Pre-operative checklist

Pre-operative or “Pre-op” means before surgery or operation. In order to implement the Checklist
during surgery, a single person must be made responsible for performing the safety checks on the
list. This designated Checklist coordinator will often be a circulating nurse, but it can be any
clinician participating in the operation.

Paper works needed to be filled out before surgery

 Surgical Consent form

This is a document the patient sign after discussing benefits, risks, and alternatives to
surgery with the surgeon.
 Blood transfusion consent
The patient will be asked to consent or specifically refuse blood transfusions. If the
patient would like to donate their own blood for surgery, it will be discussed with the
surgeon well in advance of the surgery.
 Advance healthcare directive
This allows the patient to state their wishes about the medical treatment that they do or
do not wish to receive. It also allows the patient to appoint an individual to make
healthcare decisions on their behalf in the event that they are unable to do so themselves.

Having a contact person before surgery

 Designate one person to serve as the patient’s contact person and “coach” throughout
their hospital phase of care for possibly 2-3 weeks post-operatively. Their role will be to
support the patient through this process.
 The patient’s contact person or coach should also be present on the day of their discharge
when they receive final discharge information from the care team.

When is the last time the patient should eat or drink before surgery?

 Do not eat anything (including chewing gum or candy) after midnight or at least 8 hours
prior to the patient’s surgery check-in time. The patient may ONLY have sips of clear
liquids (water, Pedialyte, or Gatorade) as needed to take medications until 5:00 am on the
morning of surgery. The patient may brush their teeth and rinse their mouth, but
instructed to not swallow any of the water.

Preparing the client the morning before the surgery

 Awaken the client an hour before pre-op medication

 Morning bath, mouth wash
 Provide clean gown
 Remove hair ornaments, braid long hair, and cover head with a cap if available.
  Remove dentures, colored nail polish, hearing aid, contact lenses, and jewelries.
 Take baseline vital sign before pre-op medication.
 Check ID band, skin prep
 Check for special orders – enema, IV line
 Check NPO and have the client void before pre-op medication
 Continue to give emotional support
 Accomplished “pre-op” care checklist

Preparing the client the night before the surgery

 Preparing the skin - Warm bath is encouraged to reduce the microorganism on the skin.
 Preparing the G.I. tract - Place the client on NPO at least 8 hours before surgery, use
cleansing enema as appropriate.
 Preparing for anesthesia - confirm anesthesiologist; confirm the mark placed on site of
surgery, any allergies, risk for blood loss during surgery, and airway/aspiration risk.

Pre-op medicines

 Tranquilizers & Sedatives

 Midazolam
 Diazepam ( Valium )
 Lorazepam ( Ativan )
 Diphenhydramine
 Analgesics - Nalbuphine ( Nubain )
 Anticholinergics - Atropine Sulfate
 Proton Pump Inhibitors
 Omeprazole ( Losec )
 Famotidine

https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-
surgery
https://www.uclahealth.org/neurosurgery/Workfiles/Site-Neurosurgery/Fusion-
RRUMC.pdf

Consent Form

It is defined as the permission a patient gives a doctor to perform a test or procedure after the
doctor has fully explained the purpose.

4 Principles of Informed Consent

 You must have the capacity (or ability) to make the decision.
  The medical provider must disclose information on the treatment, test, or procedure in
question, including the expected benefits and risks, and the likelihood (or probability)
that the benefits and risks will occur.
 You must comprehend the relevant information.
 You must voluntarily grant consent, without coercion or duress.

What requires an informed consent?

 Any surgical procedure where scalpel, scissors, suture, hemostats of electro coagulation
may be used.
 Entrance into body cavity.
 Radiologic procedures, particularly if a contrast material is required.
 General anesthesia, local infiltration and regional block.

Essential elements of informed consent

 The diagnosis and explanation of the condition.

 A fair explanation of the procedure to be done and used and the consequences.
 A description of alternative treatment or procedure.
 A description of the benefits to be expected.
 The prognosis, if the recommended care, procedure is refused.

Validity of Informed consent

 Written consent is best and legally accepted

 Signature is obtained with the client’s complete understanding of what to occur. - adult
sign their own operative permit -obtained before sedation
 For minors, parents or someone standing in their behalf gives the consent. Note: for a
married emancipated minor parental consent is not needed anymore, spouse is accepted
 For mentally ill and unconscious patient, consent must be taken from the parents or legal
guardian
 If the patient is unable to write, an “X” is accepted if there is a witness to his mark
 Secured without pressure and threat
 A witness is desirable – nurse, physician or authorized persons.
 When an emergency situation exists, no consent is necessary because inaction at such
time may cause greater injury. (Permission via phone is accepted but must be signed
within 24hrs.)

https://www.emedicinehealth.com/informed_consent/article_em.htm