• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

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.

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