Inspection checklist

Pre-procedure pause checklist for ambulatory care (JCI IPSG.3)

A pre-procedure pause checklist for ambulatory care, ensuring correct patient, procedure, and site, along with equipment, imaging, and team readiness.

Fill it in online - free, no account needed. 38 questions.

What it is for

This checklist helps ensure patient safety by verifying critical information and readiness immediately before a minor procedure or invasive test in an ambulatory setting.

The full question list

1. Patient and Procedure Verification

  1. The correct patient's identity is confirmed using at least two identifiers (e.g., name, date of birth). *
  2. The procedure to be performed is confirmed with the patient. *
  3. The procedure to be performed is confirmed with the team. *
  4. The correct site for the procedure is confirmed. *
  5. The correct site for the procedure is marked, if applicable. *
  6. The patient's consent form for the procedure is signed. *
  7. The patient's consent form for the procedure is available. *
  8. All known allergies are confirmed with the patient. *
  9. All known allergies are documented. *

2. Equipment and Imaging Readiness

  1. All necessary equipment and supplies for the procedure are present. *
  2. All necessary equipment for the procedure is functional. *
  3. Sterile instruments are confirmed to be sterile. *
  4. Sterile instruments are within their expiry dates. *
  5. Any required imaging (e.g., X-rays, ultrasound) is available. *
  6. Any required imaging (e.g., X-rays, ultrasound) is correctly displayed. *
  7. Medications required for the procedure are checked for correct dosage. *
  8. Medications required for the procedure are checked for expiry. *

3. Team Briefing and Patient Status

  1. The entire team involved in the procedure is present. *
  2. The entire team involved in the procedure is introduced. *
  3. The team confirms understanding of the procedure plan. *
  4. The team confirms understanding of any potential critical steps. *
  5. Anticipated blood loss is discussed, if relevant. *
  6. Appropriate measures for anticipated blood loss are in place, if relevant. *
  7. Patient-specific concerns (e.g., medical history, anxiety) are confirmed as resolved or managed. *
  8. The patient's vital signs are stable. *
  9. The patient's vital signs are within acceptable limits for the procedure. *

4. Environmental Checks

  1. The procedure room is visibly clean. *
  2. The procedure room is organised. *
  3. The lighting in the procedure area allows for clear visibility of the operative field. *
  4. Waste disposal bins (including sharps) are correctly placed. *
  5. Waste disposal bins (including sharps) are accessible. *
  6. Emergency call systems are functional. *
  7. Emergency call systems are accessible. *

5. Pause Leadership and Documentation

  1. Who led this pre-procedure pause? *
  2. Any additional notes or concerns raised during the pause.

6. Sign-off

  1. Name of person completing this checklist *
  2. Date and time of completion *
  3. Signature of person completing this checklist *

References

How the score works

The score is the share of scored questions that pass. N/A is left out of the score; text, dates and signatures are recorded but not scored. A completed template is a record of what you checked; it is not an inspection by a regulator or an accreditation body.

Questions

What is a pre-procedure pause?

A pre-procedure pause is a mandatory, structured team briefing conducted immediately before a procedure to confirm critical information and prevent errors.

Who should participate in the pre-procedure pause?

All members of the healthcare team directly involved in the procedure, including the proceduralist, nurses, and any other relevant staff, should participate.