Surgery Preparation List

Name:

[YOUR NAME]

Hospital Name:	[YOUR HOSPITALNAME]
Date:	[DATE]

Overview

This comprehensive list provides a template for preparing for a surgical procedure. It includes key details about the patient, assessments to be completed, equipment and supplies considerations, and patient preparation steps. This structured approach ensures all relevant information is captured and correct preparations are made for the operation.

Patient Information

Patient Information
- Name:
- Date of Birth:
- Medical Record Number:
- Allergies:
- Current Medications:

 

Surgical Procedure Details
- Procedure:
- Surgeon:
- Anesthesiologist:
- Scheduled Time:

Pre-operative Checklist
- Consent form signed
- Pre-operative medications administered
- NPO (nothing by mouth) status confirmed
- Patient identification verified

Equipment and Supplies
- Surgical instruments
- Sterile drapes
- Suction apparatus
- Anesthesia machine
- Monitoring devices

Operating Room Setup
- Sterile field established
- Equipment checked for functionality
- Proper lighting adjusted
- Team briefed on procedure details
- Emergency equipment readily accessible

Patient Preparation
- IV access established
- Pre-operative assessment completed
- Vital signs monitored
- Pre-operative hygiene maintained
- Emotional support provided

Notes:

• Check all information for accuracy and completeness.

• Ensure documented consent for the surgery is obtained.

• Confirm patient is properly informed, prepared and comfortable.

• Ensure emergency equipment is readily available if needed.

• Follow all institutional guidelines and protocols.

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