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 AT  DISCHARGE  
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: Rosenfield 3/2013
 Confirm Fluids/Equipment/Injectables available [email protected]
 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

Source: http://www.aaaasf.org/pub/pdfs/ORchecklist.pdf