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HANDOVER COUNT IN EVENT OF REPLACEMENT OF SCRUB NURSE DURING PROCEDURE \nOutgoing Scfub Nurse- - Incoming Scmb Nurse - Circulating Nurse{s) - \n1 Print Name Print Name Signature & Print name \nOUTGQOING COUNT' : \nTo be completed for permanent and temporary . \n- | reptacement - Aas . _\/\u20197 \nINCOMING COUNT \nTo be completed for temporary replacement IPY \nOPERATION ) \u2019 \nKT (% mTA FudieN \n| TALLY OF EACH ITEM USED - ADD ANY ITEMS SPECIFIC TO YOUR SPECIALITY \nSwabs (2x2) O |repes - O [TEMS REMAINING IN SITU \nSwabs {10x10) \/0 |stoopsistings o * (Typo & Number) \nAbdominal packs () |suildogs A \nSutures \u2018L Shods 6 . \nBladgs ) ' 5\" \u2018 Tibbs Cannula ] O \n'dtes | \u00a2 |poms G - \n\u2018 Syringes -, ( \" \u00e9!ap!e Gun Inserts o \nDiscard-a-pad l . |Spears 7 o \nDiathermy pencil \u2018 . C) | Throat packs . I-\\pae o \u2018 \nDiathermy tips O Throat packs < Scrub es \nSeratch pad | \u00a9 |Retrleval Bag (Bert) ' 0 ) , \nReels \\ 0 .| Digital Tourniquets \u00e9 . ; \nO i< Z \nPledgelets O p (% l-'{-\u2014~ { \nJISCREPANCY IN'COUNT -ACTIONS AND OUTCOME . . \nOUNT IN WHICH DISCREPANCY OCCURRED \nIONS TAKEN AND QUTCOME (I.E. SWABS, \\TED, SEARCH UNDERTAKEWMD EXPLORED, X - RAY TAKEN) - \nNSERT TRACEABILITY \u00e9TICKERS ON BACK OF COPY- TO STAY IN THEATRE. 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