PRE-OPERATIVELY - Immediately previous to the graduation of surgical procedure / procedure. Reels are to be evaded the open wound when not in use and must be checked as a part of the Accountable Items checks.

In normal working hours it must be attainable to make sure two scrub practitioners and two circulating practitioners are available for a two site surgery. The issue have to be escalated to the Theatre Co- ordinator to organise relief from different teams. All accountable objects for each incision must be saved separate always and recorded on a separate Accountable Items Record and separate Whiteboards. There must be a scrub practitioner and a circulating practitioner for each incision, i.e. a minimum of four folks excluding the anaesthetic practitioner.

This person must assume accountability for ensuring the chosen safety procedures are undertaken. FINAL - At the top of the process / following closure of the wound and previous to the dressing being utilized.

If a patient is returning to the ward with an intentionally retained throat pack there must be a written and verbal handover to the ward staff. At the ‘Sign Out verify’ the Accountable Items Record and the Whiteboard must be checked to agree that removal of the throat pack has occurred - or that the intention is to switch the patient to PACU with the pack in situ. The determination to make use of a throat pack should be made by the anaesthetist or surgeon for every patient as applicable.

These are any extra pieces of apparatus required for the surgical / interventional process - please see Section 1.three Accountable Items for an inventory. The incident and consequence have to be documented within the surgical notes / DATIX and Perioperative Care Plan. If they can't be accounted for the patient should be X-Rayed and the missing items retrieved if recognized. During the surgical / interventional process the circulating practitioner must examine as above and report any further instruments opened on the Accountable Items Record.