Surgical Forms

Question 1

Consent for Surgery Form

Answer 1

-Needs to be signed prior to surgery.
-Print information legibly, no abbreviations or handwriting.
-NUC’s prepare the form, not witness signing.
-Patient needs a thorough run down of their procedure prior to signing the consent form.

Question 2

Pre-Operative Checklist

Answer 2

-Checklist to ensure all pre-operative tests and procedures have been completed prior to the patient having surgery.
-Ensures nurse has documented any pre op assessments and patient has what they need prior to surgery.
-Completed and signed by nurse.

Question 3

Pre-Anaesthetic Questionnaire

Answer 3

-Completed by patient.
-Allows nurses, physicians and anaesthetist to have current information on the patient’s medical history and health.

Question 4

Anaesthetic Record

Answer 4

-Anaesthetist uses this form to record their observations and medications given to the patient during surgery.

Question 5

Peri-Operative Nursing Record

Answer 5

-Used to keep a detailed record of the patient’s surgery.
-Completed by the Operating Room Nurse.
-NUC can use this form to obtain relevant information for the surgery performed.

Question 6

Post Anaesthetic Care Unit Record

Answer 6

-PAR nurse uses this form to record the observation, medications given and patient progress while in PAR (Post Anaesthetic Recovery).

Question 7

Instrument Count Sheet

Answer 7

-Used to record all instruments used during the surgery.
-Accounts for all instruments following surgery.
-Completed by OR Nurse.