Obstetric C-Section Pre-Operative Checklist
Patient Identification
Patient Name
MRN/ID Number
Date of Birth
Date of Surgery
Surgical Team
Obstetrician
Pre-Op Checklist
Written informed consent obtained
Patient ID band checked and applied
Allergies identified
Patient washed and in clean gown
IV line inserted & patency confirmed
NPO status confirmed
Baseline vitals recorded
Pre-op labs reviewed
Blood products available (if needed)
Fetal heart rate checked
Pre-medication administered
Abdominal skin prepped
Urinary catheter inserted
Anti-embolism device/stockings applied
All necessary surgical equipment available
Comments
Pre-Op Nurse/Provider Sign-off
Name
Date & Time