WHO Surgical Safety Checklist

Instructions

Local adaptation of this Checklist is encouraged to ensure it is effectively integrated into clinical
practice. This may mean that some of the interventions are moved to a different step in the
Checklist, for example from Time Out to Sign In.

Some interventions may also be moved to the Preoperative team brief.

Any adaptations should be undertaken in accordance with your organisation's governance

scrutiny process.

This checklist contains the core content for England and Wales
WHO Surgical Safety Checklist

This checklist contains the core content for England and Wales
SIGN IN (to beHave
readall out
teamloud)
members
Hasintroduced
the namethemselves
of the procedure been recorded?
Before inductionby
onname and role?
anaesthesia Has it been confirmed that instruments, swabs
Yes and sharp counts are complete (or not
Has the patient confirmed his/her identity,
Surgeon, Anaesthetist applicable)?
and Registered
site, procedure and consent?
Practitioner verbally confirm:
Have the specimens been labeled (including
Yes
What is the patientspatient
name?name)?
Is the surgical site marked?
What procedure, site
Have
and any equipment
position problems been identified
are planned?
Yes/not applicable
Anticipated critical eventsthat need to be addressed?
Is the anaesthesia machine and medication
Surgeon: Surgeon, Anaesthetist and Registered
check complete?
How much blood Practitioner:
loss is anticipated?
Yes
What
Are there are specific are the key
equipment concerns for recovery and
requirements
Does the patient have a: management of this patient?
or special investigations?
Known allergy?
Are there any critical or unexpected steps you
No
want the team to know about?
Yes
Anaesthetist:
Difficult airway/aspiration risk?
Are there any patient specific concerns?
No
What is the patients ASA grade?
Yes, and equipment/assistance available
What monitoring equipment and other specific
Risk of >500ml blood loss (7ml/kg in
levels of support are required, for example
children)?
blood?
No
Nurse/ODP:
Yes, and adequate IV access/fluids planned
Has the sterility of the instrumentation been
confirmed (including indicator results)?
Are there are equipment issues or concerns?
Has the surgical site infection (SSI) bundle been
undertaken?
Yes/not applicable
o Antibiotic prophylaxis within the last 60
minutes
o Patient warming
o Hair removal
o Glycaemic control
Has VTE prophylaxis been undertaken?
Yes/not applicable
Is essential imaging displayed?
Yes/not applicable
PATIENT DETAILS Name:
Last name: Signature of
First name: Registered Practitioner:
Date of birth: Name:
NHS Number*: Signature of
Registered Practitioner:
Procedure:
*If the NHS Number is not immediately available, a temporary
number should be used until it is
SIGN OUT (to be read out loud)
Before any member of the team leaves the
TIME OUT (to operating
be read out
roomload)
Before start of surgical intervention
Registered Practitioner verbally confirms with
for example, skin incision
the team: