Author:
Kai Knudsen
Updated:
27 August, 2025
The overall purpose of this checklist is for the team to ensure that the correct patient is undergoing the correct operation. Additionally, the team should assess the patient's condition and take appropriate measures, including preparations for unexpected events. The pre-anesthesia check is a so-called "do-and-verify" checklist, meaning the steps are performed and then confirmed as completed.
Checklist and Instructions – Pre-Anesthesia Check-in
In emergency procedures, it is possible to only read the so-called “Red Points,” which outline the essential items that must be reviewed even in urgent situations. All items are reviewed once the situation is under control. For minor procedures under local anesthesia, endoscopies, and similar interventions, Red Points can also be used along with relevant procedure information.
The checklist is read aloud by an anesthesia staff member in the operating room.
- Each item is answered by another anesthesia staff member (airway responsible)
- The checklist must be completed before anesthesia starts
- Emergency medications and materials
This item ensures that the anesthesia cart in the room contains specified medications and materials per clinic routines/protocols and that this has been checked. “Checked” means the cart contains everything required and has been verified. - Identity and records
This item ensures the correct patient is being operated on and that the correct medical records are available. In emergencies where identity is unknown or uncertain, follow current clinic routines/protocols. “Confirmed and checked” means the right patient is being prepped for surgery and correct records are in place. - Patient status
This item ensures the patient is assessed and ASA-classified per clinic routines/protocols, fasting time assessed, and that potential bloodborne infections or multi-resistant bacteria are identified. Also includes metal implants or pacemakers that may affect the procedure, ongoing thromboprophylaxis, and allergies to medications, nickel, or latex. Relevant information should also be shared with the surgical nurse. There is no predetermined answer; relevant information is communicated, including the absence of infections/implants. - Surgical site marking
This item ensures the patient is correctly marked for surgery on the right body part and side. The response should indicate the marked body part/side. If no marking exists when needed or if uncertain, the surgeon must be contacted. Also verify the correct operating table is used. The answer should state the surgical site or that side-marking is not applicable and that the patient is on the correct table. - Ventilation, circulation, hypothermia
This item ensures the patient is assessed for risks related to ventilation, circulation, and hypothermia, and monitoring is adapted accordingly. Also includes confirming that ordered blood products are available. The answer confirms all aspects are considered and preparations made. - Urinary retention/Catheter (KAD)
This item assesses the risk of urinary retention during surgery and whether catheterization is needed. It includes clarifying when the patient last emptied their bladder. The answer confirms risk has been assessed and actions taken accordingly. - Vascular access
This item ensures adequate venous (and if applicable, arterial) access is established per patient condition and procedure. Ensure that IV/CVC/arterial lines are tested and ready. The answer confirms suitable and tested access is in place. - Antibiotics
This item ensures the patient receives correct perioperative antibiotics per clinic routine/protocol. The drug and dose are checked against the medical record. Answer includes drug, dose, and timing, or that prophylaxis is not applicable. - Airway assessment
This item ensures the patient is assessed for intubation, even if not planned. Review medical records, previous anesthesia notes, and current assessment. Evaluate the need for airway trolley (e.g., video laryngoscope). The answer confirms the airway has been assessed and a plan is in place. - Airway management
This item ensures that intubation or use of LMA can proceed safely per risk assessment and clinic protocols. The answer confirms all necessary equipment is ready and tested. - Induction medication
This item ensures that anesthetic induction medications (opioid, induction agent, muscle relaxant) are known, ready, and available. Answer includes drug and dose or “not applicable.” - Maintenance medication
This item ensures maintenance anesthesia medications are ready (opioid, maintenance anesthetic, muscle relaxant as needed). Answer includes drug and dose or “not applicable.” - Equipment checks and settings
This item ensures all equipment (syringe pumps, ventilator, monitoring) is tested, ready, and programmed correctly. Suction must be tested. Verify correct programming before any drug is given. The answer confirms everything is ready and set correctly. - Anesthesia preparation complete
If RSI is not to be performed, the pre-anesthesia checklist is complete at this point. - RSI – equipment, medication, technique
This item ensures that if RSI is planned, all related equipment, medications, and techniques are prepared. Follow protocols regarding NG tube, acid blocker, antidotes, cricoid pressure, etc. The answer confirms all preparations are done. - RSI preparation complete
If RSI is to be performed, the checklist is complete at this point.
