TRAINEE OR TRUST GRADE ST3-7 OR EQUIVALENT TRAINEE OR TRUST GRADE ST3-7 OR EQUIVALENT TRAINEE OR TRUST GRADE CT1-2 OR EQUIVALENT TRAINEE OR TRUST GRADE CT1-2 OR EQUIVALENT FOUNDATION YEAR DOCTOR FOUNDATION YEAR DOCTOR PHYSICIAN’S ASSISTANT / ASSOCIATE PHYSICIAN’S ASSISTANT / ASSOCIATE NURSE SPECIALIST OTHER __________________________________ 3.3 INDUCTION 3.4 ANAESTHESIA / ANALGESIA 3.5 INTRA-OP MONITORING ANTIBIOTICS AWAKE LIGHT SEDATION CENTRAL VENOUS CATHETER YES NO DEEP SEDATION GENERAL ARTERIAL LINE URINARY CATHETER IV ANALGESIA CARDIAC OUTPUT / FLOW MONITOR 3.7 PROCEDURES IN LAST LA INFILTRATION ONLY DEPTH OF ANAESTHESIA MONTH REGIONAL BLOCK SPINAL TEMEPRATURE PROBE 1 2 >2 EPIDURAL CSE PERIPHERAL NERVE STIMULATOR 3.8-3.10 ACTUAL PROCEDURE IF DIFFERENT TO PLANNED (See 2.1-2.3) 3.8-3.10 MODE OF SURGERY OPEN ROBOT-ASSISTED LAPAROSCOPIC-ASSISTED 3.13 PERITONEAL SOILING 3.14 DURATION 3.15 ACTUAL POST-OP DESTINATION NOT APPLICABLE NONE <2 HOURS 2-3 HOURS WARD LEVEL 1 SEROUS FLUID LOCALISED PUS >3 HOURS LEVEL 2 LEVEL 3 FREE BOWEL CONTENT / PUS / BLOOD 3.6 WARMING DEVICES 3.11 SURGICAL INCISION 3.12 INTRA-OP BLOOD LOSS NONE INTRA-THORACIC <100ml IV FLUID WARMER UPPER ABDOMINAL (OPEN) 101-500ml FORCED AIR WARMING DEVICE LOWER ABDOMINAL (OPEN) 501-1000ml
TRAINEE OR TRUST GRADE ST3-7 OR EQUIVALENT TRAINEE OR TRUST GRADE CT1-2 OR EQUIVALENT FOUNDATION YEAR DOCTOR PHYSICIAN’S ASSISTANT / ASSOCIATE NURSE SPECIALIST OTHER __________________________________ TRAINEE OR TRUST GRADE ST3-7 OR EQUIVALENT TRAINEE OR TRUST GRADE CT1-2 OR EQUIVALENT FOUNDATION YEAR DOCTOR PHYSICIAN’S ASSISTANT / ASSOCIATE 3.3 INDUCTION ANTIBIOTICS YES NO 3.4 ANAESTHESIA / ANALGESIA AWAKE LIGHT SEDATION DEEP SEDATION GENERAL IV ANALGESIA LA INFILTRATION ONLY REGIONAL BLOCK SPINAL EPIDURAL CSE 3.5 INTRA-OP MONITORING CENTRAL VENOUS CATHETER ARTERIAL LINE URINARY CATHETER CARDIAC OUTPUT / FLOW MONITOR DEPTH OF ANAESTHESIA TEMEPRATURE PROBE PERIPHERAL NERVE STIMULATOR 3.7 PROCEDURES IN LAST MONTH 1 2 >2 3.8-3.10 ACTUAL PROCEDURE IF DIFFERENT TO PLANNED (See 2.1-2.3) 3.8-3.10 MODE OF SURGERY OPEN ROBOT-ASSISTED LAPAROSCOPIC-ASSISTED 3.13 PERITONEAL SOILING NOT APPLICABLE NONE SEROUS FLUID LOCALISED PUS FREE BOWEL CONTENT / PUS / BLOOD 3.14 DURATION <2 HOURS 2-3 HOURS >3 HOURS 3.15 ACTUAL POST-OP DESTINATION WARD LEVEL 1 LEVEL 2 LEVEL 3 3.6 WARMING DEVICES NONE IV FLUID WARMER FORCED AIR WARMING DEVICE 3.11 SURGICAL INCISION INTRA-THORACIC UPPER ABDOMINAL (OPEN) LOWER ABDOMINAL (OPEN) 3.12 INTRA-OP BLOOD LOSS <100ml 101-500ml 501-1000ml
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