Surgical safety checklist
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
| BEFORE INDUCTION OF ANESTHESIA (With at least nurse and anesthesiologist) | |
| Has the patient confirmed his/her identity, site, procedure and consent? | ❑ Yes |
| Is the site marked? | ❑ Yes ❑ Not applicable |
| Is the anesthesia machine and medication check complete? | ❑ Yes |
| Is the pulse oximeter on the patient and is it working? | ❑ Yes |
| Does a patient have a known allergy? | ❑ No ❑ Yes |
| Does the patient have difficult airway or aspiration risk? | ❑ No ❑ Yes, and equipment/assistance is available |
| Risk of more than 500 ml blood loss (7ml/kg in children)? | ❑ No ❑ Yes, and two IVs/central access fluids are planned |
| BEFORE SKIN INCISION (With nurse, anesthesiologist and surgeon) | |
| Confirm all team members introduced themselves by name and role. | ❑ Yes |
| Confirm the patient's name, procedure, and where the incision will be made. | ❑ Yes |
| Has antibiotic prophylaxis been given within the last 60 minutes? | ❑ Yes ❑ Not applicable |
| Ask the surgeon about anticipated critical events. | ❑ What are the critical or non-routine steps? ❑ How long will the case take? ❑ What is the anticipated blood loss? |
| Ask the anesthesiologist about anticipated critical events. | ❑ Are there any patient-specific concerns? |
| Ask the nursing team about anticipated critical events. | ❑ Has sterility (including indicator results) been confirmed? ❑ Are there equipment issues or other concerns? |
| Is essential imaging displayed? | ❑ Yes ❑ Not applicable |
| BEFORE PATIENT LEAVES THE ROOM (With nurse, anesthesiologist and surgeon) | |
| Nurse verbally confirms the name of the procedure. | ❑ Yes |
| Nurse verbally confirms completion of instrument, sponge and needle counts. | ❑ Yes |
| Nurse verbally confirms specimen labeling (read specimen labels aloud, including the patient's name). | ❑ Yes |
| Nurse verbally confirms whether there are any equipment problems to be addressed. | ❑ Yes |
| The surgeon, anesthesiologist and nurse are inquired about any key concerns for the recovery or the management of the patient. | ❑ Yes |