AHRQ Safety Program for Perinatal Care: Labor and Delivery ...
Purpose of the tool: This tool describes the key perinatal safety elements related to safe cesarean section. The key elements are presented within the framework of the Comprehensive Unit-based Safety Program (CUSP).Who should use this tool: Nurses, physicians, midwives, and other labor and delivery (L&D) unit staff responsible for intrapartum care.How to use this tool: Review the key perinatal safety elements with L&D leadership and unit staff to determine how elements will be implemented on your L&D unit. Consider any existing facility policies, processes, or checklists related to cesarean section. Consider using preprinted checklists, laminated operating room posters, customized electronic health record tools, and staff simulation training to support implementation. An example of a safe cesarean section checklist is provided in the Appendix of this tool. Key Perinatal Safety ElementsStandardize When Possible (CUSP Science of Safety)Key Perinatal Safety ElementsExamplesUse a standardized perioperative process for cesarean section that includes the following three elements: Preoperative briefingTimeoutSignout Studies have found that the use of a standardized perioperative process with these three components (perioperative briefing, timeout, and signout) reduces surgical mortality and complications.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYXluZXM8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 1,2 This perioperative process should be the standard approach used for ALL cesarean sections. The unit procedures for this process should specify— Involvement of all physicians and staff members engaged in the surgeryThe surgical team member charged with leading each step of the perioperative processRoles of each staff member for the defined process to reduce variability from case to case and create redundancy at critical stepsAcceptable variations in the perioperative process for emergency cesarean sectionsStandardize When Possible (CUSP Science of Safety) (continued)Key Perinatal Safety ElementsExamplesPreoperative briefing The briefing reviews the plan ahead for patient care and the risks or concerns so that everyone has a shared mental model. It includes reviewing patient information, procedure, indications, risk, medical history, fetal status, and type of anesthesia.The preoperative briefing is typically led by the obstetrician/surgeon.Timeout prior to incisionThe timeout assures safety through a “huddle” or another checkpoint of redundancy for each team member to agree with the plan and maternal and fetal status. The timeout is typically led by the circulating nurse once all staff members are present in the operating room (OR).Signout and debriefThe signout and debrief provides a standard approach for wrapping up and debriefing the case by reviewing what has been done, the patient’s current status, next steps, and what went well, what may have gone better, or what might be done in the future, which is often a moment for process improvement.Create Independent Checks (CUSP Science of Safety)Key Perinatal Safety ElementsExamplesUse cognitive aids such as a checklist to guide the safe surgery perioperative process.Studies have demonstrated that safe surgery checklists can facilitate the safe surgery perioperative process.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BZ2VuY3kgZm9yIEhlYWx0aGNhcmUgUXVhbGl0eSBhbmQg
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ADDIN EN.CITE.DATA 3-6 A checklist can contain specific items for each component of the process. The checklist is designed to—Engage all relevant team membersIntroduce some redundancy into the perioperative processEnsure critical factors are considered and addressed at each stepSample safe cesarean section checklists are provided in the Appendix of this tool.Learn From Defects (CUSP Module)Key Perinatal Safety ElementsExamplesDebrief and analyze adverse events related to cesarean section.Unit can decide its approach to debriefing events based on seriousness of event, expertise available, and data monitoring and tracking capabilities. Informal debriefings by clinical team immediately following event using an approach that does not shame or blame individuals. This approach allows for understanding of what went well, what could have gone better and what could be done differently next time. An informal debriefing may be an extension of the signout component of the safe surgery perioperative process.Regular forum with a multidisciplinary team for learning from defects and sensemaking: Discovery form Root cause analysisEindhoven modelFailure mode and