SSqCL - e1.6c

• Document No.

• Name of patient

• Name of surgeon

• Name of nursing staff

• Name of procedure

• Conducted on

  Date

• Audit Title

• Registration no of patient

1.Identity

• Identity of patient confirmed by a member of operating team

• the name of patient on identity band matched to case sheet & OT List

2.Lateralisation

• the incision is marked

• The identity band on side of incision or target organ

3.Antibiotic

• the antibiotic has been given on OT table

4.Conscent

• Routine

• Special

5.Count

• Gauges

• Sponges

• Instruments

• Time

  Date

Count

• Gauges

• Sponges

• Instruments

• count complete

• Time

  Date

• Add signature

  Sign