SURGICAL SAFETY

CHECKLIST
BANGUED CHRISTIAN HOSPITAL

BRIEFING Before induction of anesthesia BRIEFING (continued) DEBRIEFING Before patient leaves OR
Hand-off from ER or Nursing Unit 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 patients 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 RR or Nursing Unit
- Anticoagulant verbally confirm
- Mechanical - Patient
- Site, side and level PATIENT INFORMATION
Difficult Airway / Aspiration Risk - Procedure
- Confirm equipment and assistance - Antibiotic prophylaxis: repeat dose? Surname: ________________________
available - Final optimal positioning of patient Given Name: _____________________
Monitoring Does anyone have any other questions Middle Name: ____________________
- Pulse oximetry, ECG, BP, temperature and or concerns before proceeding?
urine catheter Hospital Number: __________________
Blood loss Procedure: _______________________
- 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 BCH Copyright. Not to be reproduced in any manner.
matched

Adapted from the WHO Surgical Safety Checklist, World Health Organization, 2008 Surgical Safety Checklist: Bangued Christian Hospital
Version 2, June1, 2015