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T ~  @@ Llby name and role2+1-H-,121,TT ~  @@ LP /!"  % TT`  n  @@` ] LPpJ% TT  o  @@ ] LP LT  o  @@ ] LSurgeon, Anesthesiologist, an73 3.33:4..3./333..3T| o  @@] L\d Nurse 3<3!..!"  T o x  @@ Llverbally confirm/. 3.-.33 JTTy o  @@y LP /!"  % TT  %  @@  LP-T|  %  @@  L\ Patient2**.TT G %  @@  LP )!"  TT $  {  @@ j LP-T $ 1 {  @@ j Lp Site, side and l2**.**-.Td2 $ {  @@2 j LTevel*)*TT $ {  @@ j LP )!"  TT {   @@ LP-T {  @@ L` Procedure2.**..*TT {  @@ LP )!"  TT  ( @@ LP-T ( @@ L Antibiotic prophylaxis: r5...*.../&***T 8( @@  Ldepeat dose?*/**..)*.TT9 a( @@9LP )!"  TT ' ~ @@ mLP-T, '~ @@ m%L Final optimal positioning of patient..*..C)..)..-.-.**.TT'+~ @@mLP )!"  % TT`   @@` LPpK% TX   @@ LP TT   @@ LP T0 @ @@ &L Does anyone have any other questions *<3...4-33/3./..4-43. 33..33.!"  % T o @@ ]Lor concerns before proceeding? 3 .33./ 3.3.4 .3 4./.3333*% TT2m @@]LP TT3[m @@3]LP )!"  !"  %  TT  @@LP  !"    '% Ld** !??% (    %  T6 @@ L`DEBRIEFINGHCCHC=HNTT6 @@&" WMFC @#@#LP TT6K @@LP 8% TTLFb @@LLP TcF @@cLpBefore patient lea7......./.TpF @@LXves OR*.*A<% TTM+ @@LP ( ! '%    % Ld$)$ !??%   % Ld !??%  % (   "  % TTC @@2LPpK% TTD @@2LP TT)D @@2LP 5T *UD @@*2 LSurgeon reviews with entire team73 3.33 ./.B.B3.3 ./.JTTVD @@V2LP /!"  % TT*DB @@*LP-TTCDW @@CLP TTXDt @@XLP TuD @@u L`Procedure2.**..*TTD @@LP )!"  TT*B @@*LP-TTCW @@CLP TTXt @@XLP Tu @@uLlImportant intraC..*..*TT @@LP-T @@Lloperative events..**)**)*.*TT @@LP )!"  TT*BG @@*6LP-TTCWG @@C6LP TTXtG @@X6LP TuaG @@u6LFluid balance / management...-**.)*B*.*-*C*-TTaG @@a6LP *!"  % TT| @@LPpJ% TTy) @@LP LT,*y @@*%LAnesthesiologist reviews with entire :4/.3..333. ./.B.B3.3 .!"  Td*8 @@*&LTteam..JTT8 @@&LP /!"  % TT*8B @@*~LP-TTC8W @@C~LP TTX8t @@X~LP Tu8 @@u~LlImportant intraC..*..*TT8 @@~LP-T8 @@~Lloperative events..**)**)*.*TT8 @@~LP )!"  TT*B @@*LP-TTCW @@CLP TTXt @@XLP T<u/ @@u(LRecovery plans (including postoperative 6**.)*'.*.*.*...--.*..**)*!"  Tx< @@x+ Ldventilation)*.*..T< @@+L, pain management, glucose and -*.C*.*-*C)...).***..!"  Tx;B @@x Ldtemperature)*C.**.)TTC;k @@CLP )!"  % TT" @@LPpJ% TT)# @@LP LT *# @@*#LNurse(s) review(s) with entire team<3 ... ./.B.B3.3 ...JTT# @@LP /!"  % TT*#Bz @@*iLP-TTC#Wz @@CiLP TTX#tz @@XiLP T u#yz @@ui#LInstrument / sponge / needle counts.*.C*.*-...*.*).)*...*TTz#z @@ziLP )!"  TT*yB @@*LP-TTCyW&" WMFC @@# @@CLP TTXyt @@XLP T uy @@u LSpecimen labeling and management2.**C).*-*.-*..C*-*.*C).TTy @@LP )!"  TT*B&  @@* LP-TTCW&  @@C LP TTXt&  @@X LP TPue&  @@u +LImportant intraoperative events (including C..*..*..**)**)*.*.*...-!"  Tx& }  @@xl Lxequipment malfunction)*...B*.B*..*..TT& }  @@l LP )!"  % TT   @@ LPpK% TT   @@ LP TT )  @@ LP 5T*   @@* LlChanges to post<3.33..333.TT   @@ LP-T   @@ Ldoperative d33.!./.3T J  @@ Ldestination?..3.333TTK y  @@K LP /!"  % TTD   @@ LPpJ% TTA )  @@ LP LT *A   @@* #LWhat are the KEY concerns for this O3.. .3.=78.33/.!3.3 3.!"  T*   @@* "Lpatient s recovery and management?3..3.!..3/.!..33K.3.3.J.33TT   @@ LP /!"  % TT5   @@ LPpJ% TT2 )  @@ LP LT0*2 }  @@* &LCould anything have been done to make <333.4-3333./.3./3333.3J...!"  