TIMEOUT

Good ___________ everyone! I am __________________, a student nurse from Mater Dei College.

This is a case of _______________________ , _____ (age) , ______ (gender) , born on _______________

For _________________(name of procedure), Scheduled today, __________________ (date of surgery)

Under _______________________. (type of anesthesia)

With doctor ____________________ as surgeon, doctor ___________________assistant surgeon

And doctor _____________________ anesthesiologist.

Received IV.

[Patient blood type]

Mention if nay blood request, including details of blood request

Pre-op meds given

THANK YOU!

INITIAL COUNTING

Initial Counting of instruments, sponges, and ATR’s ready!

FINAL COUNTING (include scrub nurse and circu)

Excuse me, DR. ______________ , DR.________________ final counting of instruments, sponges and ATR’s done ad complete.

TIMEOUT

Good ___________ everyone! I am __________________, a student nurse from Mater Dei College.

This is a case of _______________________ , _____ (age) , ______ (gender) , born on _______________

For _________________(name of procedure), Scheduled today, __________________ (date of surgery)

Under _______________________. (type of anesthesia)

With doctor ____________________ as surgeon, doctor ___________________assistant surgeon

And doctor _____________________ anesthesiologist.

Received IV.

[Patient blood type]

Mention if nay blood request, including details of blood request

Pre-op meds given

THANK YOU!

INITIAL COUNTING

Initial Counting of instruments, sponges, and ATR’s ready!

FINAL COUNTING (include scrub nurse and circu)

Excuse me, DR. ______________ , DR.________________ final counting of instruments, sponges and ATR’s done ad
complete.