Check 1 | | | | |
Check the patient’s identity | | The operating surgeon, or nominated deputy, who will be present in the theatre at the time of the patient’s procedure | | Signed: |
Check reliable documentation and/or images to ascertain intended surgical site | | | Print name: |
Mark the intended site with an arrow using an indelible pen | | | |
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Check 2 | | | | |
Prior to leaving ward/day care area the mark is inspected and confirmed against the patient’s supporting documentation | | Ward or day care staff | | Signed: |
Relevant imaging studies accompany patient or are available in operating theatre or suite | | | Print name: |
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Check 3 | | | | |
In the anaesthetic room and prior to anaesthesia, the mark is inspected and checked against the patient’s supporting documentation | | Operating surgeon or a senior member of the team | | Signed: |
Re-check that imaging studies have accompanied patient or are available in operating theatre or suite | | | | Print name: |
The availability of the correct implant (if applicable) | | | | |
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Check 4 | | | | |
The surgical, anaesthetic and theatre teams involved in the intended operative procedure prior to commencement of surgery should pause for verbal briefing to confirm: | | Theatre staff directly involved in the intended operative procedure | | Signed: |
Presence of the correct patient | | | Print name: |
Marking of the correct site | | | |
Procedure to be performed | | | |