Stephanie Davis

OR Time Out Audit

Wrong-patient, wrong-site, wrong-procedure events can and must be prevented. Implementing evidence-based, risk-prevention strategies for the identification and verification of the correct patient, surgical site, and procedure will reduce the risk of error

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Title Page

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

Time out is conducted prior to skin Incision or introduction of scope?
All other activities are suspended (except in case of life-threatening emergency) during the time out?
During time out the procedure is identified, correct laterality if applicable is identified, and patient consent is verbalized?
Surgical Site is marked and visible ( if applicable)?
Relevant images properly labeled and displayed?
Checked implants are readily available?
Verbalized dry time for skin antiseptic has occurred (3 min.)?
Antibiotic prophylaxis ordered and started before incision?
Was a fire risk assessment protocol verbalized?

Stephanie Davis

OR Time Out Audit

Use this Template

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