This customizable document, Intraoperative Nursing Record Form, is taken from MCN Healthcare’s Outpatient Surgery and Ambulatory Services Policy and Procedure Manual. For more than 20 years, MCN has been the health care industry’s leading provider of policy and procedure templates, forms, competencies and other compliance tools.

MCN’s templates save you time, money and resources, rather than developing healthcare policy and procedure manuals from scratch.

Here is some sample content from Intraoperative Nursing Record Form:

	INTRAOPERATIVE NURSING RECORD Patient Name: Pre-op Assessment Check all applicable boxesDate: ? Verbal ? Add-On ? Verbal ? Blood Transfusion Consent Form Signed NPO After Midnight ? Major ? Inpatient ? Alert ? Agitated In Room Out of RoomAnesthesia Start StopSurgery Start StopLimitations ? None ? Other: Prep allowed to dry before draping/incision; no pooling of solution; solution-soaked materials removed from OR before incision? Time-Out Items: Dispositions: Comfort Measures Implemented ? Adequate Transfer to OR Bed ? General ? Epidural ? Blocks Anesthesia Agents...
Second excerpt:
	...Halothane ? Ethane ? Refer to Anesthesia Record Patient Monitoring: Local Cases Comments: Operation: Post-op Diagnosis: 1. 2. 3. 4. 5. 6. ? Clean ? Culture OR Medications Other than Anesthesia Irrigation/Medication/DoseSignature: Action Plan: Evaluation: Demonstrates increased anxiety Action Plan: Time Out Confirmation of Surgical Procedure, Site/Side by Surgeon, Anesthetist, Circulating RN at: RN: Condition of Skin: Prep Solution: ? Supine ? Jackknife ? Pad bony...