Orthopedic Joint Replacement Pre-Operative Checklist
Patient Information
Patient Name
Date of Birth
MRN / Patient ID
Procedure Type (e.g. Hip/Knee/Shoulder)
Scheduled Surgery Date
Pre-Operative Assessment
Informed consent signed
History & physical completed
Pre-operative lab tests completed
ECG completed
Imaging studies completed
Medical clearance obtained
Allergies
Current Medications
Infection Risk Measures
MRSA/MSSA screening done
Skin preparation completed
Prophylactic antibiotics ordered
Venous Thromboembolism (VTE) Prophylaxis
VTE risk assessment completed
Anticoagulant plan documented
Other Checklist
Evaluated by anesthesia
Patient fasting instructions given
Assistive devices arranged
Post-operative instructions reviewed
Additional Comments