effects analysisProbabilistic risk assessmentCausal tree worksheetInterdisciplinary case reviews Have a process in place to review severe maternal or neonatal morbidity and mortality events. Unit can decide its approach to reviewing cases of severe maternal or neonatal morbidity or mortality. This might include an existing medical peer review process or review by a perinatal safety or quality committee.A sample process and forms for a committee review are available at the Council on Patient Safety in Women’s Health Care:Resource: Process for Reviewing Severe Maternal Morbidity Event Select: “Get SMM Form” menuShare outcomes or process improvements from the informal (debriefing) and formally analyze with staff to achieve transparency and organizational learning.Sites can decide how often this information will be shared, how much will be shared, and with whom, and whether this is specified in a unit policy or is handled more informally.Simulation (SPPC Program Pillar)Key Perinatal Safety ElementsExamplesSample scenarios:Several scenarios include opportunities to practice and train teams regarding the safe surgery perioperative process and efficient use of a checklist to guide that processSeveral sample scenarios available through the AHRQ Safety Program for Perinatal Care can be used to train teams on the key perinatal safety elements related to safe cesarean section. Any of the sample scenarios that ultimately result in a team’s decision to proceed to the OR for cesarean section delivery either emergently or nonemergently can be used. These scenarios reinforce teamwork and communication related to—situational awareness,use of the safe surgery checklists to guide the perioperative process that involves a preoperative briefing, a timeout, and a signout,communication with rapid responders,communication with patient/family, and use of briefings, huddles, and debriefings.Teamwork Training (TeamSTEPPS?)Key Perinatal Safety ElementsExamplesHave situational awareness. Situational awareness refers to all staff caring for the patient—knowing what the patient’s plan is through briefings and team management,being aware of what is going on and what is likely to happen next,verifying and checking back on information, andproviding ongoing updates.In the context of cesarean section, situational awareness refers to the use of briefings at critical junctures in care (preoperatively, prior to incision, at end of case prior to transfer to recovery); being aware of what is going on throughout the case; and anticipating what is to happen next.Use SBAR (Situation, Background, Assessment, and Recommendation), callouts, huddles, and closed-loop communication techniques.Use SBAR, callouts, huddles, and closed-loop communication among team members. In the context of cesarean section, these techniques are particularly useful—for communicating a sense of urgency when requesting other unit personnel and provider for help responding to an identified need for cesarean delivery,Teamwork Training (TeamSTEPPS?) (continued)Key Perinatal Safety ElementsExamplesUse SBAR, callouts, huddles, and closed-loop communication techniques. (continued)for communicating changes in maternal or fetal status,when giving and receiving new orders while preparing for or during a case, andwhen briefing new care team members who arrive to support a rapid response before or during the municate during transitions of care.Use of transition communication techniques assures a shared mental model of plan of care and perceived risks between units or care teams within a unit, for example transfers between L&D room and OR, and between OR and post-anesthesia care unit/recovery room.Foster a unit perspective of the safe cesarean section checklist as a tool for maximizing team performance, as opposed to a documentation requirement.The L&D/OR/neonatal/anesthesia teams maintain a shared mental model for the safe surgery perioperative process and the role of the checklist in facilitating the process. This shared mental model acknowledges and accepts the checklist as a team tool that—belongs to the surgical team and is not “owned” by any one specific discipline,is respected as the unit’s mechanism for guiding the safe surgery perioperative process, and is taken seriously by the surgical team, as opposed to viewing the process as an exercise in documentation.Have high-reliability teams:Anyone can sound an alarm, request help, or challenge the status quo.Hierarchy is munication is continuous, valued, and expected.Team members protect each other from work overload and place requests or offers for assistance in the context of patient safety. It is expected that