Checklist for surgical safety

1. geon
Sign.
:
thetist
Sign.
:
Scrub
Nurse
Sign.
:s..
Surgeon
Name
:...
am,..
Anesthetist
Name
:.
....
Scrub
Nurse
Name:
.
D
at
e
.
tloslas
NOT
FLUIDS
PLANNED
YES,
AND
ADEQUATE
INTRAVENOUS
ACCESS
AND
DYES
IS
ESSENTIAL
IMAGING
DISPLAYED
?
YNO
NOT
APPLICABLE
(7MA
KG
IN
CHILDREN)
?
RISK
OF>
500
ML
BLOOD
LOSS
YES
YES,
AND
EQUIPMENT
I
ASSISTANCE
THE
LAST
60
MINUTES
?
HAS
ANTIBIOTIC
PROPHYLAXIS
BEEN
GIVEN
WITHIN
NO
DIFFICULT
AIRWAY/ASPIRATION
RISK
?
YES
ANY
CONCERNS
?
CONFIRMED
?
ARE
THERE
EQUIPMENT
ISSUES
OR
(INCLUDING
INDICATOR
RESULTS)
BEEN
NURSING
TEAM
REVIEWS:
HAS
STERILITY
NO
KNeDN
ALLERY
?
PATIENT-
SPECIFIC
DOES
PATIENT
HAVE
A
:
PULSE
OXIMETER
ON
PATIENT
AND
FUNCTIONING
ANTICIPATED
BL00D
LOSS
?
UNEXPECTED
STEPS,
OPERATIVE
DURATION,
SURGEON
REVIEWS
:
WHAT
ARE
THE
CRITICAL
OR
ANAESTHESIA
SAFETY
CHECK
COMPLETED
ANTICIPATED
CRITICAL
EVENTS
Salee
SITE
MARKED
/
NOT
APPLICABLE
PROCEDURE
SITE
CONSENT
PROCEDURE
PATI
E
NT
NSsae
RECOVERY
AND
MANAGEMENT
OF
THIS
PATIENT
NURSE
REVIEW
THE
KEY
CONCERNS
FOR
SURGEON,
ANAESTHESIA
PROFESSIONAL
AND
PROBLEMS
TO
BE
ADDRESSED
NO
DWHETHER
THERE
ARE
ANY
EQUIPMENT
e
VERBALLY
CONFIRM
8URGEON,
ANAESTHESIA
COUNTS
ARE
CONNECT
(
O
R
NOT
APPLICABLE)
THAT
INSTRUMENT,
SPONGE
AND
.
IDENTITY
luosbu2
PATIENT
HAS
CONFIRMED
rc'
Salen
THEMSELVES
BY
NAME
AND
ROLE
CONFIRM
ALL
TEAM
MEMBERS
HAVE
INTRODUCED
.
THE
NAM
OF,
T
HE
PROÇEDURERECORDED
NURSE
VERBALLY
SIGN
IN
BEFORE
INDUCTION
OF
ANAESTHESIA
TIME
QUT
BEFORE
SKIN
INCISION
SIGN
OUT
BEFORE
PATIENT
LEAVE
OPERATING
ROOM
HOSPITALS
CARE
Sec.
Dcortor:
Doctor
NAB
SURGICAL
SAFETY
CHECKLIST
DOA/Cat.:07/03/2023--06:33
|
CASH
PAYING
42
Y/
F
GW-07
A-BLOCK/SECOND
Name
:Mrs
SALEHA
ANJUM
CNIMRDINURIV0-19/23
APPLICABLE
AVAILABLE
CONCERNS
?
ANAESTHESIA
TEAM
REVIEWS
:ARE
THERE
ANY
(INCLUDING
PATIENT
NAME)
ye
HOW
THE
SPECIMEN
IS
LABELLED
SITE
PROFESSIONAL
AND
NURSE
CONFIRMS
WITH
THE
TEAM
:
:DrSHABNAM
RAZA
AKHTEROBSTETRICS
AND
FLOOR/GENERAL