British
Cardiovascular
Society
British
Cardiovascular
Society
WA R D C H E C K L I S T
C ATH ETER LA BO RATO RY C H ECKLIST
PATIENT PREPARATION
CHECKLIST
Patient details
PATIENT
DETAILS
PATIENT CHECKS
Patient weight?
AFFIX STICKER
kg
Procedure explained?
Yes
Consent form completed?
Yes
No
Consent form completed?
Yes
IV access established & checked?
Wristband/labels/records verbally crosschecked with patient?
Hearing aid?
Dentures?
Jewellery?
Yes
NOTES
& left with patient
& left with patient
No
Yes
& left with patient
No
Yes
taped / removed
No
Yes
Yes
No
N/A
NOTES
NOTES
___ | ___ | ___
Other
___ | ___ | ___
at
(day:month:year)
____ : ____
at
(day:month:year)
____ : ____
Insert additional question here if required
Yes
No
N/A
NOTES
If yes, record BM in bloods box below
Is O2 required?
No
Yes
No
Yes
NOTES
Known infection risk?
No
Yes
NOTES
MRSA swab
Negative
Positive
(day:month:year)
Insert additional question here if required
Yes
No
N/A
NOTES
NOTES
(day:month:year)
at
___ | ___ | ___
Team members (& visitors) identified by name and role?
(day:month:year)
at
____ : ___
Insert additional question here if required
NOTES
NOTES
HR
BP
Sats
Has sedative pre-medication been given?
No
Yes
RR
Drug
Route
IV access established & checked?
Yes
No (to be done in lab)
N/A
Patient shaved at expected access site(s)?
Yes
N/A
Dose
PO
IV
mg
Time given
Yes
No
Anticoagulation reviewed?
Yes
No
Any metal plates, pins, or joint replacements?
Yes
No
Yes
No
Insert additional question here if required
Yes
No
Yes
No
N/A
NOTES
Yes
Yes
No
Yes
No
Bloods reviewed?
Yes
IV access / operative sites identified?
Yes
Insert additional question here if required
Yes
No
N/A
NOTES
POST-PROCEDURE CHECKS
PRIOR TO TRANSFER TO LAB
Baseline vital signs
Antibiotic prophylaxis given?
NOTES
Specific risks or equipment requirements identified?
No
Yes
Yes
No
N/A
NOTES
Yes
No
N/A
NOTES
Yes
No
Case & planned procedure outlined?
Yes
N/A
Metformin?
Pacing dependent?
TEAM BRIEF
____ : ____
Clotting checked and recorded below?
Last taken
LOCATION
No
Yes
___ | ___ | ___
Yes
No
Previous imaging available?
Drug
Last taken
Yes
No
N/A
ACS: ECG changes?
GRAFT DETAILS
Is the patient on
Oral anticoagulation?
Yes
No
N/A
NOTES
Previous CABG?
DRUGS
Diabetes?
Insert additional question here if required
Pacing / Device & Electrophysiology
Contraindication to drug-eluting stents?
Last oral intake
COMORBIDITIES
___ | ___ | ___
Antiplatelet loading dose given?
N/A (male sex or > 55 years)
Not pregnant - LMP history
Not pregnant - test done
Clear fluids
Yes
No
N/A
NOTES
PCI
No
Yes
Pregnancy status checked?
No
Yes
Insert additional question here if required
Performed on
Yes
Yes
Not required
Insert additional question here if required
PRE-PROCEDURE CHECKS
Previous contrast reaction?
Glasses or contact lenses?
SAFETY
Yes
No
Yes
NOTES
Yes
Clinical records available?
Known allergy?
Does the patient have
CARDIOOLOGY
Patient identity verbally confirmed & wristband checked?
____ : ____
Insert additional question here if required
Procedure documented on patient record?
Yes
Equipment checks, sharps & swab count completed?
Yes
No
Implanted devices recorded?
Yes
N/A
Insert additional question here if required
Yes
No
N/A
NOTES
Insert additional question here if required
Yes
No
N/A
NOTES
Any equipment problems identified?
NOTES
Post-procedure handover to nursing team complete?
Yes
No
Yes
Insert additional question here if required
Yes
No
N/A
NOTES
Yes
No
N/A
NOTES
BLOODS
Hb
PLT
Checklist completed by
INR
eGFR
Signed
BM (if indicated)
Date
___ | ___ | ___
Checklist completed by
Signed
Date
___ | ___ | ___
v1.0 2014 Tom Cahill & Rod Stables
TEAM MEMBERS
Consultant
Specialist Registrar
Non-scrub Nurse
Cardiac Physiologist
Radiographer
Other
Other
Other
AIDE-MMOIRE FOR TEAM BRIEF
Team brief completed on
T eam present
I ntroductions by name and role
P rocedure outlined, with specific risks & equipment requirements
B loods reviewed
I ntravenous and operative access sites reviewed
G roup concerns?
___ | ___ | ___
at
____ : ____
NOTES
SAFETY
SAFETY
TIP BIG
British Cardiovascular Society
CARDIOOLOGY
CHECKLIST
Scrub Nurse
Integrated Safety Checklist
GENERAL ANAESTHETIC APPENDIX
Is the anaesthetic machine check complete?
Yes
Is there a risk of difficult airway or aspiration?
NOTES
Yes
No
What is the patients ASA grade?
Insert additional question here if required
NOTES
Insert additional question here if required
NOTES
Are there any patient-specific anaesthetic concerns?
NOTES
Is the correct monitoring equipment available?
Yes
No
Yes
Insert additional question here if required
NOTES
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
CHECKLIST
CARDIOLOGY
Cardiac Catheterisation Laboratory
