Safe Surgery Checklist by The World Health Organization

• Hospital

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Nurse and Anesthesia Professional verify:

• Patient identification (name and DOB)

• Surgical site

• Surgical procedure to be performed matches the consent

• Site marked

• Known allergies

• Patient positioning

• Essential imaging available

ANESTHESIA BRIEFING

• Anesthesia Professional shares:

• Anticipated airway or aspiration risk

• Risk of significant blood loss

  Yes

  No

• Two IVs/central access and fluids planned

• Type and crossmatch/screen

• Blood availability

TIME OUT

• Circulating Nurse asks:
  “Is everyone ready to perform the time out? Please state your name and role.”

• Entire Surgical Team confirms:

• Patient name

• Surgical procedure to be performed

• Surgical site

• Essential imaging available

• Antibiotic prophylaxis given within the last 60 minutes

  Yes

  No

• Antibiotic redosing plan discussed

TEAM BRIEFING

• Surgeon shares:

• Operative plan

• Possible difficulties

• Expected duration

• Anticipated blood loss

• Implants or special equipment needed

• Anesthesia Professional shares:

• Anesthetic plan

• Airway concerns

• Other concerns

• Circulating Nurse and Scrub Tech share:

• Sterility, including indicator results

• Equipment issues

• Other concerns

• Surgeon asks:
  “Does anybody have any concerns? If you see something that concerns you during this case, please speak up.”

• Nurse reviews with team:

• Instrument, sponge, and needle counts

• Name of the procedure performed

• Nurse reads aloud to team:

• Specimen labeling, including patient’s name

TEAM DEBRIEFING

• Entire Surgical Team discusses:

• Key concerns for patient recovery and management

• Equipment problems that need to be addressed

• Other opportunities for improvement