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دليل السياسات والإجراءات في غرفة العمليات
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F-OT-15 ←
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→ F-OT-13
F-OT-15 ←
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General Hospital • Operating Theatre
OT to PACU Handover Checklist
F-OT-14
SBAR / I-PASS Format
S
Situation & Background
Patient Name
MRN
Age / Gender
Procedure Performed
Surgeon
Allergies
Isolation / Precautions
A
Assessment (Intra-Op Course)
Anesthesia Type
GA
Spinal/Epidural
Regional Block
MAC/Sedation
Airway Status on Arrival
Extubated (Spontaneous)
Intubated (Ventilated)
LMA/Other
O2 Support:
Last Vitals in OT
BP:
HR:
SpO2:
Temp:
Pain / PONV
Last Analgesia:
Antiemetic given:
Reversal given:
Fluids & Blood Balance
Estimated Blood Loss
ml
Urine Output
ml
IV Fluids Given
ml
Blood Products Given
units
Lines & Catheters
PIV (Location:
)
CVC (Location:
)
Arterial Line
Foley Catheter
Epidural Catheter
NGT / OGT
Wounds, Drains & Packs
Drains:
Packs:
Dressing:
R
Recommendation (Post-Operative Plan)
Specific Instructions for PACU
Handover Checklist Verifications
Surgical Counts Correct in OT?
Yes
No
Specimens sent / labeled?
Yes
N/A
Skin integrity checked post-transfer?
Yes
No
Patient Belongings transferred?
Yes
N/A
Handover Acceptance & Signatures
1. Sending OT Nurse
Name / ID
Signature
2. Handing Over Anesthetist
Name / ID
Signature
3. Receiving PACU Nurse
Name / ID
Signature
Date
Handover Time