PreOp verification by OR staff

Images are checked and are available?

Special equipment/instruments/supplies are checked and are available?

Implants are checked and are available?

Antibiotics have been given on time.

PreOp verification by patient

Patient is asked name, DOB, MD while nurse checks Name band and chart.

Patient is asked what procedure they are having done while nurses checks consent?

Patient is asked what allergies they have while nurse checks documentation in the chart.

Patient is asked to state what site the surgery is on while nurse checks consent and the chart.

Time Out

Surgeon calls for time out just prior to incision.

All other activity ceases, every one focuses on Time Out.

Circulator reads aloud the patient's name, procedure and procedure site from the informed consent. Asks for verification.

CRNA states patient name and procedure and site.

Scrub person states which procedure they have prepped for, including site.

Scrub person looks at site marking and states she sees it and where it is located.

Surgeon states full procedure.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.