Name of the procedure performed Before Skin Incision Specimen labeling Read back specimen labeling including patient’s name Entire Surgical Team: Is everyone ready to perform the time out? Debriefing Please your name and role Entire Surgical Team Discusses: Patient’s name Equipment problems that need to be addressed. Surgical procedure to be performed Key concerns for patient recovery and management Surgical site What could have been done to make this case safer or more Essential imaging available efficient Has antibiotic prophylaxis been given within the last 60 minutes? Plan for redosing discussed Briefing This checklist is not intended to be comprehensive. Additions and modifications to fit local practice are Surgeon Shares: encouraged. on the WHO Surgical Safety Checklist, URL http://www.who.int/patientsafety/safesurgery/en, © World Health Organization Operative plan 2008 All rights reserved.’ Possible difficulties Expected duration Anticipated blood loss Implants or special equipment needed Anesthesia Provider discusses: Anesthetic plan Airway concerns Other concerns Nursing team discusses: Sterility, including indicator results Any equipment issues Other concerns Surgeon states: anybody have any concerns? If you see something that “Does concerns you during this case, please speak up.” Before Patient Leaves Room Nurse reviews with team: Instrument, sponge and needle counts are correct
Before Skin Incision Entire Surgical Team: Is everyone ready to perform the time out? Please your name and role Patient’s name Surgical procedure to be performed Surgical site Essential imaging available Has antibiotic prophylaxis been given within the last 60 minutes? Plan for redosing discussed Briefing Surgeon Shares: Operative plan Possible difficulties Expected duration Anticipated blood loss Implants or special equipment needed Anesthesia Provider discusses: Anesthetic plan Airway concerns Other concerns Nursing team discusses: Sterility, including indicator results Any equipment issues Other concerns Surgeon states: “Does anybody have any concerns? If you see something that concerns you during this case, please speak up.” Before Patient Leaves Room Nurse reviews with team: Instrument, sponge and needle counts are correct Name of the procedure performed Specimen labeling Read back specimen labeling including patient’s name Debriefing Entire Surgical Team Discusses: Equipment problems that need to be addressed. Key concerns for patient recovery and management What could have been done to make this case safer or more efficient This checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged. on the WHO Surgical Safety Checklist, URL http://www.who.int/patientsafety/safesurgery/en, © World Health Organization 2008 All rights reserved.’
two_page_format_landscape_11-20-12.docx