Surgical Safety Checklist (First Edition)

Before induction of anaesthesia

• SIGN IN

• Patient has confirmed:

• Identity

• Site

• Procedure

• Consent

• Site marked / not applicable

• Anaesthesia Safety Check completed

• Pulse oximeter on patient and functioning

• Does patient have a:

• known allergy?

  No

  Yes

• List allergies below:

• difficult airway / aspiration risk?

  No

  Yes, and equipment / assistance available

• risk of >500 ml blood loss (7 ml/kg in children)?

  No

  Yes, and adequate intravenous access and fluids planned

Before skin incision

• TIME OUT

• Confirm all team members have introduced themselves by name and role

• Surgeon, anaesthesia professional and nurse verbally confirm

• Patient

• Site

• Procedure

• Anticipated critical events

• Surgeon reviews: What are the critical or unexpected steps, operative duration, anticipated blood loss?

• Anaesthesia team reviews: Are there any patient-specific concerns?

• Nursing team reviews: Has sterility (including indicator results) been confirmed? Are there equipment issues or any concerns?

• Has antibiotic prophylaxis been given within the last 60 minutes?

  Yes

  Not applicable

• Is essential imaging displayed?

  Yes

  Not applicable

Before patient leaves operating room

• SIGN OUT

• Nurse verbally confirms with the team:

• Name of the procedure recorded

• That instrument, sponge and needle counts are correct (or not applicable)

• How the specimen is labelled (including patient name)

• Whether there are any equipment problems to be addressed

• Surgeon, anaesthesia professional and nurse review the key concerns for recovery and management of this patient