Checklist and Instructions – Pre-Surgery Check-in
The purpose of this checklist section is for the team to verify, before starting the procedure, that the correct patient is undergoing the correct operation. The team must also evaluate the patient’s condition and take proper measures, including preparation for unexpected events.
- Team introduction
The goal is for the team to clarify who is present in the OR and to open communication in case something unexpected occurs. Everyone introduces themselves with name and role and discloses relevant info, e.g., limited experience with the procedure, return after absence, newly hired, etc. Includes students/other staff. Planned staff changes are noted. Team members may also mention fatigue, early leave, or other unusual circumstances. - Patient presentation
Purpose is to double-check the correct patient with the surgeon present and confirm any study participation is prepped. Name and ID are read from the chart and verified against the patient’s ID band and surgical chart. - Type of anesthesia
Purpose is to inform the team about the type of anesthesia and any issues. A short summary is given with any relevant details. Answer: “No issues” or a short note. - Antibiotics
Ensures the patient receives prescribed antibiotics (prophylaxis or treatment). Report includes name, dose, and time given. If not yet given, state this. If not applicable, state that. - Infection and allergies
Ensure the whole team is aware of any infections or allergies that may affect the procedure. Verified via medical records (e.g., bloodborne pathogens, MRSA, drug/latex allergies). Answer includes any known issues or “none known.” - Equipment and materials
Ensures the team knows what equipment is needed. Confirm all is present, functional, and as per checklist/manual. Confirm any implants or special items are in the room, and required radiology is available. Report any discrepancies. - Patient positioning and securing
Ensure patient is on the correct table, properly positioned and secured. Note any deviations from standard. Answer: “Ready” including any deviations. - Sterility, draping, and setup
Ensure sterile materials are checked and handled per routine, skin cleaned, patient draped, and sterile field set up correctly. Answer: “Confirmed.” - Planned procedure and side
The team should hear a concise summary of what procedure is being done, expected course, incision site, and expected blood loss. Answer: planned procedure, side, estimated time, expected bleeding, and incision site confirmed by anesthetic nurse. - Expected critical steps
Inform the team about potentially difficult or complex steps, including anesthetic issues. If expected blood loss >500 ml (or >7 ml/kg for children), the surgeon must mention this. - Questions and comments
All team members are encouraged to ask questions and raise concerns. Everyone is responsible for this point. - Start check complete
This marks that all preparations are done and surgery can begin.
Checklist and Instructions – Conclusion
The overall purpose of this section of the checklist is for the team to summarize what has been done, so that adequate information can be passed on to the next team responsible for the patient postoperatively. Furthermore, to highlight problems, lessons learned, and opportunities for improvement, so the next operation can be even better. This section is also a so-called “read-and-do” checklist, meaning each item is read and the task performed immediately. During this checklist, all agreed orders should be documented in writing to ensure continued care is aligned with the surgical team’s intentions.
The “Conclusion” checklist is initiated by the surgeon and read by a nurse assistant or other non-sterile staff in the OR. The scrub nurse responds to item 1. The anesthesia nurse responds to items 2–4. The surgeon responds to items 5–12. The entire team is responsible for item 13.
