Template

CMS Surgical Services Requirements Checklist

by Chad Niemeyer, from the Community

20+

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.

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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

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
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: 200+
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Template
Prevention of Retained Surgical Items Checklist
Use this CMHS scrub assessment to help perioperative teams prevent retained surgical items. It guides sponge and instrument counts before incision, at wound and skin closure, and during handoffs; supports organized sterile fields, visual and verbal participation by scrub and circulator, reference to the count board, safe sharps handling, discrepancy escalation, and postoperative verification. Ideal for hospitals and surgical centers seeking consistent, auditable practice aligned with patient safety.
by D W, from the Community
Downloads: 20+
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OR WalkRound Internal Audit Checklist
Audit your operating room against best-practice standards with this OR WalkRound internal audit checklist. It covers leadership and staffing requirements, nurse manager qualifications and competency assessments, preoperative evaluation and documentation, patient acceptance and surgical counts, day surgery policies, operative reporting, postoperative care plans, and pain management. Fire safety, environmental controls, and comprehensive infection prevention and control measures are included to help teams improve safety, compliance, and quality of surgical services.
by NQMA KFMC, from the Community
Downloads: 10+
Get
Template
World Health Organization 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.
by SafetyCulture
Downloads: 5,000+
Get

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

200+

Get

Template

Prevention of Retained Surgical Items Checklist

Use this CMHS scrub assessment to help perioperative teams prevent retained surgical items. It guides sponge and instrument counts before incision, at wound and skin closure, and during handoffs; supports organized sterile fields, visual and verbal participation by scrub and circulator, reference to the count board, safe sharps handling, discrepancy escalation, and postoperative verification. Ideal for hospitals and surgical centers seeking consistent, auditable practice aligned with patient safety.

by D W, from the Community

20+

Get

Template

OR WalkRound Internal Audit Checklist

Audit your operating room against best-practice standards with this OR WalkRound internal audit checklist. It covers leadership and staffing requirements, nurse manager qualifications and competency assessments, preoperative evaluation and documentation, patient acceptance and surgical counts, day surgery policies, operative reporting, postoperative care plans, and pain management. Fire safety, environmental controls, and comprehensive infection prevention and control measures are included to help teams improve safety, compliance, and quality of surgical services.

by NQMA KFMC, from the Community

10+

Get