assistance will be actively sought and offered.Team members will advocate for the patient when one person’s viewpoint does not coincide with another using team communication techniques: Assert a corrective action in a firm and respectful manner.Use CUS language: “I am concerned. I am uncomfortable. This is a safety issue.”Use the "two-challenge" rule, repeating concern, and asking whether you have been heard.Use a predetermined “stop the line” phrase.Teamwork Training (TeamSTEPPS?) (continued)Key Perinatal Safety ElementsExamplesHave high-reliability teams (continued)Team members manage conflict using a constructive positive approach to emphasize “what is right, not who is right”:D: Describe the specific behavior or situation.E: Express how the situation makes you feel or concerns you.S: Suggest other alternatives.C: Consequences stated in terms of team goals, not punishment.Patient and Family Engagement (CUSP Module)Key Perinatal Safety ElementsExamplesCommunicate risks and benefits of cesarean delivery with the patient and family.Process for consent may vary by urgency of the clinical situation, but the patient and family are part of the team.Ensure a shared mental model with patient and family as well as the clinical team.Have training and policies for L&D staff to provide timely, clear information to patient and family to explain what is happening, what needs to happen next, risks, benefits, and processes for obtaining consent. Provide reassurance continuously.Disclose any unintended outcomes.Unit-established process for disclosing unintended outcomes. This may include the following:Prompt, compassionate, and honest communication with the patient and familyInvestigationOngoing communication with the patient and familyApology and remediationSystem and process improvementMeasurement and evaluationEducation and trainingReferences: ADDIN EN.REFLIST 1.Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491-9. PMID: 19144931.2.Russ S, Rout S, Sevdalis N, et al. Do safety checklists improve teamwork and communication in the operating room? A systematic review. Ann Surg. 2013 Dec;258(6):856-71. PMID: 24169160.3.Agency for Healthcare Quality and Research’s Patient Safety Network. Patient Safety Primer on Checklists. 2012 October. . Accessed May 2, 2016.4.Hales B, Terblanche M, Fowler R, et al. Development of medical checklists for improved quality of patient care. Int J Qual Health Care. 2008 Feb;20(1):22-30. PMID: 18073269.5.Physician-Patient Alliance for Health & Safety. 5 Benefits of Adopting Patient Safety Checklists. 2013 March 19. . Accessed May 2, 2016.6.Gawande AA. The Checklist Manifesto: How to Get Things Right. 1st ed., New York, NY: Metropolitan Books; 2009.7.World Health Organization. Patient Safety: Safe Surgery: Why Safe Surgery Is Important. 2014 . Accessed May 2, 2016.AppendixEvery effort was made to ensure the accuracy and completeness of these resources. However, the U.S. Department of Health and Human Services makes no warranties regarding errors or omissions and assumes no responsibility or liability for loss or damage resulting from the use of information contained within.Sample Checklist for Cesarean DeliveryA checklist for cesarean delivery serves as a guide for teams by including the key safety-related steps: preoperative briefing, timeout, and signout, as well as the timing and location as shown in the following figure:This sample tool is based on the framework of the World Health Organization’s Surgical Safety Checklist, with adaptation for Cesarean Section. ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2014</Year><RecNum>57</RecNum><DisplayText><style face="superscript" font="Times New Roman">7</style></DisplayText><record><rec-number>57</rec-number><foreign-keys><key app="EN" db-id="tvp90vefjvtss3ezsd7vzvp1p2sf2fftrdp9">57</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Patient Safety: Safe Surgery: Why Safe Surgery Is Important</title></titles><volume>2014</volume><number>August 25</number><dates><year>2014</year></dates><urls><related-urls><url> The Safe Cesarean Checklist for Planned/Routine Cesarean Sections is available in two formats: an “at a glance” format or a “large print” format. Examples of both formats have been included on the following pages. They both contain the same information. The “at a glance” format provides all information on one page. The “large print” format provides the same information across multiple pages using a clear, easy-to-read font. Hospital can review and adapt the contents and the format into whatever best meets unit needs.At A Glance: Safe Cesarean Checklist for Planned/Routine Cesarean SectionAt the briefing