSISTANCE AVAILABLE THE LAST 60 MINUTES?
RISK OF >500ML BLOOD LOSS (7ML/KG IN CHILDREN)? ‰ YES
‰ NO ‰ NOT APPLICABLE
‰ YES, AND ADEQUATE INTRAVENOUS ACCESS IS ESSENTIAL IMAGING DISPLAYED?
AND FLUIDS PLANNED
‰ YES
‰ NOT APPLICABLE

THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED.