Before induction of anaesthesia
Has the patient confirmed his/her identity, site, procedure, and consent?
Is the site marked?
Is the anaesthesia machine and medication check complete?
Is the pulse oximeter on the patient and functioning?
Does the patient have a:
Difficult airway or aspiration risk?
Risk of >500ml blood loss (7ml/kg in children)?
Before skin incision
Confirm all team members have introduced themselves by name and role
Confirm the patient's name, procedure, and where the incision will be made
Had antibiotic prophylaxis have been given within the last 60 minutes?
What are the critical or non-routine steps?
List critical or non-routine steps
How long will the case take?
Include estimated time
What is the anticipated blood loss?
Include blood loss estimate
Are there any patient specific concerns?
To Nursing Team:
Has sterility (including indicator results) been confirmed?
Are there equipment issues or any concerns?
Is essential imaging displayed?
Before patient leaves operating room
Nurse Verbally Confirms:
The name of the procedure?
Completion of instrument, sponge and needle counts
Specimen labelling (read specimen labels aloud, including patient name)
Whether there are any equipment problems to be addressed
To Surgeon, Anaesthetist and Nurse:
Are there any key concerns for recovery and management of this patient?