Template

AMS Surgical Charts

by Curt Werner, from the Community

This AMS Surgical Charts checklist supports antimicrobial stewardship for surgical patients. It captures procedure type, prophylactic antibiotic timing, agent selection (such as cefazolin or vancomycin), allergy and MRSA risk status, dosing and redosing intervals, route of administration, and documentation requirements. It helps teams align with Therapeutic Guidelines, review ongoing prophylaxis at 24 hours, and engage patients on antibiotic use and resistance.

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Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
WHO Surgical Safety Checklist
This WHO Surgical Safety Checklist helps surgical teams reduce errors and complications by aligning on critical steps before anesthesia, before incision, and before the patient leaves the operating room. It prompts verification of patient identity, procedure, site marking, anesthesia machine and medication checks, pulse oximetry, allergy status, airway risk, and expected blood loss. The team confirms introductions, planned procedure, incision site, timely antibiotic prophylaxis, sterility, equipment readiness, and essential imaging. Before sign out, nurses confirm counts, specimen labeling, equipment issues, and the team aligns on recovery concerns. Customize this template to fit local practice and strengthen teamwork and communication.
by misbah haq, from the Community
Downloads: 0
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Template
CMS Surgical Services Requirements Checklist
Use this checklist to assess compliance with CMS hospital surgical services requirements. It covers organization and staffing, circulating and scrub roles, surgical privileges, policies and protocols, informed consent, required equipment, and provisions for immediate postoperative care. Includes guidance on outpatient alignment with inpatient quality, PACU monitoring, and safety practices such as alcohol based skin prep risk reduction and surgical counts.
by Chad Niemeyer, from the Community
Downloads: 20+
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Template
WHO Surgical Safety Checklist
The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. The surgical checklist has gone on to show significant reduction in both morbidity and mortality and is now used by a majority of surgical providers around the world. The checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged. Based on the WHO Surgical Safety Checklist,Copyright World Health Organization 2009. All rights reserved.
by SafetyCulture
Downloads: 300+
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Template
World Health Organization Surgical Safety Checklist
This WHO Surgical Safety Checklist template helps operating room teams reduce errors and complications by standardizing key safety steps before anaesthesia, before incision, and before the patient leaves the OR. It covers identity and consent confirmation, site marking, anaesthesia machine and medication checks, pulse oximeter use, allergy and airway risks, anticipated blood loss, team introductions, antibiotic prophylaxis timing, equipment and sterility confirmations, essential imaging display, and final counts and specimen labeling. Prompts guide surgeons, anaesthetists, and nursing staff to share critical concerns and align on recovery plans. The checklist is widely adopted and can be adapted to local practice.
by Renan Silveira, from the Community
Downloads: 0
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WHO Surgical Safety Checklist

This WHO Surgical Safety Checklist helps surgical teams reduce errors and complications by aligning on critical steps before anesthesia, before incision, and before the patient leaves the operating room. It prompts verification of patient identity, procedure, site marking, anesthesia machine and medication checks, pulse oximetry, allergy status, airway risk, and expected blood loss. The team confirms introductions, planned procedure, incision site, timely antibiotic prophylaxis, sterility, equipment readiness, and essential imaging. Before sign out, nurses confirm counts, specimen labeling, equipment issues, and the team aligns on recovery concerns. Customize this template to fit local practice and strengthen teamwork and communication.

by misbah haq, from the Community

Get

Template

CMS Surgical Services Requirements Checklist

Use this checklist to assess compliance with CMS hospital surgical services requirements. It covers organization and staffing, circulating and scrub roles, surgical privileges, policies and protocols, informed consent, required equipment, and provisions for immediate postoperative care. Includes guidance on outpatient alignment with inpatient quality, PACU monitoring, and safety practices such as alcohol based skin prep risk reduction and surgical counts.

by Chad Niemeyer, from the Community

20+

Get

Template

WHO Surgical Safety Checklist

The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. The surgical checklist has gone on to show significant reduction in both morbidity and mortality and is now used by a majority of surgical providers around the world. The checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged. Based on the WHO Surgical Safety Checklist,Copyright World Health Organization 2009. All rights reserved.

by SafetyCulture

300+

Get

Template

World Health Organization Surgical Safety Checklist

This WHO Surgical Safety Checklist template helps operating room teams reduce errors and complications by standardizing key safety steps before anaesthesia, before incision, and before the patient leaves the OR. It covers identity and consent confirmation, site marking, anaesthesia machine and medication checks, pulse oximeter use, allergy and airway risks, anticipated blood loss, team introductions, antibiotic prophylaxis timing, equipment and sterility confirmations, essential imaging display, and final counts and specimen labeling. Prompts guide surgeons, anaesthetists, and nursing staff to share critical concerns and align on recovery plans. The checklist is widely adopted and can be adapted to local practice.

by Renan Silveira, from the Community

Get

AMS Surgical Charts

About author

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WHO Surgical Safety Checklist

CMS Surgical Services Requirements Checklist

WHO Surgical Safety Checklist

World Health Organization Surgical Safety Checklist

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WHO Surgical Safety Checklist

CMS Surgical Services Requirements Checklist

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