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Pre & POst Operative Checklist

The document is a pre-operative checklist for a patient undergoing surgery. It includes the patient's name, age, sex, surgery details, consent forms signed, vital signs, tests completed, and confirmations that identification bands are checked, the surgical site is marked, and betadine wash/mouthwash are done. It requires signatures from the ward and operating room nurses to confirm all preparations are complete.

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mangesh virkar
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7K views2 pages

Pre & POst Operative Checklist

The document is a pre-operative checklist for a patient undergoing surgery. It includes the patient's name, age, sex, surgery details, consent forms signed, vital signs, tests completed, and confirmations that identification bands are checked, the surgical site is marked, and betadine wash/mouthwash are done. It requires signatures from the ward and operating room nurses to confirm all preparations are complete.

Uploaded by

mangesh virkar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
  • Pre-Operative Checklist: Outlines the necessary checks and patient information required before an operative procedure is conducted.
  • Post-Operative Checklist: Lists the observations and necessary procedures to follow after the operative care for patient recovery.

Pre Operative Checklist

ACCIDENT. ORTHOPEDIC. SURGICAL & ICU

Name of Patient : Age : Sex : IPD NO :


Name of Surgery / Procedure : Name of Surgeon :
Type of Anesthesia : Name of Anesthetist :
To Shift to OR at : On (Date) :

ID Band Checked Yes No Pre-Medication

Site Marking Done Yes No 1. at


2. at
Consent Signed
3. at
1. By Patient Yes No
4. at
2. Surgeon Yes No
Blood group : Rh :
3. Anesthetist Yes No
Blood Available :
PAC Done Yes No

Shaving / clipping Done Yes No PRBC : Units :


Denture Removed Yes No
FFP : Units :
Any Other Devices On Patient Yes No
Specify : Platelets : Units :

Vital Parameters At Hrs.


Allergy known :
Temp Pulse Resp

BP SpO2

Betadine Wash / Bath Yes No Reasons For Late Shifting (If any) :
Chlorhexidine Mouth Wash Done Yes No

Betadine Paint Done Yes No

Investigations :
All Reports Attached & File Complete Yes No

Pending if Any

Serology Status : HIV Yes No HCV Yes No Hbs Ag Yes No

Pre-operative x-ray CT MRI USG

Ward Nurse OT Nurse

Name : Name :

Signature : Signature :

Date : Time : Date : Time :


Post Operative Checklist
POST OPERATIVE CHECKLIST
ACCIDENT. ORTHOPEDIC. SURGICAL & ICU

Name of Patient IPD No.:


Age: Sex: Bed No.: Ward : Operation : Done / Not Done
Under Dr.:
Surgeon : Type of Aneshtesia : GA/LA/SA/BBlock
If If
Checking Count Present (Tick) Absent (Cross) Remarks / Comments

Patient sensation / alertness

Operation site bleeding / soakage

Pulsation (pulse assessing points)

Is Oxygen flow meter ? On Off


Any drainage / Catheter / Wire / Special Stitch

Peripheral Warmness

Cyanosis / Abnormal body colour

Handed over same Investigation Reports

All radiological Plates are


Handed over Other Documents
Linen
Others
Articles / Instruments
Is the specimen labeled ?
For Biopsy
For handing over to relatives
Dr's Order -
For discard after showing to
The relatives

For immediate positioning


Dr's Order -

For latter positioning

IV Fluids
Dr's Order
Medications
Post
Oxygen hours
Operative -
Resting hours
NBM Hours
Dressing Changing hours

Time : Date : Place :

Place :
Name & Signature
Signature
(Ward Staff)
(OT Staff Name)

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