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Perform a surgical time out

Learner Task: Perform a surgical time out.
Educator Checklist: Surgical Time Out
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.


Included =1 Not included =0
Definition and purpose
Describes the purpose of the surgical safety checklist
Identifies the three times that the surgical safety checklist is utilized during a surgical case
Performance of the pre-incision surgical safety checklist
Confirms that all team members have been introduced by name and role
Confirms the patient’s identity, surgical site and procedure
Reviews anticipated critical events (critical steps, operative duration and anticipated blood loss)
Confirms with anesthesia staff any concerns specific to the patient
Confirms with nursing staff: A) sterility of OR, B) equipment availability and C) other concerns
Confirms that appropriate choice of prophylactic antibiotics and time of administration have been given prior to incision or that they are not indicated
Confirms that all essential imaging results for the correct patient are displayed in the room