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Ensuring Correct Surgery and Invasive Procedures Pre-Training Questionnaire

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Ensuring Correct Surgery and Invasive Procedures Pre-Training Questionnaire Rank your confidence level regarding each of the following statements using scale below: Not confident at all < 1-------------2--------------3--------------4-------------5 > Completely confident

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Ensuring Correct Surgery and Invasive Procedures

Pre-Training Questionnaire

Rank your confidence level regarding each of the following statements using scale below:

Not confident at all < 1-------------2--------------3--------------4-------------5 > Completely confident

I am confident in my understanding of . . .

the definition of a surgical or non-surgical invasive procedure . . . . . . . . . 1 2 3 4 5

the use of a checklist prior to the start of an invasive procedure . . . . . . . .1 2 3 4 5

the system factors that contribute to incorrect procedures . . . . . . . . . . . 1 2 3 4 5

“speaking up” when something does not seem quite right . . . . . . . . . . . . 1 2 3 4 5

the actions to be taken when a team member is not able or refuses to

follow the steps to ensure correct site surgery and invasive procedures . 1 2 3 4 5

6. the Ensuring Correct Surgery and Invasive Procedure Directive as

applied in special circumstances (e.g. endoscopy) . . . . . . . . . . . . . . . . . 1 2 3 4 5

7. when the time-out process occurs and who must participate . . . . . . . . . 1 2 3 4 5

8. the key components of marking the procedure site . . . . . . . . . . . . . . . . . .. 1 2 3 4 5

9. the important elements of proper patient identification . . . . . . . . . . . . . 1 2 3 4 5

10. the correct method for reviewing imaging studies prior to commencing

an operation or invasive procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 2 3 4 5

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Ensuring Correct Surgery and Invasive Procedures

Observational Checklist

Facility _________ Date________ Time Block_______Team_______ Rater _______

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