Safe Surgery Checklist

NOTE: As of January 1, 2018, ASCs are no longer required to report on safe surgery checklist use (ASC-6) to the Centers for Medicare & Medicaid Services (CMS).

Even though ASCs are no longer required by Medicare to report the use of a safe surgery checklist, it is still a good idea for facilities to continue using a checklist, as it ensures that the ASC has implemented safe surgery practices during each of the three critical perioperative periods.

Several organizations have developed boiler plate checklists that can be adjusted to suit the needs of a particular ASC:

CMS's Example of Safe Surgery Practices
First Critical Point	Second Critical Point	Third Point
prior to administering anesthesia	prior to skin incision	during closure of incision and prior to patient leaving the operating room
Verbal confirmation of patient identity Mark surgical site Check anesthesia machine/medication Assessment of allergies airway and aspiration risk	Confirm surgical team members and roles Confirm patient identity, procedure and surgical incision site Administration of antibiotic prophylaxis within 60 minutes before incision Communication among surgical team members of anticipated critical events Display of essential imaging as appropriate	Confirm the procedure Complete count of surgical instruments and accessories Identify key patient concerns for recovery and management of the patient
CMS ASC Quality Reporting Program Quality Measures Specification Manual Version 1.0a

CMS's Example of Safe Surgery Practices
First Critical Point	Second Critical Point	Third Point
prior to administering anesthesia	prior to skin incision	during closure of incision and prior to patient leaving the operating room
Verbal confirmation of patient identity Mark surgical site Check anesthesia machine/medication Assessment of allergies airway and aspiration risk	Confirm surgical team members and roles Confirm patient identity, procedure and surgical incision site Administration of antibiotic prophylaxis within 60 minutes before incision Communication among surgical team members of anticipated critical events Display of essential imaging as appropriate	Confirm the procedure Complete count of surgical instruments and accessories Identify key patient concerns for recovery and management of the patient
CMS ASC Quality Reporting Program Quality Measures Specification Manual Version 1.0a

Safe Surgery Checklist

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Safe Surgery Checklist

Reproduction in whole or in part without written permission from ASCA is prohibited.

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This content is available to members only.

If you think you have received this message in error, please contact ASCA at asc@ascassociation.org or 703.836.8808.