Before induction of anaesthesia
(with at least nurse and anaesthetist) Has the patient confirmed his/her identity, site, procedure, and consent? Yes Is the site marked? Yes Not applicable Is the anaesthesia machine and medication check complete? Yes Is the pulse oximeter on the patient and functioning? Yes Does the patient have a: Known allergy? No Yes Difficult airway or aspiration risk? No Yes, and equipment/assistance available Risk of >500ml blood loss (7ml/kg in children)? No Yes, and two IVs/central access and fluids planned
Before skin incision
(with nurse, anaesthetist and surgeon) Confirm all team members have introduced themselves by name and role. Confirm the patient’s name, procedure, and where the incision will be made. Has antibiotic prophylaxis been given within the last 60 minutes? Yes Not applicable Anticipated Critical Events To Surgeon: What are the critical or non-routine steps? How long will the case take? What is the anticipated blood loss? To Anaesthetist: 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? Yes Not applicable
Before patient leaves operating room
(with nurse, anaesthetist and surgeon) 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: What are the key concerns for recovery and management of this patient?
This checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged.
Revised 1 / 2009
© WHO, 2009