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
