Scribd
Upload
356 views1 page

Preoperative Checklist Guide

The document is a preoperative checklist from the Ilocos Sur Provincial Hospital-Gabriela Silang in Vigan City, Philippines. It contains 19 items to be checked for a patient before surgery, including obtaining consent, medical clearance, preparing materials/medicines, cross-matching blood, preparing the operative area, administering pre-op medications, and notifying the operating room. The checklist is to be filled out with the patient's name, hospital number, ward, and vital signs and signed by a nurse and OR personnel to confirm completion.

Uploaded by

Hanna La Madrid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
356 views1 page

Preoperative Checklist Guide

The document is a preoperative checklist from the Ilocos Sur Provincial Hospital-Gabriela Silang in Vigan City, Philippines. It contains 19 items to be checked for a patient before surgery, including obtaining consent, medical clearance, preparing materials/medicines, cross-matching blood, preparing the operative area, administering pre-op medications, and notifying the operating room. The checklist is to be filled out with the patient's name, hospital number, ward, and vital signs and signed by a nurse and OR personnel to confirm completion.

Uploaded by

Hanna La Madrid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Republic of the Philippines

Province of Ilocos Sur


ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG
Vigan City

PREOPERATIVE CHECKLIST

SURNAME:_________________________________ AGE: ______________ HOSP NO._________________________

GIVEN NAME:______________________________ M.I._______ SEX:________ WARD:_______________________

AM PM NIGHT REMARKS
1. Kind of operation/procedure
2. Consent for the Operation signed
3. Medical clearance updated
4. Materials and medicines completed
5. Available blood properly cross-matched
6. Operative area prepared
7. Bowel prep done
8. With pre-op orders
9. NPO post-midnight maintained
10. Hair prepared, combed if necessary
11. Oral hygiene don
12. Nail polish/make-up/contact lens removed
13. Jewelries removed
14. Dentures removed
15. Dressed in gown/camisa
16. Underwear removed
17. With wrist identification tag
18. Vital signs taken before and after pre-op medications
______BP ______PR _______RR ______Temp. _______Wt.

19. Pre-op medication administered


20. OR notified

Confirmed by:

_________________________________ _________________________________
Nurse Signature over Printed Name OR Personnel

You might also like