27+ Sample Perioperative Checklist Templates

What is a Perioperative Checklist?

A perioperative checklist is a type of medical checklist containing all fundamental pre-operative procedures which are confirmed by the nurse, the physician directly caring for the patient, and the patient. It is an essential integrated pre-procedural checklist used to optimize the patients for surgery and maintain adequate pre-surgical preparation by identifying several patient safety issues, preventing surgical delays, and facilitating interdisciplinary collaboration with the medical interdisciplinary team. 

There are some well-known examples of preoperative checklists that demonstrate effectiveness in minimizing errors and preventing risks in surgery and critical care. A published report about Atul Gawande’s “Checklist Manifesto” presented a 19-item surgical safety checklist that reduced complications in high-income countries from 9.3% to 6.6%. The Veterans Health Administration demonstrated another example with an 18% reduction in the annual mortality rate for medical facilities that participated in their perioperative checklist program. Also, a clinical study published in the Netherlands displayed an absolute 10.6% risk reduction rate in post-operative complications.

Major Goals of Perioperative Assessment

Conducting a perioperative assessment while using a clinical evaluation report and other health assessment forms is beneficial to evaluate the preoperative medical condition of the patient, the invasiveness of the surgical procedure that will be carried out, and the type of anesthetic to be administered. It determines the possible risk factors or the functional capacity of the patient based on his or her medical history and physical examination. Here are the major goals to consider in your checklist while performing a perioperative assessment.

Documentation of the Condition and Assessment of the Patient’s Overall Health Status: Include the patient’s past and current medical history, a family history, a surgical history, a social history of using alcohol, illegal drugs, and tobacco, a history of allergies, current and recent drug therapy, unusual drug reactions and any complications associated with previous anesthetics. Obtain if the patient has a family history of adverse reactions associated with anesthesia. For children, add birth history that focuses on risk factors like premature birth, congenital chromosomal malformations, history of recent infections, and perinatal complications. Build the information while performing an assessment of the patient’s overall health condition while focusing on a pre-anesthesia physical examination. This examination includes a complete assessment of the airway, heart, and lungs, plus documentation of vital signs. Order some laboratory tests as well. Doing these methods will help you to uncover the hidden conditions or diseases that could cause problems both during and after surgery. Perioperative Risk Assessment: According to one large clinical study, there is at least one complication in 17% of surgical patients. Conduct an in-depth assessment of the perioperative risk which is the function of the patient’s preoperative medical condition, the invasiveness of the surgical procedure, and the type of anesthetic administered. There are three types of major complications related to surgery: cardiac, respiratory, and infectious complications. Also, there are individual factors that can greatly affect the surgery such as age and the type of surgical procedure. Cardiovascular Risk Assessment: There are various factors and indicators that guide the decision-making process of the surgical team such as the cardiovascular risk, the functional capacity, and the surgery-specific risk of the patient. There are also major, intermediate, and minor predictors for the risk of perioperative cardiac complications. For example, some intermediate clinical predictors or markers of stable coronary artery disease are previous myocardial infection, mild angina, silent ischemia, compensated congestive heart failure, diabetes mellitus, and renal insufficiency. While some surgery-related predictors for intermediate risk of perioperative cardiac complications are abdominal or thoracic surgery, neurosurgery, ENT procedures, minor vascular surgery, orthopedic surgery, and prostatectomy. Pulmonary Risk Assessment: The most essential parts of preoperative pulmonary risk assessment are comprehensive medical history documentation and physical examination. Some examples of postoperative pulmonary complications are atelectasis, bronchitis, bronchospasm, hypoxemia, pneumonia, respiratory failure with prolonged mechanical ventilation, and many others. The risk factors for postoperative pulmonary complications are ages more than 60, emergency surgery, more than 3 hours of surgery under general anesthesia, obesity, poor general health status, presence of obstructive sleep apnea, and procedure-related risk factors. The site of surgery is the most significant of these risk factors, mainly with abdominal and thoracic surgery having pulmonary complication rates ranging from 10-40%. This shows that the closer the surgery is to the diaphragm, the higher the risk of pulmonary complications.

Stages of Perioperative Process

Being linked with a complex stress response that is equivalent to the magnitude of the injury, the surgical procedures, anesthesia administration, as well as the total operating time, amount of intraoperative blood loss, degree of postoperative pain, and other side effects can lead to more problems in the perioperative period. That’s why the perioperative process must be implemented well to reduce the stress response to surgery and trauma, improve outcomes, lower the length of hospital stay, and other aspects.

