| #
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Step
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Instructions
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Good Skills (Learning Objectives)
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Common Errors
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Guidance
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| 1
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Environmental readiness check
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Articulates that OR environmental cleaning checklist / terminal cleaning checklist are completed
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| 2
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Verify:
- Planned procedure
- Surgeon requirements/preferences
- Special equipment needs
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Articulates planned procedures and setup/special equipment required confirmed with surgeon
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| 3
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Gather supplies
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Articulate that all needed equipment is available and ready
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| 4
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Check and position OR furniture
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Position OR bed/table, Mayo/side tables, anesthesia workstation and stools; ensure clear transfer space and walkways.
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Correct ergonomic layout; unobstructed walkways; table aligned with lights; patient transfer space ready
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Poor positioning causing crowding or obstruction; table not aligned to lights
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Do a quick walk-around: transfer path, anesthesia access at head, and clear entry and exit routes.
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| 5
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Check lighting
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Power on overhead/portable lights; position over expected field; confirm focus, intensity and movement range.
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Lights positioned over surgical field; bulbs working, light arms stable; adjustable focus, intensity and movement range confirmed
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Lights not tested; burned-out bulbs discovered during surgery; lights positioned incorrectly away from the operative field; focus or intensity not adjusted appropriately; movement range and stability of light arms not checked
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Confirm sterile light handles/covers are available if used; set initial position for average patient height and expected surgical field.
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| 6
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Check suction system
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Assemble canister/tubing; connect to wall/portable suction; test suction; keep spare canister/tubing.
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Test suction function; correct tubing connections; spare canister ready
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Weak suction pressure; leaks or blockages in tubing; no spare canister
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If weak, check canister seal, tubing kinks, regulator, and power source (if portable).
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| 7
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Check anesthesia machine
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Confirm anesthesia team has completed machine check; verify oxygen source present; ensure readiness for patient arrival.
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Verify with anesthesia lead that machine tested per protocol; oxygen supply adequate; circuits leak-checked; all alarms and safety systems functional
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Oxygen empty; leaks or disconnections in circuit; machine not tested before case
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If the machine is not cleared, pause room readiness sign-off and escalate to anesthesia lead.
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| 8
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Set up waste disposal system
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Place sharps containers and labeled waste bins in standard locations; ensure liners are present and accessible.
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Clearly labeled, color-coded bins in correct locations
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Bins missing, not within reach of procedural area, or mislabeled; sharps container absent
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If not properly organised, stop and correct the setup by repositioning or replacing waste containers before proceeding.
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| 9
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Verify available surgical instrument sets
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Check correct set(s) for planned case; confirm seals intact; verify sterility indicators/expiry as visible; stage for opening.
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Confirm availability and correct type; check seals intact
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Missing sets; damaged packaging; incorrect sets pulled
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Escalate early — avoid opening incorrect sets and wasting sterile supplies.
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| 10
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Arrange sterile supplies (without opening)
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Check correct set(s) for planned case; confirm seals intact; verify sterility indicators/expiry as visible; stage for opening.
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Sterile packs placed on clean, dry surfaces; labels visible; expiry dates checked
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Expired packs; damaged packaging; placed on contaminated surfaces
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Leave a clear landing zone for opening; avoid stacking that crushes packaging or hides indicators.
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| 11
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Check patient positioning equipment
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Confirm needed positioning aids (straps, padding, armboards, stirrups, head ring) are present, intact, and clean.
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Equipment present, clean, functioning and within reach
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Equipment missing or not easily accessible; straps frayed; padding torn
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Match to likely case needs before the patient arrives; replace/flag damaged items.
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| 12
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Set up auxiliary equipment such as diathermy, warming devices
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Route cords to reduce trip/pull risk; keep plugs accessible; avoid crossing walkways.
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Cables inspected; grounding pads ready; devices tested
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Faulty cables; ESU not tested; warming device missing
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Route cords to reduce trip/pull risk; keep plugs accessible; avoid crossing walkways.
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| 13
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Verify emergency equipment, supplies and medications
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Confirm crash cart access and key items (functional airway equipment, supplies, medications, oxygen) reachable; verify charge/power.
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Fully stocked; airway equipment (defibrillator, bag valve mask, suction) functional; equipment, supplies and medications accessible
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Missing medications/supplies/equipment; defibrillator not charged
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Quick reach test:
- Can the team access the emergency kit without moving clutter?
- Can the team identify the backup location of emergency items before starting?
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| 14
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Patient data board, time-out list and count board
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Prepare checklist/time-out materials; set up a count board; ensure patient placeholders are ready (update at time-out).
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OR safety checklist and time-out set up for patient to be operated on with current, up-to-date information
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Missing OR safety checklist and/or count board
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Limit premature PHI (patient health information); update immediately before time-out; keep board visible to the team.
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| 15
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Final room readiness check
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Run a final sweep: clear pathways, remove hazards, confirm stations ready, retrieve or escalate missing items.
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All stations ready; pathways clear; alarms and safety systems activated; safety hazards removed
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Missing items; clutter; alarms and safety systems not functional; tripping hazards present
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Use a consistent sweep order (door → anesthesia → scrub/circulator → exits) to avoid omissions.
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| 16
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Ensure backup energy supply
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Verbalizes that backup energy supply is checked and functional
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