Transcript Preprocedure Checklist

Pre-Procedure Checklist
Verification of patient, procedure, site at time of admission or entry
Relevant documents match to the correct patient, procedure and site:
H&P/progress note relevant to the intended procedure
H&P is updated if performed prior to day of procedure
Nursing assessment
Pre-anesthesia/sedation assessment performed
Completed informed consent form signed by LIP and patient
Correctly labeled diagnostic and radiology test results
Required blood products, implants, devices and/or special equipment
SCIP Measures (VTE, Beta Blockers, etc.)
Pre-Induction Pause
Has the patient confirmed his/her identity, site, procedure and consent?
Is the site marked (if applicable)?
Is the anesthesia machine and medication check complete?
Is pulse oximeter on and functioning?
Does the patient have a
Known allergy?
Difficult airway/aspiration risk (if yes, is difficult airway cart in room?)
Risk of >500ml blood loss (if yes, are 2 IVs/central access and fluids planned?)
Risk of hypothermia (if yes, fluid and forced air warmer is available)
Risk of malignant hyperthermia (if yes, discussed with staff)
Pre-Incision Timeout
Have all new team members been introduced by name and role?
What is the patient’s name?
What procedure is planned?
Where will the incision be made? (Is site/level marked?)
Does the procedure and site match the informed consent form?
Is the patient positioned correctly?
Are relevant images and results properly labeled and displayed?
Has antibiotic been started and are needed irrigation fluids available?
Has the skin prep evaporated fully?
Are blood products, implants, devices, & special equipment available?
Are there any anticipated critical events (e.g., airway, blood, duration)?
Are there any safety concerns regarding patient Hx, allergies, medications?
IntraOP/Post-Procedure Debrief/Huddle
How shall I record the name of the procedure
Are the instrument, sponge and needle counts complete?
How shall I label the specimens?
What are the key concerns for recovery and management of this patient?
Any “went wells”?
Any “to improves”?