station/nursing stationIn operating room – Before skin incisionBefore mother leaves the operating roomPREOP BRIEF (5 minutes) – Surgeon initiatesTIMEOUT (5 minutes) – Circulating nurse initiates when all staff presentSIGNOUT & DEBRIEF (2 minutes) – Circulating nurse initiatesConfirm/all participants present: Anesthesia provider Surgeon First assistant Resident physician (if applicable) Patient’s labor and delivery (L&D) nurse Circulating nurse Charge nurse Operating room (OR) technician Pediatrics Primary maternity provider (if other than surgeon)Team reviews: Patient name Patient date of birth Patient informed of risks and benefits of C/S, patient and family questions answered. Consent signed (Yes / No)Procedure planned: Cesarean section Cesarean section with bilateral tubal ligation (BTL) OtherIndications for procedure: Scheduled repeat C/S Arrest of dilation Arrest of descent Nonreassuring Fetal Heart Rate Tracing (NRFHRT) Malpresentation Other____________________________________Pertinent medical history: Previous abdominal surgeries/Cesarean section (Yes/No) Allergies (Yes/No)-If Yes, then list allergy and reaction Group B strep status (Positive/Negative/Unknown)Fetal status: Chorioamnionitis (Yes/No/Unknown) Meconium (Yes/No/Unknown)Type of anesthesia planned: Spinal Epidural Combined General Blood products needed/anticipated? (Yes/No)Planned start/incision Time: ____:____AM/PMPurpose of time out explained to patient if alert (“we are following a checklist to ensure your safety”)All staff introduce themselves: Anesthesia provider Surgeon First assistant Resident physician (if applicable) Patient’s L&D nurse (if applicable) Circulating nurse OR technician Pediatric providerCirculating nurse verbalizes: Identity (patient name & date of birth)Procedure planned: Cesarean section Cesarean section with BTL OtherIndications for procedure: Scheduled repeat C/S Arrest of dilation Arrest of descent NRFHRT Malpresentation Other___________________________________________________________________ Cord blood collection (Yes/No) Consent signed & on chart (Yes/No) Fetal tracing status (Category I/Category II/Category III) Allergies (Yes/No) If yes, specify________________________________________________ Patient positioned (Lateral displacement done/Vaginal hand needed? (Yes/No) Pneumatic compression stockings on (Yes/No) Grounding pad applied (Yes/No) Foley catheter in (Yes/No)Surgeon confirms: Expected duration of procedure Should blood be available in the room for this case? (Yes/No anticipated)* If yes, then make preparations if not already available) Additional instruments needed/anticipated (Yes/No)Anesthesia provider confirms: Type of anesthesia used (Spinal/Epidural/Combined/General) Antibiotics infused within 60 minutes of incision time (Yes/No) Anesthesiology concerns (Yes/No) If yes, specify_______________________________Pediatric provider confirms: GBS status (Positive/Negative/Unknown) Meconium (Yes/No/Unknown) Chorioamnionitis (Yes/No/Unknown) Pediatric concerns (Yes/No) If yes, specify_____________________________________Items reviewed:Procedure performed Cesarean section Cesarean section with BTL Other______________________________ Antibiotics infused within 60 minutes of incision time (Yes/No) If No, consider administration of antibiotics Sponge/needle/instrument counts correct (Yes/No) Cord gases labeled (Yes/NA) Specimens labeled (Yes/NA) Deep vein thrombosis (DVT) prophylaxis planned Sequential compression devices (SCDs) only SCD+prophylactic heparin SCD+adjusted dose heparin N/A Any equipment issues* (Yes/No) If yes list here: ____________________________________________________________________________________________ Any system issues* (Yes/No) If yes list here: ____________________________________________________________________________________________Postoperative concerns/issues for the team to be aware of? (Each team member listed below either says “Yes” and states the issues or says “No Concerns” if none) Surgeon Nurse Anesthesia provider Pediatric provider*Any equipment/systems issues identified should be recorded and provided to designated person so they can be addressed and resolution shared with the unit.At A Glance: Safe Cesarean Checklist for Urgent/Emergency Cesarean SectionsAt the briefing station/nursing stationIn operating room – Before skin incisionBefore mother leaves the operating roomPREOP BRIEF – Not performedTIMEOUT (5 minutes) – Circulating nurse initiates ONLY if appropriate for the level of maternal/fetal distress and clinical situationSIGNOUT& DEBRIEF (2 minutes) – Circulating nurse initiatesN/APurpose of time out explained to patient if alert (“we are