Pre-op Checklist — Nursing

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

ASA Physical Status

ASA 1 — Healthy: No medical problems, non-smoker, BMI <30

ASA 2 — Mild disease: Smoker, social drinker, pregnancy, obesity (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 (>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

Minor Surgery (skin, endoscopy, dental, eye): ASA 1–2 no routine tests. ASA 3–4 consider kidney, ECG (if no recent ECG in last 6–12 months, they need one).

Intermediate Surgery (cholecystectomy, hip/spine, major uro/gynae):

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

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

Major / Complex Surgery (joint replacement, colectomy, vascular, transplant):

Test	ASA 1	ASA 2	ASA 3–4
FBC	Yes	Yes	Yes
Kidney (UEC)	Consider	Yes	Yes
ECG	Consider (>65)	Yes	Yes
Coagulation	—	—	Consider

Diabetes — Check on Admission

Ketones (finger-prick)

<0.6 — Normal, proceed
0.6–1.5 — Recheck 1hr, notify anaesthetist
>1.5 — Alert the anaesthetist

Blood Glucose (BGL)

4–12 mmol/L — Acceptable
<4 — Give a sweet clear fluid (e.g. apple juice), recheck BSL in 30 mins
>12 — Notify anaesthetist

Also check: HbA1c (within 3 months) | SGLT2i stopped 3 days prior? (if not, check ketones even if BGL normal) | GLP-1 fasting plan confirmed? | Insulin doses taken/held?

Admission Quick Checks

Fasting: Food 6hr, clear fluids 2hr. Confirm last intake time.

Medications: Which taken today? Blood thinners — check admission sheet (surgeon may want continued). Insulin dose?

Allergies: Band on? Reactions documented? Latex allergy?

Consent & ID: Form signed? Site marked? ID band matches?

Escalate to Anaesthetist

Ketones >1.5 mmol/L — do not proceed
BGL <4 or >12 mmol/L
SGLT2i not stopped — check ketones regardless
Not fasted or unsure of timing
Blood thinners — check admission sheet, surgeon may want continued. Clarify with anaesthetist if unsure
New symptoms — chest pain, breathlessness, fever
Missing or abnormal test results
GLP-1 — not stopped or unsure of fasting plan

References: NICE NG45 (2016), ESC/ESAIC 2022, AHA/ACC 2024, WPH Diabetes Guideline. For full details see gasatthegong.org/preop-testing