Preoperative Preparation: Verification, Readiness, and the Time-Out
Confirming the right patient and the right plan
Identify the patient with two independent identifiers (name plus date of birth or medical record number); never use the room number. Cross-check the armband against the chart, the consent form, and the OR schedule. Confirm allergies (explicitly ask about latex), NPO status, dentures, contacts, hearing aids, jewelry, nail polish, and valuables, and document removal or securing of items. Verify that labs, history and physical, and imaging are on the chart and that blood products are available if anticipated.
Informed consent
The surgeon obtains consent and explains risks, benefits, alternatives, and the possibility of unforeseen findings. The CST's job is verification: the form is present, the procedure and site match the schedule, the signature belongs to the patient or a legal guardian, and the witness signature is appropriate. Minors and incapacitated adults require a guardian. Use an interpreter for patients with limited English; the patient must sign in a language they understand. The CST never counsels the patient about risks.
NPO and prophylaxis
Clear liquids: 2 hours. Breast milk: 4 hours. Infant formula, nonhuman milk, or a light meal: 6 hours. Fatty, fried, or meat-containing meal: 8 hours. Give prophylactic antibiotics within 60 minutes before incision (vancomycin and fluoroquinolones within 120 minutes) and redose for prolonged cases or large blood loss.
Room, prep, and time-out
Set up the room, case cart, instruments, suction, electrosurgery unit, and positioning devices before the patient enters. Remove hair with clippers, not razors. Prep from clean to dirty and let the agent dry completely, especially alcohol-based chlorhexidine. The operating surgeon marks the site, involving the patient when possible. Pause for a formal time-out before incision.
Traps: confusing the witness with the person who obtained consent; accepting a verbal "NPO since midnight" without verifying; prepping or draping before the time-out.
Rule of thumb: NPO is 2-4-6-8.