T* C  @@* "Lthis case safer or more efficient?3..././.. 4 J3!....33TTD q  @@D LP .!"  % Td& h  @@r LTHand<.33TTd&   @@dr LP-T,& G  @@r %Loff to PACU / RR, Nursing Unit or ICU337<<<<==3 .33<33 <<TTD& r  @@Dr LP / % TT   @@ LP .!"    '% Ld   !??% (    %  T   @@j LtPATIENT INFORMATIONCB>CG>H=NHSB>NH% TT' 9y  @@j LP ( ! '%    % Ld   !??%   % Ld   !??%  % (   "  Rp@"Arial Narrow5 0 06 0A&Arial arrow^?$4 ׼00Ln0(dv% TT  @@ LP %'% Ld!??% % Ld!??% F(GDIC !b $$>>% % V0 NF6NFGnbGnb6NF6% % $$@@: $$>>_888 % % V,r  NF6NFGnbGnb6% % $$@@( : " FGDIC% ( 666666666666666666666666666666666666&bWMFC@@# 6 66 6  6 66 6  6 66 6  6 66 6  6 66 6 66666666666666666666  ."System-@"Arial- "2 -SURGICAL SAFETY   2 -A @"Arial-2 L CHECKLIST  2 LM @"Arial-52 _www.safesurgerysaveslives.ca  2 _L ,- @ !d+-'@"Arial-S2 -0Adapted from the WHO Surgical Safety Checklist,    =2 (! 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AB204@!!A@AB2202DDDDDDDDDDDDDD200 A 0 A@DB14DB@!@11A1DDDDDDDDDDDDDDDDDDDDDDDDDDDD100 A !@1C!1A#A##1@!@0#1A !@!100!@!@0!1 A A 1#11 000A !0!#!D@A@D0!@0CD01#AC1@1D@!0$@1 A#1@00A !11 0!@#@A11@!!1A0 1!@A@1!0 1!$0@!@1#10!@@A@C@#1!$!0100 !300A  0A0@00000  '--$"!"XX!"!--',T&"2 0]"&TYour 9 2 0x"&T "2 <E"&TOrganizational  2 <"&T 2 I\"&TLogo 2 Iu"&T '@"Arial-   2 n-  @"Arial-   2 q-   - @ !v+-  @"Arial-  2 -BRIEFING   2 t  2 x@"Arial- 2  82 Before induction of anesthesia- 2 ,  ,-  - @ !u+- - @ !+- -  '@"Arial- 2 -Hand  2 L-;2 P off from ER, Nursing Unit or ICU     2  ,'@Wingdings- 2 -p @"Arial- 2 8 >2 C"Anesthesia equipment safety check  ,'2 C completed  2  ,'- 2 -p - 2 8 72 CPatient information confirmed    2  ,'@"Arial- 2 C- 2 G  2 J /2 OIdentity (2 identifiers) 2  ,' 2 C- 2 G  2 J 2 O Consent(s) 2  ,' 2 C- 2 G  2 J &2 OSite and procedure 2  ,' 2 C- 2 G  2 J #2 OSite, side and l2  evel markeda  2  ,' 2 C- 2 G  2 J ,2 OClinical documentation  2  ,' 2 !C- 2 !G  2 !J C2 !O%History, physical, labs, biopsy and x 2 !-2 !rays 2 !+ ,'- 2 6-p - 2 68 12 6CReview final test results   2 6 ,'- 2 K-p - 2 K8 @2 KC#Confirm essential imaging displayed    2 K ,'- 2 `-p - 2 `8 2 `C ASA Class   2 ` ,'- 2 u-p - 2 u8 2 uC Allergies  2 ux ,'- 2 -p - 2 8 2 C Medications - 2  ,' 2 C- 2 G  2 J 12 OAntibiotic prophylaxis: d2  ouble dose? 2  ,' 2 C- 2 G  2 J #2 OGlycemic control  2  ,' 2 C- 2 G  2 J 2 O Beta blockers 2  ,'- 2 C- 2 G  2 J F2 O'Anticoagulant therapy (e.g., Warfarin)? @"Arial- 2  ,'- 2 -p - 2 8 "2 CVTE Prophylaxis   2  ,'- 2 C- 2 G  2 J 2 O Anticoagulant 2  ,'- 2 C- 2 G  2 J 2 O Mechanical - 2  ,'- 2 -p - 2 8 >2 C"Difficult Airway / Aspiration Risk     2  ,'- 2 C- 2 G  2 J =2 O!Confirm equipment and assistance k  ,'2 O available 2 ~ ,'- 2 /-p - 2 /8 2 /C Monitoring  2 / ,'- 2 <C- 2 <G  2 <J O2 <O-Pulse oximetry, ECG, BP, arterial line, CVP,   ,'.2 HOtemperature and urine c) 2 HatheterG 2 H ,'- 2 ^-p - 2 ^8 2 ^C Blood loss  2 ^ ,'- 2 jC- 2 jG  2 jJ L2 jO+Anticipated to be more than 500 ml (adult)   ,'52 wOor more than 7 ml/kg (child)   2 w ,' 2 C- 2 G  2 J C2 O%Blood products required and available) 2  ,'@"Arial- 2 -  2 C- 2 G  2 J -A2 O$Patient