Every surgical journey depends on careful preparation. Missing steps can lead to cancelled operations, wrong-site surgery, aspiration, infections and medication errors. Nurses on wards, day surgery units and pre-assessment clinics are responsible for much of this preparation. Here’s a practical checklist (always follow your local pre-operative policy).
1. Fasting: not too long
Common guidance for healthy adults having elective surgery (based on anaesthesia society guidelines):
- Food (including milk): stop about 6 hours before anaesthesia.
- Clear fluids (water, clear juice without pulp, black tea or coffee): allowed until about 2 hours before. Some newer guidance allows clear fluids closer to surgery.
- Breast milk for infants: about 4 hours; formula about 6 hours.
The old practice of “nil by mouth from midnight” often leaves patients fasting 12–18 hours, causing dehydration, hypoglycaemia, headache, discomfort and delirium in older adults. If theatre is delayed, ask whether the patient can drink clear fluids. Check special instructions for diabetes and for specific procedures.
2. Identity, consent and site marking
- Correct identification band(s) and allergy band if applicable.
- Signed consent form, checked against the planned procedure; patient understands what’s happening. See informed consent.
- Surgical site marked by the surgical team where required (especially left/right procedures).
3. Medicines
- Anticoagulants and antiplatelets: check instructions on when they were stopped or bridged.
- Diabetes medicines and insulin: follow the peri-operative plan; monitor glucose. See insulin safety.
- Medicines that should usually continue (with a sip of water) as advised, such as many heart medicines and Parkinson’s medicines.
- Medicines that may need holding (e.g. some ACE inhibitors, SGLT2 inhibitors) per anaesthetic instructions.
- Pre-medications as prescribed.
4. Investigations and observations
- Baseline vital signs, weight and height.
- Bloods, group and save or crossmatch, ECG, pregnancy test (for women of childbearing age, per policy), as required.
- Report abnormal results.
5. Physical preparation
- Shower or wash; theatre gown.
- Hair removal only if necessary, with clippers, not razors. See surgical site infection.
- Remove jewellery (tape wedding rings if policy allows), make-up, nail varnish or gel nails (they interfere with oxygen saturation monitoring), hair accessories with metal.
- Dentures, hearing aids, glasses and prostheses: document and follow policy (some go to theatre with the patient).
- Empty bladder.
- VTE prophylaxis: anti-embolism stockings and prescribed medicines. See VTE prevention.
6. Psychological preparation
Explain what will happen, answer questions and acknowledge anxiety. Anxious patients often have more pain afterwards. Respect religious practices, such as wishing to pray before surgery.
7. Handover to theatre
Complete the pre-operative checklist and hand over clearly to theatre staff: identity, procedure, consent, allergies, fasting times, last medicines, observations, any concerns. This feeds into the WHO Surgical Safety Checklist.
After surgery: see our post-operative nursing care checklist.
Based on ASA and European Society of Anaesthesiology fasting guidelines, NICE NG45 (Routine preoperative tests) and NICE NG125. Educational content: follow local pre-operative policy and anaesthetic instructions.