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  • Nursing Form

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    Cheurnevee Ramirez
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    This document is a pre-operative checklist for nursing staff. It includes boxes to check that various pre-op tasks have been completed, including obtaining consent, notifying relevant medical staff, completing diagnostics and preparations, administering medications, checking items to be removed prior to surgery like nail polish or dentures, and endorsing the patient's care to helpers and the operating room. The checklist helps ensure all necessary pre-op steps are taken care of before a patient undergoes a surgical procedure.

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    FORM

    Original Title

    NURSING FORM

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    This document is a pre-operative checklist for nursing staff. It includes boxes to check that various pre-op tasks have been completed, including obtaining consent, notifying relevant medical staff, completing diagnostics and preparations, administering medications, checking items to be removed prior to surgery like nail polish or dentures, and endorsing the patient's care to helpers and the operating room. The checklist helps ensure all necessary pre-op steps are taken care of before a patient undergoes a surgical procedure.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    16 views1 page

    Nursing Form

    Uploaded by

    Cheurnevee Ramirez
    This document is a pre-operative checklist for nursing staff. It includes boxes to check that various pre-op tasks have been completed, including obtaining consent, notifying relevant medical staff, completing diagnostics and preparations, administering medications, checking items to be removed prior to surgery like nail polish or dentures, and endorsing the patient's care to helpers and the operating room. The checklist helps ensure all necessary pre-op steps are taken care of before a patient undergoes a surgical procedure.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    PRE-OPERATIVE CHECKLIST

    Nursing Service Department

    Name Age/Sex Room/Ward

    Place a check mark or N/A on the corresponding boxes. DO NOT leave blank boxes.

    Consent Signed O.R. Notified

    Anesthesiologist Notified Surgeon Notified

    CP/Pedia Clearance/Evaluation Done Diagnostics for OR (C-rays/CT scans) Prepared

    Pre-op Medications Skin-Tested, Result: ______ Pre-op Medications Given

    Materials for O.R Complete Anesthesia Medications Complete

    Blood for O.R. Use Available Skin Preparation Done/Site marking done

    Nail Polish Checked/Removed Pre-operative Shower Done (Elective)

    Dentures Checked/Removed Jewelleries/Accessories Removed

    Underwear Removed O.R. Gown Worn

    NPO 6-8 Hours Pre-op Checked IV Line Functioning

    Enema/Bowel Preparation Done NGT Inserted and Checked

    IFC inserted V.S. Prior to O.R. Taken

    Endorsed to Helper: _________________ Endorsed to O.R. NOD: ________________

    Accomplished by: ___________________________________________ Date/Time: _______________________________


    Signature over printed name

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