grouped, screened and cross ,'-2 OmatchedG - 2 } ,','-   2 qh  ,' - @ !vf- -  2 hBRIEFING   2  @"Arial-2 (con 2 t2 inuedI 2 )- 2   ,- - @ !uf-- @ !f-- '- 2 hp - 2 s )2 ~Surgeon(s) review(s)  2  ,'- 2 ~- 2   2  2  Specific pat2  ient conce+2 rns, critical steps, ,'2 and )2 special instruments  2  or implantst  2 J  2 M ,'- 2 hp - 2 s 72 ~Anesthesiologist(s) review(s)   2 , ,'- 2 ~- 2   2  F2 'Specific patient concerns and critical ,'(2 resuscitation plans  2  ,'- 2 hp - 2 s (2 ~Nurses(s) review(s)   2  ,'- 2 ~- 2   2  R2 /Specific patient concerns, sterility indicator ,';2  results and equipment / implant   2 6issues 2 Y ,'- 2 (hp - 2 (s >2 (~"Patient positioning and support / ,'"2 6~Warming devices   2 6 ,'- 2 Khp - 2 Ks (2 K~Special precautions  2 K ,'- 2 `hp - 2 `s G2 `~(Expected procedure time / Postoperative  ,'2 n~ destination 2 n ,' 2 |h ,' - @ !f- -  2 hTIME OUT   2   2  - 2  )2 Before skin incision - 2 +  ,- - @ !f-- @ !f-- '- 2 hp - 2 s D2 ~&All team members introduce themselves     ,'#2 ~by name and role  2  ,'- 2 hp - 2 s 72 ~Surgeon, Anesthesiologist, an2 2d Nurse  ,'#2 ~verbally confirm 2  ,'- 2 ~-2  Patient 2  ,' 2 ~-%2  Site, side and li2 evel 2  ,' 2 ~-2   Procedure 2  ,' 2 ~-22  Antibiotic prophylaxis: r2  epeat dose? 2 H ,' 2 ~-C2 % Final optimal positioning of patient  2 @ ,'- 2 /hp -2 /s  2 /z D2 /~&Does anyone have any other questions  ,'-:2 =~or concerns before proceeding?- 2 =D  2 =G ,','-   2 q  ,' - @ !v- -  2  DEBRIEFING   2   2  - 2  &2 Before patient lea2 pves OR - 2   ,- - @ !u-- @ !-- '- 2 p - 2   2  ;2  Surgeon reviews with entire team   2  ,'- 2 - 2   2  2  Procedure 2  ,' 2 - 2   2  "2 Important intra  2 -#2 operative events 2 p ,' 2 - 2   2  22 Fluid balance / management   2 Z ,'- 2 p - 2  C2 %Anesthesiologist reviews with entire   ,'2 team 2  ,'- 2 - 2   2  "2 Important intra  2 -#2 operative events 2 p ,' 2 - 2   2  G2 (Recovery plans (including postoperative ,'2  ventilation:2 , pain management, glucose and   ,'2  temperature)  2   ,'- 2 -p - 2 - @2 -#Nurse(s) review(s) with entire teamt    2 - ,'- 2 :- 2 :  2 : @2 :#Instrument / sponge / needle countst  2 : ,' 2 F- 2 F  2 F ;2 F Specimen labeling and management    2 F ,' 2 S- 2 S  2 S L2 S+Important intraoperative events (including  ,',2 `equipment malfunction)   2 `D ,'- 2 up - 2 u  2 u "2 uChanges to post  2 u-2 u operative d2 ua estination? 2 u ,'- 2 p - 2  @2 #What are the KEY concerns for this t   ,'>2 "patients recovery and management?   2  ,'- 2 p - 2  D2 &Could anything have been done to make  ,'>2 "this case safer or more efficient?  2 | ,'- 2 Hand  2 -C2 %off to PACU / RR, Nursing Unit or ICU     2  - 2  ,' - @ !- -  (2 PATIENT INFORMATIONo    - 2 O  ,- - @ !-- @ !-- '@"Arial Narrow- 2  - @ !0oQ-- @ !0o---$---- $--'-՜.+,D՜.+,h$ hp  Calgary Health Region ' *BRIEFING - Before induction of anesthesia Title(Ya ContentTypeSSCAccessedCount0Safe Surgery Checklist Document Content Type782  !"#$%&'()*+,./012346789:;<=>?@ABCDEFHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      "#$%&'(/Root Entry F@li? 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