Wollongong coastline

Pre-op Checklist

Pre-op Checklist — Nursing

A guideline is an evidence-based recommendation to assist clinical decision-making — not a rule, but a framework that supports professional judgement.

Quick reference for patient admission — based on NICE NG45, ESC 2022 & AHA/ACC 2024

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ASA Physical Status

Check the patient's ASA grade on the anaesthetic chart or booking form

ASA 1 — Healthy
No medical problems, non-smoker, BMI <30
ASA 2 — Mild disease
Smoker, social drinker, pregnancy, obesity (BMI 30–40), controlled DM/HTN, mild asthma/lung disease, controlled epilepsy, controlled dysrhythmias, well-controlled GORD
ASA 3 — Severe disease
Poorly controlled DM/HTN, COPD, morbid obesity (BMI >40), hepatitis/alcohol dependence, pacemaker/ICD, reduced EF, Hx MI/stents/CABG (>3mo), Hx CVA/TIA (>3mo), dialysis
ASA 4 — Life-threatening
Recent (<3mo) MI/stroke, ongoing ischaemia, severe valve disease, sepsis

Note: The majority of patients for Day Surgery fall into the ASA 1 & 2 categories.

Routine Tests by Surgery Type

Check these results are available before the patient goes to theatre

Minor Surgery

e.g. skin lesion, hernia (local), endoscopy, dental, eye surgery

ASA 1–2: No routine tests required
ASA 3–4: Consider kidney function, ECG (if no recent ECG in last 6–12 months, they need one)

Intermediate Surgery

e.g. cholecystectomy, tonsillectomy, hip/spine, major uro/gynae, carotid

TestASA 1ASA 2ASA 3–4
FBC——Consider
Kidney (UEC)—ConsiderYes
ECG—Consider*Yes

* Age >65 → Yes. Recent ECG in notes → No.

Major / Complex Surgery

e.g. joint replacement, colectomy, hysterectomy, vascular, transplant

TestASA 1ASA 2ASA 3–4
FBCYesYesYes
Kidney (UEC)ConsiderYesYes
ECGConsider (>65)YesYes
Coagulation——Consider

Diabetes — Check on Admission

Ketones (finger-prick)
  • <0.6 mmol/L — Normal, proceed
  • 0.6–1.5 mmol/L — Recheck in 1hr, notify anaesthetist
  • >1.5 mmol/L — Alert the anaesthetist
Blood Glucose (BGL)
  • 4–12 mmol/L — Acceptable range
  • <4 mmol/L — Give a sweet clear fluid (e.g. apple juice), recheck BSL in 30 mins
  • >12 mmol/L — Notify anaesthetist, may need insulin
Also check:
  • HbA1c — should be available if not done in last 3 months
  • SGLT2 inhibitor? (empagliflozin, dapagliflozin) — should be stopped 3 days before. If not stopped, check ketones even if BGL is normal
  • GLP-1? (Ozempic, Mounjaro, Trulicity) — check fasting plan with anaesthetist. See Diabetes & Surgery guide
  • Insulin — confirm which doses were taken/held this morning

Admission Quick Checks

Fasting
  • Food: 6 hours before
  • Clear fluids: 2 hours before
  • Confirm last intake time
Medications
  • Which meds taken today?
  • Blood thinners — check admission sheet (surgeon may want continued)
  • Insulin — dose taken/held?
Allergies
  • Confirm allergy band on
  • Document reactions (not just drug name)
  • Latex allergy?
Consent & ID
  • Consent form signed?
  • Correct site marked?
  • ID band matches notes?

Escalate to Anaesthetist

  • Ketones >1.5 mmol/L — alert the anaesthetist
  • BGL <4 or >12 mmol/L
  • SGLT2 inhibitor not stopped — check ketones regardless of BGL
  • Not fasted — confirm timing with anaesthetist
  • Blood thinners — check admission sheet, surgeon may want them continued. Clarify with anaesthetist if unsure
  • New symptoms — chest pain, breathlessness, fever, productive cough
  • Missing test results — bloods, ECG not available
  • Abnormal results — significantly out of range
  • GLP-1 medication — not stopped or unsure of fasting plan
References:
1. NICE Guideline NG45: Routine Preoperative Tests for Elective Surgery (2016)
2. 2022 ESC/ESAIC Guidelines on CV Assessment for Non-Cardiac Surgery
3. 2024 AHA/ACC Perioperative CV Management for Noncardiac Surgery
4. WPH Diabetes & Surgery Management Guideline
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