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  • NHMSFAP Surgical Safety Checklist Template

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    This document outlines a surgical safety checklist to be used before, during, and after surgery. The checklist includes steps to confirm patient identity, site of surgery, consents, allergies and medications, anticipated blood loss, and equipment safety. During a timeout before incision, the team introduces themselves and confirms critical details. After surgery, the team reviews important events, counts, labeling, and recovery plans with the patient's nurses and destination. The goal is to promote safety and efficiency in surgical care.

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    This document outlines a surgical safety checklist to be used before, during, and after surgery. The checklist includes steps to confirm patient identity, site of surgery, consents, allergies and medications, anticipated blood loss, and equipment safety. During a timeout before incision, the team introduces themselves and confirms critical details. After surgery, the team reviews important events, counts, labeling, and recovery plans with the patient's nurses and destination. The goal is to promote safety and efficiency in surgical care.

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    © All Rights Reserved
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    36 views1 page

    NHMSFAP Surgical Safety Checklist Template

    Uploaded by

    nsmanarultfahmy
    This document outlines a surgical safety checklist to be used before, during, and after surgery. The checklist includes steps to confirm patient identity, site of surgery, consents, allergies and medications, anticipated blood loss, and equipment safety. During a timeout before incision, the team introduces themselves and confirms critical details. After surgery, the team reviews important events, counts, labeling, and recovery plans with the patient's nurses and destination. The goal is to promote safety and efficiency in surgical care.

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    © All Rights Reserved
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    of 1

    SURGICAL SAFETY Your

    CHECKLIST
    Organizational
    Logo
    www.safesurgerysaveslives.ca

    BRIEFING – Before induction of anesthesia BRIEFING (continued) DEBRIEFING – Before patient leaves OR
    Hand-off from ER, Nursing Unit or ICU  Surgeon(s) review(s)  Surgeon reviews with entire team
    - Specific patient concerns, critical steps, - Procedure
     Anesthesia equipment safety check and special instruments or implants - Important intra-operative events
    completed - Fluid balance / management
     Anesthesiologist(s) review(s)
     Patient information confirmed - Specific patient concerns and critical  Anesthesiologist reviews with entire
    - Identity (2 identifiers) resuscitation plans team
    - Consent(s) - Important intra-operative events
    - Site and procedure  Nurses(s) review(s) - Recovery plans (including postoperative
    - Site, side and level marked - Specific patient concerns, sterility indicator ventilation, pain management, glucose and
    - Clinical documentation results and equipment / implant issues temperature)
    - History, physical, labs, biopsy and x-rays
     Patient positioning and support /  Nurse(s) review(s) with entire team
     Review final test results Warming devices - Instrument / sponge / needle counts
     Confirm essential imaging displayed  Special precautions - Specimen labeling and management
    - Important intraoperative events (including
     ASA Class  Expected procedure time / Postoperative equipment malfunction)
    destination
     Allergies  Changes to post-operative destination?
     Medications  What are the KEY concerns for this
    - Antibiotic prophylaxis: double dose? TIME OUT – Before skin incision patient’s recovery and management?
    - Glycemic control
     All team members introduce themselves  Could anything have been done to make
    - Beta blockers
    - Anticoagulant therapy (e.g., Warfarin)? by name and role this case safer or more efficient?
     VTE Prophylaxis  Surgeon, Anesthesiologist, and Nurse Hand-off to PACU / RR, Nursing Unit or ICU
    - Anticoagulant verbally confirm
    - Mechanical - Patient
    - Site, side and level PATIENT INFORMATION
     Difficult Airway / Aspiration Risk - Procedure
    - Confirm equipment and assistance - Antibiotic prophylaxis: repeat dose?
    available - Final optimal positioning of patient
     Monitoring  “Does anyone have any other questions
    - Pulse oximetry, ECG, BP, arterial line, CVP, or concerns before proceeding?”
    temperature and urine catheter
     Blood loss
    - Anticipated to be more than 500 ml (adult)
    or more than 7 ml/kg (child)
    - Blood products required and available
    - Patient grouped, screened and cross
    matched

    Adapted from the WHO Surgical Safety Checklist, © World Health Organization, 2008 Surgical Safety Checklist: Canada
    Version 1, January 9, 2009

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