Order 1103231: Clinical Case study post op

Date PRE POST PRE POST

n/a n/a

  n/a n/a

   

  n/a n/a

  n/a n/a

n/a  



n/a n/a

Marked   

*Notify surgeon/Reg n/a n/a n/a

n/a n/a

n/a n/a n/a

n/a n/a n/a

2400 n/a n/a

2400 n/a n/a

  n/a n/a

(circle) Top/Bottom/Partial denture n/a n/a n/a n/a

n/a n/a n/a n/a

n/a n/a  

Pre-Operative Antibiotics: n/a n/a

n/a n/a n/a n/a

 

n/a 



Bloods n/a 

ECG n/a 

n/a 

 

n/a n/a

n/a 

UR NUMBER 075486

Chelsea Bassett Joelle Latham

Lisa Leanard

P E

R I-O

P E

R A

T IV

E C

H E

C K

L IS

T M

R 7

1 A

Chelsea bassett

Joelle Latham

Lisa Leonard

Signature:

Signature:

Signature: Post- Operative check performed by:

Xray/Scans:

Patient reception check performed by:

Given and signed

Given and signed

Pre-Operative check performed by:

Medical Certificate

Follow up Appointments

Observations Checked

Discharge SummaryGraduated compression stockings insitu

(Circle) N/A / with Patient / With Doctor

VTE Prevention Anticoagulant

Investigations: FBC updated

Check/Wound/Drain tube

POST OP ONLY

Epidural Test Dose

Post Op Orders

Glasses

Hearing aids

Posthetic devices

Pacemaker insitu:

Seen by technician

Pre Op Prep: Skin Prep (Betadine)

Bariatric: (>120kg) - Notify Theatre

(obtain Hover mat prior to transfer to OT)

Cytotoxic Drugs Within 48 hours

Weight Recorded:

Anaes. Record

Fasting time: Food

Fluid(Document time)

Own teeth:

Pre-medication Ordered

Ordered

IV Therapy IV bung flushed

IV orders written

Clip

Bowel Prep

Identification Labels: Min of 20

Infectious State: Please state:

Theatre notified

History: (circle) Old New

Jewellery: (circle) Taped / Removed

Make-up/Nail Polish: Removed

Underwear: (circle) Disposable / Own

Female Sanitary Products:

NB:Please remove tampons Pad in situ

Personal items with patient:

Contact lenses

Procedure on consent form corresponds with

Theatre List

* Do not allow pt to leave holding bay

Side and site of surgery:

 Not Marked

Allergies:

Wrist band

Patient Identifcation (check against

Notify surgeon/registrar  Not completed

Consent form:

Admission form: Wrist band

Leg band

Patient/rep signature

Doctors signature

Comments: (e.g. Alerts, manual handling issues, Infections, Bariatric skin integ.)

PRE AND POST OPERATIVE CHECKLIST YES P NO O Not Applicable N/A

5/03/2018

DOCTOR John Smith

DATE OF BIRTH

ROBERTS Darren

25 Happy Street CAIRNS 4860 23/11/1968

SURNAME

FIRST NAME

ADDRESS

SIMULATED HOSPITAL