Microsoft word - rosenfield checklist form as .doc word doc for aaaasf newsletter as of 3 14 2013.doc
FROM THE DAY OF CONSULTATION UNTIL THE DAY BEFORE SURGERY
IN THE OPERATING ROOM BEFORE THE INCISION IS MADE
IV antibiotic given 1 hour pre-incision TIME GIVEN:
Medical “issues” to be cleared B4 surgery:
Consent form posted and photos displayed
Findings w/review previous sed/anesth records
Tobacco use: When and How many packs/day ?
Drug and chemical abuse: When and Which?
AUGMENTATION: Nipples marked before prep
BREAST REDUCTION: Markings scratched before prep
ABDOMINOPLASTY: Pubis shaved, foley placed, deep clean umbo
Previous anesth problem in family member?
FACELIFT: Deep clean of ear canals/postauricular creases
RHINOPLASTY: Local anesthesia placed before prep
PRE-INCISION SURGICAL PAUSE: name/procedures/allergies/
DURING THE OPERATION
Low/High B.P. meds? Psychiatric medications?
Cal patient’s family at start of surgery and q 1.5 hours
Check patient’s arm and leg position after every bed position adjustment
Path specimen obtained and correctly labeled
BEFORE THE WOUND IS CLOSED
PRE-CLOSURE PAUSE: Consent checked/needle & sponge
MRSA PROTOCOL: Nasal Swap PRN Hibiclens : Mupirocin:
count confirmed/marcaine injected prn breast & abdomen/
MALIGNANT HYPERTHERMIA EVAL FORM COMPLETED
AFTER THE WOUND IS CLOSED
Final IV meds given prn—(eg. Zofran, Decadron)
Hx of Glaucoma/Cataracts/Dry Eye/Lasik Surgery?
POST-SURGICAL TEAM CONFERENCE: REVIEW any post-op issues
AFTER THE SURGERY
Surgeon to cal family/caregiver immediately postoperatively.
D/C instructions and appointment given to patient and family
Confirm H & P / Labs / Med Clearance:
PRE-DISCHARGE MEETING: Final status check & postop review
Narcotics drawer locked and key put away
Turn off monitoring equipment and oxygen and back door locked
PSYCH EVALUATION FORM COMPLETED: Score: /10
Patient bag/medications given (including narcotics from fridge)
DAY OF SURGERY BEFORE ENTERING THE OPERATING ROOM
Post op appointment date: / / and TIME : POSTOP FORM COMPLETED: for pickup/after care and post-op appt.
Camera in Room 3 with card in place and batteries replaced NPO status confirmed
MORNING and FIRST 2 DAYS after SURGERY
Office staff member rotate to “phone check” patient re:
H & P reviewed (including routine meds) & Anesthesia pre-op form reviewed
Confirm application of ice to operative site
Screening tests reviewed (EKG, labs) and Pregnancy test PRN
Confirm understands medicine regimen
Confirm re-start of anti-hypertensive medications
POSTOP FORM COMPLETED: Contacts for pickup/aftercare and post-op appt.
Confirm al questions answered & needs addressed
Noted: Past surg’s within operative zone:
Confirm Fluids/Equipment/Injectables available
PO meds given: Valium, Emend, Pepcid, Antibiotics PRE-SURGICAL TEAM CONFERENCE: REVIEW surgical plan Patient voided and removed all jewelry “Coast Clear” confirmed B4 patient transfer from holding area
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