Preoperative Stage: As the first stage of the perioperative process, it focuses on the preparation of the patient for surgical procedure. It is divided into two sub-methods: hospital admission and control of preoperative studies. Hospital admission has these objectives: the patient’s administrative admission, their correct identification, and hospitalization in the corresponding unit. This method is carried out by trained medical administrative personnel. Control of preoperative studies has these objectives: control of the required blood tests, presurgical cardiology studies, imaging studies (radiography, tomography, ultrasound, etc.), and many others. Operative Stage: This is the second stage of the perioperative process which contains three sub-steps: anesthetic induction (perform the anesthesia required by the patient according to the surgical procedure to be performed), surgery (solve the health issue that afflicts the patient), and anesthetic recovery (perform the patient’s anesthetic recovery and helps him to regain consciousness). In this stage, the main goal is to carry out the surgery of the patient successfully. Postoperative Stage: It is the third stage of the perioperative process with the goal to complete the surgery successfully in two sub-steps: control during hospitalization (detect any sign or symptom of an immediate postoperative complication) and ambulatory control (provide the necessary advice for the patient’s welfare which includes oral medication, healing, wound controls, diet, and rest, and schedule of the next consultation to prevent and identify any mediate postoperative complication).

How to Create a Perioperative Checklist

Implementing the use of a perioperative checklist in medicine and surgery is crucial to help in lowering the risk of adverse events and improving patient safety. Follow the basic steps in this section so that you can easily and quickly create a simple perioperative checklist.

Step 1: Include the Patient’s Information

Write the first name and last name of the patient, the name of the surgeon, and the date of surgery. Indicate in the checklist when the patient is correctly identified, the procedure to be performed, when the surgical consent form is completed, when the copy of the living will or advance directives on the chart is completed, and when the preoperative instruction are provided to the patient or the legal representative of the patient.

Step 2: Add the Medical Documentation

Kindly check your checklist when the following documents are completed: the patient’s medical history and physical examination attached, physician’s orders attached, pathology or laboratory studies, radiologic studies with site identification if applicable, EKG, and other tests.

Step 3: Indicate the Surgical Information

Check or circle these options in the surgical information section when accomplished: the time of surgery verified, surgical procedure verified, surgical site verified, surgical position verified, required positioning device, implants, and other verified surgical instrumentation. Add your comments in the last part of this section.

Step 4: Use a Sample Perioperative Checklist

If you need to obtain a ready-made perioperative checklist, there are many types and examples of perioperative checklist templates that you can freely select, download, and use for your perioperative process. Sample.net provides an eclectic and unique collection of checklists and document templates for your medical and surgical management work. Choose your preferred sample perioperative checklist template, edit the contents, and save the document.


FAQs

What are the different phases of the perioperative process?

The different phases of the perioperative process are preoperative, operative, and postoperative. 

Why is a perioperative checklist essential?

A perioperative checklist is essential because it guides pre-op or perioperative nurses to enhance the safety of the patient during the surgical operation especially in preventing complications and risks. It assists new inpatient and perianesthesia nurses to determine certain items and other factors that can influence patient outcomes negatively if not pre-operatively addressed. 

What are the key roles of a perioperative nurse?

A perioperative nurse has key roles as a circulating nurse, an instrument or scrub nurse, a preoperative or patient reception nurse, a Post Anesthetic Care Unit or recovery nurse, a registered nurse first assistant, and a patient educator. 

What are some things you need to always explain to a patient before surgery?

Here are some questions to answer and explain to a patient before surgery: Why do they need the operation? How will the operation be carried out? Are there other treatment options and is this operation the best option for them? What are the benefits, possible complications, and risks of the operation? Will their medical history and the medication they are currently taking mean the risks, benefits, and possible complications will be different for them? What are their anesthesia options? What can they expect prior to the surgical operation? What can they expect for their recovery in terms of diet, medication, treatment, and home care? Tell them about your professional experience with the operation. Is the surgical facility accredited and properly staffed? How much will the operation cost the patient and what type of medical insurance do you take?

What is a perioperative assessment?

A perioperative assessment is an in-depth evaluation or review of a patient in order to determine the stability of the patient for surgery and how to optimize current medical conditions for the given surgery to be performed. 

As a preoperative nurse or a member of the surgical team, it is important to be skilled in creating and completing a perioperative checklist. This clinical document helps multidisciplinary teams in hospitals and medical facilities in enhancing patient care and improving surgical safety outcomes. Easily download and use our sample perioperative checklist templates for perioperative process and medical management such as a medical timeline, a medical incident report, and a medical case summary.