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Sign In
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Staff
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Time Stamp
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Patient Has Confirmed:
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Site Marked?
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Anesthesia Safety Check Completed?
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Pulse Oximeter:
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Does the patient have a known allergy?
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Difficult airway or aspiration risk?
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Risk of >500ml bloodloss
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Time Out
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Confirm all team members have introduced themselves by name and role
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Surgeon, Anesthesia Professional and Nurse Verbally confirm Patient, Site & Procedure
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Anticipated Critical Events
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Surgeon Reviews: What are the critical or unexpected steps, operative duration & anticipated blood loss?
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Anesthesia Team Reviews: Are there any patient-specific concerns?
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Nursing Team Reviews: Has sterility (including indicator results) been confirmed? Are there equipment issues or any concerns?
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Has antibiotic prophylaxis been given within the last 60 minutes?
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Is Essential imaging displayed?
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Sign out
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Staff
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Time Stamp
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Nurse verbally confirms with the team:
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Surgeon, anesthesia professional and nurse review the key
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Concerns for recovery and management of this patient
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