It is important to understand the necessity of pre-operative check lists before transferring the child as a patient to the operating theatre. Each point on the check list need to be checked by a number of different professionals, the information recovered from these questions will fully prepare staff for the patient’s transfer and during surgery.

It is the responsibility of the registered nurse or support worker to complete the theatre check list in full prior to transferring the child to the operating theatre. Once the child’s care has been transferred to the theatre staff, a WHO Surgical Safety checklist must be completed. This will allow precautions to be taken or, if necessary, the surgery postponed. The reasons why it is important to follow this check list are listed below. Pre-operative safety checks ensure that the patient is safely prepared for transfer to theatre and for their surgery:

• Past medical history/previous anaesthetic: Knowing the child’s past medical history will alert staff to any risk factors which could cause problems in surgery, such as breathing problems, heart conditions or previous reactions to anaesthetics. This allows important considerations and preparations to be made to incorporate the patient’s conditions or reactions.
  
• Pre-operative fasting: It is important to know the last time the child ate or drank. Fasting must be in accordance with local policy. Normally this fasting period is six hours for food and two hours for clear fluids. The aim of pre-operative fasting is to minimise the volume of the contents of the stomach and thus regurgitation which may lead to aspiration of its contents into the lungs.
  
• Known allergies: A patient’s allergy status needs to be clearly recorded so necessary changes can be made in surgery to prevent anaphylaxis during the operation. This may involve changing or avoiding certain medications, or altering equipment being used, e g. latex gloves, depending on the allergy.
  
• Baseline observations/weight: Baseline observations are fundamental in ascertaining the fitness of the patient before surgery. Recording the patient’s temperature, pulse and respiration (TPR) and blood pressure (BP) will outline any concerns which can be brought to the attention of the anaesthetist, and will allow comparison for the patient’s recovery. Knowing a child’s weight is vital for the administration of anaesthetic medication, therefore, before the child is transferred to theatre, a weight needs to be ascertained.
  
• Consent form/patient details: Consent is an important part of medical ethics and is needed before the surgery can take place. It will depend on who is giving consent, if it is the patient’s parent only or if the child is competent to give consent as well. The checks should also involving ensuring the person consenting has parental responsibility.
  
• ID bracelet/operation site marked: Before transfer the patient should have an ID bracelet on their wrist. Red or white ­depending on allergy status, with the correct patient details. This includes the patient’s name, date of birth, address, NHS number and hospital number. If required, the patient should have a mark for the operation site before being transferred to theatre. The ID bracelet, the details and operation site will be checked in the anaesthetic room. If any of these is missing, or if the details are incorrect, surgery will be delayed.
  
• Seen by anaesthetist/doctor: Each patient before transfer should be seen by both the anaesthetist and the doctor. They will both go through their necessary check list to ensure the patient is fit for surgery and that they understand the procedure, and the anaesthetic technique which is going to be used. It is at this stage that either the anaesthetist or the doctor may cancel or postpone the surgery if they feel it is not required or it is unsafe to proceed. Therefore, it is paramount that the patient has been seen so that these safety checks can be made before transferring the patient to theatre.
  
• Loose teeth: Loose teeth may be problematic when securing the child’s airway during the induction of anaesthesia. Occasionally if very loose they may have to be removed to prevent accidental removal and aspiration into the lungs.
  
• Bowels emptied: Due to the effect of the general anaesthetic, the muscles in the body will relax, therefore, it is best for the patient to have emptied their bowels before going to theatre.
  
• Removal of glasses/contact lenses/hearing aids: The child should be able to wear any visual aids or hearing aids to theatre and these should be removed in the recovery room before surgery. Hearing aids are important as communication with the child is essential at every stage, so they should be removed last.
  
• Jewellery/make-up/nail polish removed: All jewellery should be removed as a safety precaution. If it cannot be removed, adhesive tape should be applied over the item so as it will not catch and pull and cause trauma during surgery. Nail polish should be removed so fingers can be used to position the oxygen saturation monitor probe. Nail polish also harbours microorganism.
  
• Pre-medication/medication administered: The pre-medication should be administered as prescribed. Any additional medication, e.g. inhalers/nebulizers that have been administered prior to transfer to theatre should be noted on the pre-operative check list.
  
• Wounds/skin condition: Wounds and any breaks in the skin/rashes or bruising should be noted on the pre-operative check list.
  
• MRSA status: This should be noted in accordance with local policy.