1. Coloff, Kelly RN, BSN
  2. Mayer, Dale RN, MS, CS


Review how one facility updated its pre-procedure checklist for transferring patients from the telemetry unit to the cardiovascular laboratory.


Article Content


Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

When used appropriately and consistently, pre-procedure checklists enhance patient safety and care efficiency.


Although it may seem daunting, keeping pre-procedure checklists current is a realistic change process-and one that your staff members can customize from department to department to optimize patient care. For example, in the hospital setting, clinicians initially prepare patients who are scheduled for cardiovascular procedures on the telemetry unit; the patients are then transported to the cardiovascular laboratory (CVL) for cardiac catheterization/percutaneous coronary intervention (PCI). Clinicians use the pre-procedure checklists to document nursing activities in the telemetry unit, thus ensuring care continuity. The checklists assist the telemetry nurses to prepare patients for transfer to the CVL. Once patients are transferred, the checklists include a section for CVL nurses to document pre- and post-procedure assessments.


Setting standards

All in-patient procedures that necessitate patient transfers between units call for the use of checklists. To ensure a smooth transfer from one hospital unit to another, it's essential that the pre-procedure checklist contains pertinent nursing activities in a logical sequence.


The lack of comprehensive published literature related to the use of pre-procedure checklists emphasizes the need for change and improvement in the hospital setting. Implementing change in nursing units with little supporting data is difficult, but offers numerous opportunities for innovation and creativity. The most compelling motivation for improving pre-procedure checklists is to increase nurses' use, thus fostering smoother patient transitions throughout your facility.


Nurses at our facility cited the following obstacles to proper use of pre-procedure checklists:


[white diamond suit] out-of-date checklists that fail to reflect current nursing policy and/or procedures


[white diamond suit] too many small tasks enumerated on the checklists


[white diamond suit] lack of logical nursing-task arrangement on the checklists.



These specific objections to preprocedure checklists point to the larger issue of patient safety and nursing efficiency. Checklists must be kept up-to-date to accurately reflect the unit's policies and procedures.


Ideally, pre-procedure checklists should be short and concise, with each item on the checklist serving a distinct purpose. Although the numerous tasks associated with patient transfer make it difficult to eliminate items from the list, doing so helps to avoid duplicate charting and minimize confusion.


Using a well-designed checklist that follows the patient through the entire procedure enhances patient safety by allowing a coordinated check and recheck system between different hospital units. For example, if a patient on the telemetry unit is scheduled for PCI, the pre-procedure checklist is initiated on the telemetry unit and completed in the CVL.


Tailor checklists to provide accurate information for the specific procedure being performed. The care record should offer areas in which to document chart review and preoperative assessment, including record information, laboratory work, time of last oral intake, time of last voiding, presence of intravenous access, a list of current medications, and alerts to allergies. 2


Recommendations for immediate pre-procedure preparations that are especially important for patients undergoing procedures in the CVL include accurate height and weight, marking of distal pulses, electrocardiogram with rhythm strip, removal of telemetry monitors, and groin preparation. Pre-procedure documentation should use a streamlined charting system, such as a simple checklist with space for narrative documentation.


By simply rearranging the current checklist items, you can make these forms user-friendly. Consider grouping tasks by paperwork, lab reports, and hands-on patient care to improve the checklist's organization.


Advancing practice

Improving pre-procedure checklists helps nurses improve patient care before, during, and after procedures. Directly involve nurses and other caregivers from relevant departments with the form's redesign. In this specific change project, nurses from both the telemetry unit and the CVL made suggestions for the revised form.


Build a basis of good communication during the change process to facilitate better communication between units after implementing the change. As the nurse manager, promote this process by encouraging staff to participate in updating the forms. Also, don't overlook the importance of educating staff regarding the form's usage. Anticipate possible staff resistance to the checklists, as well as the need for interventions to bring about the change.


Be aware of checklists' impact on nursing practice; this may be more apparent on the transferring units, where the changes may add to nursing responsibilities. Obviously, the pros of improving pre-procedure checklists outweigh the cons. As a nurse manager, it's important for you to stay a step ahead in identifying the barriers to effectively implemented changes.




Mishler, M.: "Interventions for Preoperative Clients,"Medical-surgical Nursing across the Health Care Continuum, 3rd ed. Philadelphia: W.B. Saunders Company, 1999.


2. Ferrara-Love, R.: "Preoperative Patient Assessment and Preparation,"Ambulatory Surgical Nursing Care Curriculum. Philadelphia: W.B. Saunders Company, 1999. [Context Link]