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SAFE SURGERY SAVES LIVES

WORLD ALLIANCE FOR PATIENT SAFETY

WHO SURGICAL SAFETY CHECKLIST (ADVANCED DRAFT)

Prior to induction of anaesthesia Prior to skin incision Prior to patient leaving

the operating room

SIGN IN TIME OUT SIGN OUT

PATIENT CONFIRMED CONFIRM ALL TEAM MEMBERS NURSE VERBALLY CONFIRMS WITH
IDENTITY HAVE INTRODUCED THEMSELVES BY THE TEAM:
SITE NAME AND ROLE
PROCEDURE THE NAME OF THE PROCEDURE
CONSENT SURGEON, ANAESTHESIA RECORDED
PROFESSIONAL AND NURSE
SITE MARKED/NOT APPLICABLE VERBALLY CONFIRM THAT INSTRUMENT, SPONGE AND
PATIENT NEEDLE COUNTS ARE CORRECT (OR
ANAESTHESIA SAFETY CHECK SITE NOT APPLICABLE)
COMPLETED PROCEDURE
HOW THE SPECIMEN IS LABELED
PULSE OXIMETER ON PATIENT AND ANTICIPATED CRITICAL EVENTS (INCLUDING PATIENT NAME)
FUNCTIONING SURGEON REVIEWS: WHAT ARE THE
CRITICAL OR UNEXPECTED STEPS, WHETHER THERE ARE ANY
DOES PATIENT HAVE A: OPERATIVE DURATION, ANTICIPATED EQUIPMENT PROBLEMS TO BE
KNOWN ALLERGY? BLOOD LOSS? ADDRESSED
NO
YES ANAESTHESIA TEAM REVIEWS: ARE SURGEON, ANAESTHESIA
THERE ANY PATIENT-SPECIFIC PROFESSIONAL AND NURSE REVIEW
DIFFICULT AIRWAY/ASPIRATION CONCERNS? THE KEY CONCERNS FOR
RISK? RECOVERY AND MANAGEMENT
NO NURSING TEAM REVIEWS: HAS OF THIS PATIENT
YES, AND EQUIPMENT/ASSISTANCE STERILITY (INCLUDING INDICATOR
AVAILABLE RESULTS) BEEN CONFIRMED? ARE
THERE EQUIPMENT ISSUES OR ANY
RISK OF >500ML BLOOD LOSS CONCERNS?
(7ML/KG IN CHILDREN)?
NO ANTIBIOTIC PROPHYLAXIS GIVEN IN
YES, AND ADEQUATE IV LAST 60 MINUTES?
ACCESS/FLUIDS PLANNED YES
NOT APPLICABLE

ESSENTIAL IMAGING DISPLAYED?

YES
NOT APPLICABLE