following a checklist to ensure your safety”)All staff introduce themselves: Anesthesia provider Surgeon First assistant Resident physician (if applicable) Patient’s labor and delivery (L&D) nurse (if applicable) Circulating nurse Operating room (OR) technician Pediatric providerCirculating nurse verbalizes: Identity (patient name & date of birth)Planned procedure: Cesarean section Cesarean section with bilateral tubal ligation (BTL) OtherIndications for procedure: Arrest of dilation Arrest of descent Malpresentation Nonreassuring Fetal Heart Rate Tracing /fetal distress Maternal distress Other___________________________________________________________________ Consent signed & on chart (Yes/No) Cord blood collection (Yes/No) Fetal tracing status (Category I/Category II/Category III) Allergies (Yes/No) If yes, specify________________________________________________ Patient positioned (Lateral displacement done/Vaginal hand needed? (Yes/No) Pneumatic compression stockings on (Yes/No) Grounding pad applied (Yes/No) Foley catheter in (Yes/No)Surgeon confirms: Expected duration of procedure Should blood be available in the room for this case? (Yes/No anticipated)* If yes, then make preparations if not already available) Additional instruments needed/anticipated (Yes/No)Anesthesia provider confirms: Type of anesthesia used (Spinal/Epidural/Combined/General) Antibiotics infused within 60 minutes of incision time (Yes/No) Anesthesiology concerns: (Yes/No) If yes, specify_________________________________Pediatric provider confirms: GBS status (Positive/Negative/Unknown) Meconium (Yes/No/Unknown) Chorioamnionitis (Yes/No/Unknown) Pediatric concerns (Yes/No) If yes, specify______________________________________Items reviewed:Procedure performed Cesarean section Cesarean section with BTL Other______________________________ Antibiotics infused within 60 minutes of incision time (Yes/No) If No, consider administration of antibiotics Sponge/needle/instrument counts correct (Yes/No) Cord gases labeled (Yes/NA) Specimens labeled (Yes/NA) Deep vein thrombosis (DVT) prophylaxis planned Sequential compression devices (SCDs) only SCD+prophylactic heparin SCD+adjusted dose heparin N/A Any equipment issues* (Yes/No) If yes list here: ______________________________________________________________________________________________ Any system issues* (Yes/No) If yes list here: ______________________________________________________________________________________________Postoperative concerns/issues for the team to be aware of? (Each team member listed below either says “Yes” and states the issues or says “No Concerns” if none) Surgeon Nurse Anesthesia provider Pediatric provider*Any equipment/systems issues identified should be recorded and provided to a designated person so they can be addressed and resolution shared with the unit.Safe Cesarean Checklist for Planned/Routine Cesarean SectionDetailed Preoperative Briefing Checklist(5 minutes)Who: Surgeon initiatesWhen: Before operating room (OR), after decision to proceed with cesarean section (C/S) is madeWhere: Briefing station/nursing stationConfirm/all participants present: FORMCHECKBOX Anesthesia provider FORMCHECKBOX Surgeon FORMCHECKBOX First assistant FORMCHECKBOX Resident physician (if applicable) FORMCHECKBOX Patient’s labor and delivery nurse FORMCHECKBOX Circulating nurse FORMCHECKBOX Charge nurse FORMCHECKBOX OR technician FORMCHECKBOX Pediatric provider FORMCHECKBOX Primary maternity care provider (if other than surgeon)Team reviews: FORMCHECKBOX Patient name FORMCHECKBOX Patient date of birth FORMCHECKBOX Patient informed of risks and benefits of C/S, patient and family questions answered. FORMCHECKBOX Consent signed (Yes/No)Procedure planned: FORMCHECKBOX Cesarean section FORMCHECKBOX Cesarean section with bilateral tubal ligation FORMCHECKBOX Other__________________Indications for procedure: FORMCHECKBOX Scheduled repeat C/S FORMCHECKBOX Arrest of dilation FORMCHECKBOX Arrest of descent FORMCHECKBOX Nonreassuring fetal heart rate tracing FORMCHECKBOX Malpresentation FORMCHECKBOX Other___________________Pertinent medical history:Previous abdominal surgeries/cesarean section: FORMCHECKBOX Yes FORMCHECKBOX NoAllergies: FORMCHECKBOX Yes If yes, specify_______________________________________________ FORMCHECKBOX NoGroup B streptococcus status: FORMCHECKBOX Positive FORMCHECKBOX Negative FORMCHECKBOX UnknownFetal status:Chorioamnionitis: FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownMeconium: FORMCHECKBOX Yes FORMCHECKBOX NoType of anesthesia planned: FORMCHECKBOX Spinal FORMCHECKBOX Epidural FORMCHECKBOX Combined FORMCHECKBOX GeneralBlood products needed/anticipated? