F-OT-02: Pre-Operative Checklist | دليل السياسات والإجراءات في غرفة العمليات

Patient Name

MRN

Date

Age

Sex

M F

Ward / Location

Weight (kg)

Allergies

Proposed Surgery / Procedure

Surgeon

Site / Side

BP (mmHg)

HR (bpm)

Temp (°C)

SpO2 (%)

Fasting: Solids (Time)

Fasting: Clear Liq (Time)

Item to Check	Ward / Holding Nurse	Remarks / Comments
A. Identification & Consents
Patient ID band attached and correct (2 Identifiers)	Yes No N/A
Allergy band attached (if applicable)	Yes No N/A
Surgical Consent signed and valid	Yes No N/A
Anesthesia Consent signed and valid	Yes No N/A
Blood Transfusion Consent signed (if required)	Yes No N/A
Patient Notes / Medical Records present	Yes No N/A
B. Investigations & Blood Readiness
Recent Lab Results available (CBC, Coag, Chem)	Yes No N/A
ECG / Echo reports available (if indicated)	Yes No N/A
CXR / Imaging available (if indicated)	Yes No N/A
Blood Group & Save / Crossmatch confirmed	Yes No N/A
C. Patient Preparation
Surgical Site Marked by Surgeon	Yes No N/A
Patient washed and in hospital gown	Yes No N/A
Jewelry / Body piercings removed & secured	Yes No N/A
Dentures / Bridges / Loose teeth removed	Yes No N/A
Contact lenses / Glasses / Hearing aids removed	Yes No N/A
Makeup / Nail polish / Hair pins removed	Yes No N/A
Bladder emptied / Foley catheter intact	Yes No N/A
D. Medications
Anticoagulants stopped per protocol	Yes No N/A
Diabetic medications / Insulin managed per orders	Yes No N/A
Pre-medication given as prescribed	Yes No N/A
Prophylactic Antibiotics available/sent with patient	Yes No N/A

General Hospital • Operating Theatre