🏥
دليل السياسات والإجراءات في غرفة العمليات
→ F-OT-04
F-OT-06 ←
🏠 البوابة
الرئيسية
📋 جدول المحتويات
📚 الأقسام
🏠 البوابة
الرئيسية
📋 محتويات
📚 الأقسام
→ F-OT-04
F-OT-06 ←
Copy HTML
Download
Print
Clear
General Hospital • Operating Theatre
Combined Safe Surgery & Counts Record
F-OT-05
Patient Name
MRN
Date
Procedure / Site
Surgeon
Anesthetist
Circulating / Scrub Nurse
1. Sign In
Before Induction
Patient confirmed: Identity, Site, Procedure, Consent
Site marked
Yes
N/A
Anesthesia machine & medication check complete
Pulse oximeter on patient and functioning
Known Allergy?
No
Yes
Difficult Airway / Aspiration Risk?
No
Yes, equipment/assistance available
Risk of >500ml blood loss?
No
Yes, two IVs/central access ready
2. Time Out
Before Incision
Team members introduced by name & role
Surgeon, Anesthetist & Nurse verbally confirm:
• Patient • Site • Procedure
Anticipated Critical Events
Surgeon:
Critical steps, duration, blood loss
Anesthetist:
Patient-specific concerns
Nursing:
Sterility confirmed, equipment issues
Antibiotic prophylaxis given within last 60 min?
Yes
N/A
Is essential imaging displayed?
Yes
N/A
3. Sign Out
Before Patient Leaves
Nurse Verbally Confirms:
Procedure name is correctly recorded
Counts complete (See table below)
Specimen labeling (read aloud including patient name)
Equipment problems addressed
To Team:
Key concerns for recovery & management?
Surgical Counts Record
Circulating & Scrub Nurse Co-Verification
Item
First Count
Added Quantity
Mark (✓) if count is correct
Second Count
Third Count
Closing Count
Sponges & Textiles
RAYTEC 45X45
RAYTEC 40X40
RAYTEC 30X30
RAYTEC 4X4
CHERRIES / PEANUTS
PATTIES / COTTON PELLETS
Sharps & Instruments
BLADES
NEEDLES
INSTRUMENT SET: Main
INSTRUMENT SET: Addl
MISC (Vessel loops, etc.)
Final Count Result
Completed (Correct)
Incorrect (Discrepancy)
Surgeon Notified
Action taken if incorrect:
Surgeon Signature
Scrub Nurse Signature
Circulating Nurse Signature