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دليل السياسات والإجراءات في غرفة العمليات
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F-OT-14 ←
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الرئيسية
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الرئيسية
📋 محتويات
📚 الأقسام
→ F-OT-12
F-OT-14 ←
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General Hospital • Operating Theatre
OT On-Call Activation Log
F-OT-13
Date of Activation
Time Request Received
Requesting Surgeon / Specialty
Intended Procedure
Patient MRN
Urgency Category
Emergency
Urgent
Staff Mobilization & Response Tracking
Role Needed
Staff Member Contacted
Time Called
Time Response Received
ETA Given
Actual Arrival
Escalated?
(Yes/No)
Remarks / Alternate Called
Circulating Nurse (1st Call)
No
Yes
Scrub Nurse/Tech (1st Call)
No
Yes
Anesthesia Tech/Support
No
Yes
OT Coordinator / Runner
No
Yes
Secondary Scrub (if needed)
No
Yes
CSSD On-Call (if needed)
No
Yes
Radiographer (C-Arm/Xray)
No
Yes
No
Yes
No
Yes
Were there any delays in activation or response?
No delays (Team arrived within target time)
Yes, delay occurred
Incident Report Filed (If Applicable)
Details of Escalation / Reasons for Delay / Corrective Actions Taken:
Activating Charge Nurse / Coordinator
Name / ID
Signature
Date
Time Signed
OT Manager Review (Post-Event)
Name / ID
Signature
Date Reviewed