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownPlanned start/incision time: _____:_____ FORMCHECKBOX AM FORMCHECKBOX PMDetailed Timeout Checklist(5 minutes)Who: Circulating nurse initiates when all staff are presentWhen: Before skin incisionWhere: In operating room (OR)All staff introduce themselves: FORMCHECKBOX Anesthesia provider FORMCHECKBOX Surgeon FORMCHECKBOX First assistant FORMCHECKBOX Resident physician (if applicable) FORMCHECKBOX Patient’s labor and delivery nurse (if applicable) FORMCHECKBOX Circulating nurse FORMCHECKBOX OR technician FORMCHECKBOX Pediatric providerCirculating nurse verbalizes:Identity: FORMCHECKBOX Patient Name FORMCHECKBOX Patient date of birthPlanned operation: FORMCHECKBOX Cesarean section FORMCHECKBOX Cesarean section with bilateral tubal ligation FORMCHECKBOX Other__________________________Indications for procedure: FORMCHECKBOX Scheduled repeat cesarean section FORMCHECKBOX Arrest of dilation FORMCHECKBOX Arrest of descent FORMCHECKBOX Nonreassuring fetal heart rate tracing FORMCHECKBOX Malpresentation FORMCHECKBOX Other____________________Consent signed & on chart: FORMCHECKBOX Yes FORMCHECKBOX NoCord blood collection: FORMCHECKBOX Yes FORMCHECKBOX NoFetal tracing status: FORMCHECKBOX Category I FORMCHECKBOX Category II FORMCHECKBOX Category IIIAllergies: FORMCHECKBOX Yes FORMCHECKBOX No If yes, specify______________________________________Patient positioned: FORMCHECKBOX Lateral displacement FORMCHECKBOX Vaginal hand needed: FORMCHECKBOX Yes FORMCHECKBOX NoPneumatic compression stockings on: FORMCHECKBOX Yes FORMCHECKBOX NoGrounding pad applied: FORMCHECKBOX Yes FORMCHECKBOX NoFoley catheter in: FORMCHECKBOX Yes FORMCHECKBOX NoSurgeon confirms:Expected duration of procedure: ____________Should blood be available in the room for this case? FORMCHECKBOX Yes, anticipated* FORMCHECKBOX No* If yes, then make preparations if not already available.Additional instruments needed/anticipated: FORMCHECKBOX Yes FORMCHECKBOX NoAnesthesia provider confirms:Type of anesthesia used: FORMCHECKBOX Spinal FORMCHECKBOX Epidural FORMCHECKBOX Combined FORMCHECKBOX GeneralAntibiotics infused within 60 minutes of incision time: FORMCHECKBOX Yes FORMCHECKBOX NoAnesthesia provider concerns: FORMCHECKBOX Yes FORMCHECKBOX No If yes, specify_______________________________________Pediatric provider confirms:Group B streptococcus status: FORMCHECKBOX Positive FORMCHECKBOX Negative FORMCHECKBOX UnknownMeconium: FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownChorioamnionitis: FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownPediatric concerns: FORMCHECKBOX Yes FORMCHECKBOX No If yes, specify_________________________________________________________Detailed Signout & Debrief Checklist(2 minutes)Who: Circulating nurse initiatesWhen: Before patient leaves operating roomWhere: In operating roomItems reviewed:Procedure performed: FORMCHECKBOX Cesarean section FORMCHECKBOX Cesarean section with bilateral tubal ligation FORMCHECKBOX Other__________________________Antibiotics infused within 60 minutes of incision time: FORMCHECKBOX Yes FORMCHECKBOX No If no, consider administration of antibioticsSponge/needle/instrument counts correct: FORMCHECKBOX Yes FORMCHECKBOX NoCord gases labeled: FORMCHECKBOX Yes FORMCHECKBOX NASpecimens labeled: FORMCHECKBOX Yes FORMCHECKBOX NADeep vein thrombosis prophylaxis planned: FORMCHECKBOX Sequential compression devices (SCDs) only FORMCHECKBOX SCD+prophylactic heparin FORMCHECKBOX SCD+adjusted dose heparin FORMCHECKBOX N/AAny equipment issues: FORMCHECKBOX Yes* FORMCHECKBOX No*If yes, list here:Any system issues: FORMCHECKBOX Yes* FORMCHECKBOX No*If yes, list here:*Any equipment/systems issues identified should be recorded and provided to designated person so they can be addressed and resolution shared with the unitPostoperative concerns/issues for the team to be aware of?(Each team member listed below either says “Yes” and states the issues or says “No Concerns” if none.)Surgeon: FORMCHECKBOX Yes______________________________________________________________ FORMCHECKBOX No concernsNursing: FORMCHECKBOX Yes______________________________________________________________ FORMCHECKBOX No concernsAnesthesia provider: FORMCHECKBOX Yes______________________________________________________________ FORMCHECKBOX No concernsPediatric provider: FORMCHECKBOX Yes______________________________________________________________ FORMCHECKBOX No concerns44005508790305AHRQ Publication No. 17-0003-21-EFMay 2017020000AHRQ Publication No. 17-0003-21-EFMay 2017 ................
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