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