You may copy, translate, distribute and present the following SAFE SITE Tool Kit items as long as you reference the Minnesota Hospital Association as the source of this material. If the tool is hospital-specific, please also cite the hospital as a source.



AFE SITE TEAM

• SAFE SITE Team - Example: [DOC]
• Physician Champion: [PDF]
• Time-Out DVD, "Safe Site Surgery - Recommendations for Conducting an Effective Time-Out": [watch]
  

CCESS TO INFORMATION

• Bedside Procedure Verification: [DOC]
• WHO checklist with Minnesota Time Out: [XLS]
  
• Auditing tool: [DOC]
  
• Pre-operative Verification Checklist Inside the OR: [DOC]
  
• Pre-operative Verification Auditing Form Inside the OR: [DOC]
  
• Pre-operative Verification Checklist Outside the OR: [DOC]
  
• Pre-operative Auditing Form Outside the OR: [DOC]
  
• Good Catch Form: [PDF]
• Data Report Examples: [PPT]

• Policy & Procedure Example: [PDF]
• Senior Leadership Checklist: [DOC]
• Can a Nurse Stop a Surgeon Article: [link]

DUCATE STAFF AND PATIENTS

• RN Competency: [DOC]
• CST Competency: [DOC]
• Patient Safety Sheet: [PDF]
  
• Staff Learning Packet: [DOC]
• Patient Education Tool: [PDF]
  
  
  

IGN SITE WITH INITIALS

• Site Marketing Recommendations and Guidance: [PDF]
• Dental Chart: [DOC]
  
  

NFORMED CONSENT AND VERIFICATION

• Minnesota Alliance for Patient Safety (MAPS) website
  
  

IME-OUT

• Time-out DVD "Safe Site Surgery: Recommendations for Conducting an Effective Time-Out": [watch]
• MDH Wrong-Site Surgery Fact Sheet: [PDF]
• Large Time-Out Poster: [PDF]
• Inside the OR Time-Out Guide: [DOC]
• Inside the OR Time-Out Script: [DOC]
• Outside the OR Time-Out Guide: [DOC]
• Outside the OR Time-Out Script: [DOC]
• Outside the OR Time-Out (Stop Sign) Poster: [PDF]
  

FFECTIVE COMMUNICATION

• Operating Room "Time-Out" Briefing: [PDF]
• Post Procedure Debriefing: [PDF]
• Pre-operative Team Communication Guide: [DOC]