Cardiac Surgery Pre-Operative Checklist
Patient Information
Patient Name:
Date of Birth:
Medical Record Number:
Surgery Date:
Pre-Operative Checks
Consent Form Signed
Allergies Checked
NPO Status Confirmed
Pre-op Labs Resulted
Blood Products Ready
Imaging Reviewed
Implants/Devices Available
Medications Reviewed
Prophylactic Antibiotics Ordered
Pre-op ECG Done
Team Preparation
Team Briefing Completed
Surgical Site Marked
Equipment Checked
Anesthesia Ready
IV Access Secured
Comments
Additional Notes: