Circulating Nurse Pre-Operative Assessment – Developing the Plan of Care
The circulating nurse reviews the patient’s hospital record and performs a preoperative assessment prior to the patient entering the OR. Most institutions have a preoperative checklist to ensure that no steps are missed. Here is a list of what the ORNAC standards recommend:
Identify the correct patient by checking the armband and asking them to verbally communicate their name, DOB, and hospital ID number.
Take infection precautions. For example, is the patient under any additional precautions? Has there been a Covid screen? Do they have any symptoms? Is the patient vaccinated?
Ensure informed consent has been obtained.
Check for any advanced directives.
Ensure the surgical site is marked.
Check the patient’s medical history including smoking, cannabis use, alcohol intake, allergies, anesthetic history (does the patient or any family member develop complications from anesthetics?), previous surgeries, metal implants, cochlear implant, or pacemaker.
Check for medications: Current medications including what has been taken and what has been held (ie. What the surgeon has asked the patient not to take prior to their surgery). Is the patient on blood thinners, over-the-counter medications, vitamins, herbal supplements, pre-operative medications, etc.
What is the patient’s fasting/NPO status — it is important to know the institution’s policy.
Check that the surgical site prep is completed including a preoperative bath/wash, antiseptic wipes, any hair removal required, etc. Note that hair removal should be done less than two hours before surgery to reduce the risk of surgical site infection.
Check the patient’s skin — are there bruises, lacerations, or scars? Remove any makeup, nail polish, artificial nails, and jewelry.
Check for the presence of non-removable jewelry or tattoos, assistive devices, dentures, eyeglasses, etc.
Check their elimination status. When is the last time they voided?
Check current vital signs such as weight and height.
Check lab and diagnostic tests — pregnancy test, if applicable, and glucometer readings if the patient is diabetic. Check hospital policy.
Check their level of anxiety and/or pain — give a sedative to minimize anxiety, if appropriate.
Check the patient’s blood type, screen, and availability of products, if required.
Verify the patient’s temperature and the need for warming, according to hospital policy.
Verify the need for VTE prophylaxis, if required. Ensure that stockings are on.
Address any questions or concerns.
Patient Meal Intake
Liquid and Food Intake
Minimum Fasting Period (Hours)
Clear liquids (For example, water, clear tea, black coffee, carbonated beverages, and fruit juice without pulp)
2
Breast Milk
4
Non-Human milk, including infant formula
6
Light meal (for example, toast and clear liquids)
6
Regular or heavy meals (may include fried or fatty food, meat)
8
Stop Eating and Drinking Before Anesthesia or Sedation:
Stop clear fluids 3 hours before operation time
Stop breast milk 4 hoursbefore operation time
Stop bottle feeds/tube feeds 6 hoursbefore operation time
Stop solid foods at midnight before operation time
