PeriOp checklist

PeriOp checklist

posted by Judith Bittner on Feb 9, 2018 1:58 pm

We have a three check perioperative checklist (admitting or floor, preop, OR) and my question is when a patient comes directly from ICU to the OR they are only getting two checks(floor and OR) isn't this a different standard of care for the ICU patient?  Is there an AORN guideline to support the the same number of checks for every patient whenever possible? 

Re: PeriOp checklist

posted by Erin Kyle on Feb 14, 2018 2:31 pm

Thank you for submitting this question on ORNL.  Your question about standardizing care is a valid one.  While AORN does not provide specific guidance around the number of times checklists should be reviewed or the content of checklists, we do support practice standardization that promotes optimal outcomes and patient safety.  In situations where AORN Guidelines do not answer your practice questions in detail, AORN recommends that a multidisciplinary team, with representation from all stakeholder groups in the organization, convene to discuss practice standardization.  The multidisciplinary team may discuss the ways in which ICU patients are similar, or dissimilar to patients coming from other locations (outpatient/day surgery preoperative are, inpatient nursing of a lower acuity, etc.).  In this way, you and your team may determine what is best and safest in this situation and standardize that practice.  

Thank you for all you do to promote optimal outcomes and patient safety as an AORN member!

Erin Kyle, DNP, RN, CNOR, NEA-BC
Perioperative Practice Specialist
Association of periOperative Registered Nurses (AORN)
2170 S. Parker Road, Ste. 400 
Denver, CO 80231

Re: PeriOp checklist

posted by Karin Brown on Mar 13, 2018 12:19 pm

First, if you don't mind could you attach a copy of the check-lists you use for peri-op and OR, please!? Second, I'm assuming that since the patient was at some point admitted to ICU they received the first of the three checks at that time even if there is a delay in when the patient is scheduled for surgery?
Karin Brown, BSN

Re: PeriOp checklist

posted by Munira Amin on Mar 15, 2018 12:57 am

Checklists are made for ensuring appropriate handover process. We also have a checklist where in ward, Pre-operative area and OR parts are to be completed. This is a normal flow of patients. In handover process, it is important that wherever the patient is handed over, it should be marked on a checklist. 

For ICU patients, these patients are directly been handed over from ICU staff to OR staff and hence there remains no need for filing up a portion where the patient is not handed over to. 

Munira Amin, Administrator, OR/RR/CSSD

Re: PeriOp checklist

posted by Jessica Patton on Mar 17, 2018 12:02 pm

I am needing to create a pre-op checklist for patients from pre-op to OR...many times I go get my patient from preop and I have no clue that anesthesia has ordered medications via verbalizing to the preop nurse and I just go get my patient all check on my end are good. I start taking my back back to OR and stopped in hall because preop nurse needs to give medication. Does anyone have any suggestions or currently have a checklist for preop to OR?

Re: PeriOp checklist

posted by Pat Guzzo on Mar 18, 2018 9:20 pm

Jessica, it sounds like you need some type of communication tool to tell the OR staff that the patient is not 'ready.' There are a number of ways to do this. It can be by a 'marker' on the census board (where all patients are listed with their bed location), a tag on the patient stretcher or room door (i.e. bright red tile hung from the IV pole), or anywhere else OR staff checks to see if all requirements are complete in preop preparation.

Ideally, the person CAUSING the 'hard stop' is the one to put up the signal (i.e. if the anesthesiologist orders a med or test that needs to be done preop, he/she is the one to flag the patient that they aren't ready). That avoids the scenerio of the preop nurse being unaware of, say, new orders put into the computer.  If the order will possibly cause a delay (patient not ready when the OR is), the OR boardrunner also shoud be notified; perhaps the following case can be moved up.

This is 'outside' the regular preop checklist, as you are dealing with changes that occur AFTER the checklist has been completed. 

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