Sign in | Before induction of anesthesia | __ | Patient has confirmed: - Identity
- Site
- Procedure
- Consent
| __ | Site marked/not applicable | __ | Anesthesia safety check completed | __ | Pulse oximeter on patient and functioning | Does patient have a: | Known allergy? | __ | No | __ | Yes | 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 | | Time out | Before skin incision | __ | Confirm all team members have introduced themselves by name and role | __ | Surgeon, anesthesia professional, and nurse verbally confirm | Anticipated critical events | __ | Surgeon reviews: What are the critical or unexpected steps, operative duration, anticipated blood loss? | __ | Anesthesia 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 | | Sign out | Before patient leaves operating room | Nurse verbally confirms with the team: | __ | The name of the procedure recorded | __ | That instrument, sponge, and needle counts are correct (or not applicable) | __ | How the specimen is labeled (including patient name) | __ | Whether there are any equipment problems to be addressed | __ | Surgeon, anesthesia professional, and nurse review the key concerns for recovery and management of this patient | |