- Needles, cannulas, drapes, and instruments
The purpose is to ensure no unintended material is left in the patient at the end of surgery, and that the scrub nurse communicates their assessment of blood loss. The scrub nurse confirms instrument, gauze, and needle counts are done and nothing is missing, and reports any issues with sterility and/or draping. The answer “Checked” confirms all checks are complete and satisfactory. - Planned pain management
The purpose is for the anesthesia nurse (or another person handing over to the next care team) to receive an order on the patient’s planned pain treatment. Treatment may follow a specific order or clinic routine/protocol. - Planned fluid/nutrition/fasting
The purpose is for the anesthesia nurse (or another person handing over to the next care team) to receive an order on the patient’s planned fluid and nutrition intake. The anesthesia nurse also compiles blood loss information in cooperation with the scrub nurse and surgeon. Plans may follow a specific order or clinic routine. This item also includes continued fasting, if applicable. - Medications
The purpose is to clarify the patient’s planned medication regimen, at least until the next scheduled order, for both regular and surgery-related drugs. Done in collaboration with the surgeon and anesthesiologist. - Procedure performed
The purpose is for the team to understand what procedure was performed, including any deviations or complications, and planned postoperative care, so that correct information is communicated to the next care unit. - Specimens
The purpose is to ensure any tissue samples or specimens collected are handled properly. The surgeon confirms with the scrub nurse that specimens are correctly labeled and handled. If no specimens were taken, the answer is “Not applicable.” - Thromboprophylaxis
The purpose is for the patient to receive correct thromboprophylaxis. Drug, dose, and timing must follow the surgeon’s order or clinic routine. If not applicable, answer “Not applicable.” - Antibiotics
The purpose is to ensure the patient receives appropriate antibiotic prophylaxis or treatment. Drug, dose, and timing must follow the surgeon’s order or clinic protocol. If not applicable, answer “Not applicable.” - Drains
The purpose is to provide correct instructions for managing any placed drains. Includes number of drains, location, management (active/passive/flushing needs). If no drains are placed, answer “Not applicable.” - Urinary retention
The purpose is to minimize postoperative urinary retention. If the patient has a catheter (KAD), this is noted. If not, the next time for bladder scanning is stated. This can be individualized or follow clinic routines. - Mobilization
The purpose is to provide clear mobilization instructions to the next care unit. - Radiology referral
If the patient is to undergo immediate postoperative imaging, this point clarifies who writes the referral and when. If not applicable, answer “Not applicable.” - Evaluation
This point serves two purposes: to highlight any equipment issues and ensure they are addressed, and for the surgical team to briefly reflect on: What did we learn? What can we improve next time? to support continuous improvement. - Conclusion complete
At this point, all parts of the checklist have been reviewed.
Checklist for ICU Rounds
| Overview | What are the current intensive care issues Evaluation of interventions performed during the care process |
| Anamnesis/Background | Ongoing and past health problems relevant to intensive care? Patient’s prior level of function. |
| STATUS | |
| Respiration/Lungs | Ventilator settings. Blood gases. Intubation, weaning, extubation, tracheostomy Respiratory care – interventions? Pleural drainage? |
| Circulation | Vasoactive and inotropic drugs Need for extended monitoring? PiCCO? Fluid status, fluid therapy Coagulation Thromboprophylaxis Abdominal pressure measurement |
| Neurology | Level of consciousness? Ongoing sedation? Pain? Sleep? Delirium (manifest, screening) Wake-up? CFM? |
| Renal Function Fluid/Electrolyte Balance | Renal function and urine output? Fluid balance – input vs output Weight Dose adjustment of medications? Diuretics? Electrolytes – Na, K, Ca, Mg, Phosphate. Blood gases. Dialysis? – Dialysis documentation in a separate document |
| Gastrointestinal Nutrition | Fasting? Oral intake? Swallowing function? TPN? Tube feeding? Abdominal status, gastric retention, bowel function? Ulcer prophylaxis? Laxatives? Blood sugar? Energy needs, protein needs, nutrition strategy? Insulin |
| Infection | Infection control? Cultures/antibiotics? Healthcare-associated infections? Temperature Infection markers |
| Skin/Tissue | Oral status, skin, wounds, sutures/staples? Pressure ulcers? |
| Vascular access | Insert new?, secure, replace, remove? |
| Activity | Mobilization Physiotherapy Restrictions? |
| Psychosocial | Relatives, minor children/child protection report Social worker? Interpreter needed? |
| PLANNING | |
| Medications | Update/sign the medication list |
| Treatment Strategy | Limited treatment strategy and documentation? Donation? Level of care conference? |
| Target Orders | Update target orders. Are there orders to maintain the goals? |
| Planning | Order lab tests. Examinations? Treatments? Surgery? Family conversations? Preparation for transfer, contact with home unit? Other certificates |
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