The checklist is designed as a basic template that serves as a quality and safety measurement tool.
Before administering anesthesia
• Confirm patient identity
• Engage parents, guardians and patient (when applicable)
• Confirm procedure to be performed
• Confirm written consent
• Confirm anesthesia and medication check
• Assess patient allergies
• Assess airway and aspiration risk
• Confirm patient medical history
• Confirm relevant radiologic and diagnostic tests are included in patient chart or EHR
• Ensure all necessary special equipment is available
• Confirm placement of pulse oximeter
• Confirm appropriate management of insulin, anti-coagulents and anti-platelet medications
• Confirm responsible adult transportation is available for after the procedure
• Confirm appropriate room cleaning took place
Before introducing the endoscope
• Confirm all team members’ identity and roles
• Confirm patient’s identity and procedure
• Confirm administrator of antibiotic prophylaxis
Before the patient leaves the procedure room
• Identify key concerns for patient recovery and management
• Confirm restrictions for patient diet and activity in recovery interval
• Confirm specimens taken during the procedure
• Perform medication reconciliation
• Discontinue prophylactic antibiotics (when applicable)
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