Postoperative Handover Checklist
1. Patient Specific Information
Patient Number
Name
First Name
Last Name
Age
Allergy Status
Diagnosis
Procedure
Current Patient Status
Please Select
Drowsy
Unconscious
In serious pain
Fully awake, conscious and doing well
Current Patient Status
Has the zonal/ward nurse recorded the vital signs of the patient in the EMR?
Please Select
Yes
No
2. Anaesthetic Information
Anaesthesia Type
Please Select
GA (General Anaesthesia)
LA (Local Anaesthesia)
Spinal
Epidural
CSE (Combined Spinal and Epidural)
Intraoperative anaesthetic course and any complications
Is a postoperative blood transfusion required?
Medications given in theatre
Plan for monitoring (Vitals parameter range and action)
Plan for intravenous fluids
Plan for pain relief
Plan for lines. eg- central venous, arterial
Any postoperative investigations required?
3. Surgical Information
Consultant Surgeon
Duration of Surgery
Intraoperative surgical course and any complications
How much blood was lost (if any)? Any blood transfusions during surgery? if so, how many pints?
Plan for nasogastric tube/feeding
DVT prophylaxis plan
Antibiotic plan
Consultant Anaesthesiologist
First Name
Last Name
Signature
Nurse Anaesthetist
First Name
Last Name
Signature
Zonal/Ward Nurse
First Name
Last Name
Signature
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