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Time Outs

Time-outs are required everywhere in the hospital, even for minor procedures at the bedside. Time-outs are initiated by the physician.

Call Patient Safety for more information,
Rosendo Contreras, RN, MSN, 325-670-3418

Pre-Procedure Verification and Time Out

Pre-Procedure Verification and Time Out Policy, 3.1088

To outline the process preventing wrong site, wrong procedure, and wrong person surgeries and procedures through the use of the Universal Protocol (UP). There are three (3) components according to the Universal Protocol: Pre-procedural verification, site marking, and the time out.

All three (3) components are performed to ensure relevant documents and related information or equipment is available prior to the start of the procedure, correctly identified, labeled and matched to the patient's identifiers. They also provide identification of the correct procedural site and a final assessment of all components of the Universal Protocol. Once the processes are reviewed, these must show to be consistent with the patient's expectations and with the teams' understanding of the intended patient, procedure and site (UP 01.01.01).

General Rule: This policy applies to all surgical and non- surgical invasive and other procedures that may affect patient safety (UP 01.01.01). These procedures, as defined by UP, include: those involving the puncture or incision of the skin, insertion of an instrument, or insertion of foreign material into the body as well as general anesthesia or deep sedation.

View the Pre-Procedure Verification and Time Out policy - 3.1088.

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