Strategy 2: Communicating to Improve Quality (Tool 3)



Appendix E. Endoscopy Checklist TemplateEndoscopy Safety ChecklistPreprocedure Area/Procedure RoomEndoscopy Safety ChecklistPreprocedure Area/Procedure RoomBefore Patient Enters RoomNurse, Anesthesia Professional, and Patient Review:Patient identification (name and date of birth)Procedure to be performed matches the consentKnown allergiesPatient height, weight, body mass indexHistory and physicalAnesthesia Professional and Nurse Discuss:Anesthesia safety check is completedType of anesthesiaAnticipated airway and aspiration riskPatient-specific concernsThis checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged.Based on the WHO Surgical Safety Checklist, who.int/patientsafety/safesurgery/checklist/en/index.html, ? World Health Organization 2009. All rights reserved. Endoscopy Safety ChecklistProcedure RoomEndoscopy Safety ChecklistProcedure RoomBefore Procedure BeginsTeam IntroductionsPlease state your name and roleProceduralist Shares:Any changes to the plan and possible difficultiesNecessary equipment/devices are availableAnesthesia Professional Shares:Anesthetic planAirway and other concernsNursing Team Shares:Any equipment issues Other concernsNursing Team Confirms:All medications correct and labeledIs everyone ready to perform the timeout?The Team Performs The TimeoutPatient’s name Procedure to be performed matches the consent formProcedure siteProceduralist States:“Does anybody have any concerns? If you see something that concerns you during this case, please speak up.”Before Patient Leaves Room DebriefingNurse Reviews With Team:Name of the procedure performedIdentify/confirm patient restriction for diet or activity in recovery intervalSpecimen labeling Read back specimen labeling including patient’s nameTeam Discusses:Equipment problems that need to be addressedKey concerns for patient recovery and management Whether anything can be done to make the next case safer or more efficientThis checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged.Based on the WHO Surgical Safety Checklist, who.int/patientsafety/safesurgery/checklist/en/index.html, ? World Health Organization 2009. All rights reserved. ................
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