Free Surgical Safety Checklist Template
Safety Checklist
Prepared by: Dr. [Your Name]
Hospital: [Your Hospital Name]
Date: June 12, 2058
Before Induction of Anesthesia:
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Verify Patient Identity: Confirm patient's name, date of birth, and medical record number. Cross-check with the patient's identification band and medical records.
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Confirm Procedure: Ensure clarity on the planned surgical procedure. Confirm with the surgical team and review relevant medical documentation.
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Site Marking: Clearly mark the surgical site. Verify the site with the patient and involve the surgical team in the process.
Before Skin Incision:
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Confirm Allergies: Check and confirm patient allergies. Ensure necessary precautions are in place, and alternatives are considered.
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Antibiotic Prophylaxis: Confirm administration of appropriate antibiotics within the recommended time frame. Ensure compatibility with patient allergies.
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Essential Equipment: Verify availability and functionality of essential equipment, including anesthesia machines, monitors, and specialized tools required for the procedure.
Before Patient Leaves Operating Room:
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Sponge and Instrument Count: Conduct a thorough count of sponges, instruments, and any other surgical items used during the procedure. Cross-verify with the initial count.
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Confirm Specimen Labeling: Ensure accurate labeling of any surgical specimens. Communicate specimen details to pathology if applicable.
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Postoperative Plan: Discuss the postoperative care plan with the anesthesia team and other relevant healthcare providers. Confirm any specific patient needs or concerns.
Throughout the Procedure:
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Team Communication: Encourage open communication within the surgical team. Foster an environment where team members feel comfortable raising concerns or asking questions.
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Patient Positioning: Ensure proper patient positioning to prevent complications such as pressure injuries or nerve damage.
This checklist aims to enhance patient safety by addressing critical aspects of surgical care, promoting effective communication, and minimizing the risk of errors during the entire surgical process.
