Surgical Safety Checklist at University of Miyazaki Hospital | |||
ID: Patient name: Department: | Date: | ||
Enter before (at operating room entrance) | At the entrance of operating room | ||
□Patient identification | |||
□Document verification | |||
□Confirmation of surgical site | |||
□Order of prevention of deep vein thrombosis | |||
In the operating room | |||
□Patient confirmation by attending doctor with personal data assistance | |||
□Confirmation of surgical site (preoperative marking) by attending doctor | |||
□Allergy confirmation | |||
Reporting for anesthesiologist | |||
□Confirmation of preoperative orders | |||
Observing items by operating room nurse | |||
Back abnormality □absence □presence ( ) | |||
Limitation of joint range of motion □absence □presence ( ) | |||
Skin abnormality □absence □presence ( ) | |||
□Not applicable | |||
(Abridgement of checklist due to emergency operation) | |||
※Leave to record the abridged items | |||
Before Skin incision (Time out) | □Self-introduction of members | ||
□Recognition of patient name, surgical site by doctors | |||
□Scheduled operating time | |||
□Predicted blood loss (much more than usual amounts, etc.?) | |||
□Important matters in surgery | |||
□Timing of antibiotics | |||
□Importance in anesthesia | |||
□Continuous analgesia by Patient-Controlled Analgesia (PCA) (necessary, unnecessary) | |||
□Duration of PCA | |||
□The prohibition of steroid, Anticoagulant, dialysis intervention, and etc. during the operation | |||
□Problem lists | |||
□Preparation of required materials and equipments | |||
Time out time ( : ) | |||
Time out members: Operator: ( ) Anesthesiologist: ( ) | |||
Attending doctor: ( ) Scrub nurse: ( ) | |||
Circulating nurse: ( ) | |||
□Not applicable (ultra-emergency operation) | |||
Leaving before | □Confirmation of surgical procedure, position of drain | ||
□Count of equipments Scrub nurse: ( ) Circulating nurse: ( ) | |||
Numbers of used equipments: Set ( ) Single ( ) | |||
Numbers of returned equipments: Set ( ) Single ( ) | |||
□Count of gauze □Not applicable Scrub nurse: ( ) Circulating nurse:( ) | |||