Anaesthetic Safety Checklist
Pre-Induction
Patient NAME, owner CONSENT & PROCEDURE confirmed IV CANNULA placed & patent AIRWAY EQUIPMENT available & functioning Endotracheal tube CUFFS checked ANAESTHETIC MACHINE checked today Adequate OXYGEN for proposed procedure BREATHING SYSTEM connected, leak free & APL VALVE OPEN Person assigned to MONITOR patient RISKS identified & COMMUNICATED EMERGENCY INTERVENTIONS available
Pre-Procedure— Time Out
Patient NAME & PROCEDURE confirmed DEPTH of anaesthesia appropriate SAFETY CONCERNS COMMUNICATED
Recovery
SAFETY CONCERNS COMMUNICATED Airway, Breathing, Circulation( fluid balance), Body Temperature, Pain ASSESSMENT & INTERVENTION PLAN confirmed ANALGESIC PLAN confirmed Person assigned to MONITOR patient
This checklist was written by the AVA with design and distribution support from