Checklists: Admission, Pre-Op and Post-Op

Checklists: Admission, Pre-Op and Post-Op

How to Use Checklists:

  • The Do-and-Verify Method 

    • Do all these pre-op or post-op tasks by memory. Then go through each point on a real checklist (phone or paper) to double check that you did it. 

 

  • Be systematic and consistent (This is how I was trained for doing pre-flight checks before flying). The safety in the United States aviation industry is amazing and is partly powered by the use of checklists.

 

  • Medical students, use this checklist for operative patients during any downtime you have to check the orders. If you find something, let the resident know and be a hero. 

Quick Reference Checklist for patients you didn’t admit:

  • These are the major things that will hold up a case from starting. 

  • Case requested

  • Periop Antibiotics: Ancef

  • Tranexamic acid (TXA)

  • Blood products

  • NPO, no food intake

  • Hold on anticoagulants

  • Consent

  • Imaging reviewed

  • COVID test

  • Pregnancy test

  • Clearance (also no accidental food)

Full Pre-op and Admission Checklist:

  • Ask last meal timing

  • Ask DNR status

  • Case request order and call OR desk

  • NPO

  • Hold anticoagulants (Do this in orders)

  • Correct imaging 

    • Full images of the whole bone that is being operated on. Example: Full femur films in case of long nail for hip fractures

  • Orders for Operating room

    • Order blood products on standby for OR if needed

    • Periop antibiotics, ancef if no history of ancef specific anaphylaxis

    • TXA

    • Operative and blood consents

  • Weight bearing status

  • Diet order

  • Medicine and other consults if needed

    • message them to let them know, or ask nursing for help contacting

  • Foley

  • Med reconciliation of home meds

  • Pain meds

  • Antiemetics

  • Labs and tests (all should be “Stat”)

    • EKG

    • chest x-ray

    • type and screen

    • PT/INR

    • CMP

    • CBC 

    • Pregnancy test

    • Covid screen

Post-op Checklist:

  • X Rays in PACU (not always necessary for Nails or cases with saved fluoroscopy)

  • 5 P’s

    • Pain (analgesics)

    • Puke (anti-emetic)

    • Pus (antibiotics)

    • Prophylaxis (DVT/PE)

    • Previous meds

  • Post op PT/OT

  • Med rec for discharge

  • Scripts for discharge

  • Discharge instructions

  • Transfer orders/documentation (if going to SAR)

  • Follow up provider

 

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