Perioperative Surgical Count & Time-Out Checklist [FREE PDF]
Perioperative nurses and surgical teams use this checklist per AORN Guidelines for Perioperative Practice and WHO Surgical Safety Checklist for surgical counting and Universal Protocol compliance.
- Industry: Healthcare / Surgery
- Frequency: Per Procedure
- Estimated Time: 10-15 minutes
- Role: Circulating Nurse
- Total Items: 8
- Compliance: AORN Guidelines, WHO Surgical Safety Checklist
Sign-In & Time-Out
Complete WHO/Universal Protocol sign-in and time-out.
- Has patient identity been confirmed with two identifiers and matching consent?
- Is the surgical site marked by the surgeon and verified during time-out?
- Has the full surgical time-out been conducted with all team members participating?
- Sign-in and time-out notes
Surgical Counts & Sign-Out
Complete surgical counts and sign-out procedure.
- Were initial counts of sponges, sharps, and instruments completed before incision?
- Do final counts reconcile (sponges, sharps, instruments) before closure?
- Are specimens labeled in the presence of the surgeon and handled per protocol?
- Counts and sign-out notes
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Why Use This Perioperative Surgical Count & Time-Out Checklist [FREE PDF]?
This perioperative surgical count & time-out checklist [free pdf] helps healthcare / surgery teams maintain compliance and operational excellence. Designed for circulating nurse professionals, this checklist covers 8 critical inspection points across 2 sections. Recommended frequency: per procedure.
Ensures compliance with AORN Guidelines, WHO Surgical Safety Checklist. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Perioperative Surgical Count & Time-Out Checklist [FREE PDF] cover?
This checklist covers 8 inspection items across 2 sections: Sign-In & Time-Out, Surgical Counts & Sign-Out. It is designed for healthcare / surgery operations and compliance.
How often should this checklist be completed?
This checklist should be completed per procedure. Each completion takes approximately 10-15 minutes.
Who should use this Perioperative Surgical Count & Time-Out Checklist [FREE PDF]?
This checklist is designed for Circulating Nurse professionals in the healthcare / surgery industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.