Just in time teaching Preoperative / Preprocedural Checklist

Why is the preoperative / pre-procedure checklist important? •

Essential for hand-off communication for patient transitions to the operating room, special procedures room, and diagnostic imaging, MRI, or a procedure done at Froedtert Hospital.

Who is responsible for which parts of the checklist? • • • •

The nurse caring for the child (EDTC, Clinics, Day Surgery Unit or Inpatient Unit) starts filling out the checklist when a surgery or procedure is scheduled. The form must be completed in its entirety. The nurse sending the patient for the surgery/procedure is responsible for making sure the checklist is complete and accurate (Incomplete forms delay the start). Use your initials in the checkboxes, not a checkmark or “x”.

What items on the check list may be overlooked? • Nickname: List the name that patient recognizes and responds to. Rationale: Important for use during emergence from anesthesia. • Underwear: Remove before going to surgery/procedure. Rationale: Some children have accidents when emerging from anesthesia. Note: underwear may be left on if unable to remove it or the patient refuses to remove it. Let the child know that it will be removed. • NPO: Ask patient and family what time they last ate food and drank clear liquids. List these times, not the ordered NPO time. List last G-Tube feed time or time continuous feeds stopped. Rationale: Patients are at risk for aspiration if NPO guidelines are not followed. • Vital Signs Day of Surgery: Chart most recent vital signs, O2 saturation and time done. Rationale: Used as a baseline for comparison during and after operation. • Pre-op Bath: Initial each bath given and indicate what type of bath was given. • Parents / Guardians Here? Document presence of parent / legal guardian. Parents must accompany their child in order to address last minute questions and give consent for anesthesia. If they are unable to be present, a contact phone number should be documented. • Sickle Cell Screening: Patients of African-American or biracial decent need to have documentation of sickle cell status prior to administration of anesthesia. → Check for status documentation in Sunrise under significant events. → If not listed, contact state lab. → If unable to obtain results, consult with the physician to determine if an order for sickle cell screen is indicated. • HCG (Need Order): Urine or serum HCG testing must be done prior to surgery or administration of general anesthesia for female post-menarchal patients (with or without developmental delay) and pre-menarchal patients with Tanner stage 4 or 5 characteristics to minimize fetal exposure to harmful medications and general anesthesia. Obtain order and document results. Notify attending physician and anesthesiologist if positive results. • Transfer Note: Document time patient left area to go to the operative or procedural area. All patients must be sent via cart, regular bed or crib. Unacceptable methods of transport include ambulation, wheelchair, Vail bed and Clinitron bed. • RN Signatures: Any nurse completing portions of this form should sign and initial on the signature line. Nurse completing the form should date and time the form upon its completion.

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Contact: Kathy Leack ext: 6564