Pre op checklist template 2026

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  1. Click ‘Get Form’ to open the pre op checklist template in the editor.
  2. Begin by entering the patient's name and date at the top of the form. This ensures that all information is accurately attributed to the correct patient.
  3. In the 'Scheduled Procedure' section, specify the procedure planned for the patient. This helps in tracking and verifying surgical details.
  4. Review and check off each item under 'History and Physical Examination Performed' and 'Labs and EKG Attached'. Ensure all necessary documents are attached for a comprehensive review.
  5. List any medications, including prescriptions, over-the-counter drugs, and herbal products. This is crucial for assessing potential interactions during surgery.
  6. Evaluate patient risk factors and prior anesthetic complications. Documenting these details aids in tailoring anesthesia plans effectively.
  7. Confirm that all processes have been performed by checking off items like 'Patient Identifier Checked' and 'Time-Out Prior to Procedure'.
  8. Finally, ensure that the orthopaedic surgeon signs at the bottom of the form to validate completion before proceeding.

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The Preoperative Checklist is completed by clinicians working within their scope of clinical practice and is designed to aid patient preparation prior to their transfer to theatre and support effective clinical handover when there is a transfer of professional responsibility and accountability.
It involves briefing, sign-in, timeout, sign-out and debriefing, and is now advocated by the National Patient Safety Agency (NPSA) for all patients in England and Wales undergoing surgical procedures. The medical profession has been slow in adapting such checklists into everyday practice.
Checklist 1: Sign-In (Before Anesthesia) Surgical Site, Procedure, and Surgical Consent. Your surgical team will ask you to confirm everything about your planned surgery, including the location and type of surgery planned. Proper Surgical Site Marking. Medications and Allergies. Anesthesia. Preparing for a Blood Transfusion.
Does your organization find the global surgical package challenging to work with? Check out our latest whitepaper! Preoperative visits. Intra-operative services that are considered a usual and necessary part of a surgical procedure. Complications Following Surgery. Postoperative visits. Postsurgical pain management. Supplies.
Pre-operative assessment If the assessment involves a visit to the hospital, some tests may be carried out. This is to check if you have any medical problems that might need to be treated before your operation, or if youll need special care during or after the surgery.

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Five Steps to Safer Surgery is a surgical safety checklist. It involves briefing, sign-in, timeout, sign-out and debriefing, and is now advocated by the National Patient Safety Agency (NPSA) for all patients in England and Wales undergoing surgical procedures.
This usually involves a summary of your medical history, a physical exam, an EKG and review of your medications and lab work. If your health condition dictates, other tests or evaluations by additional specialists may be necessary.
The five pillars of ACS should now be defined as Trauma, Emergency Surgery, Critical Care, Elective General Surgery, and Surgical Rescue (6). 1. Leppniemi A: Emergency medicine and emergency surgery Wheres the beef?

pre op checklist template