Preoperative care: assessment, teaching, fasting, skin preparation and the checklist
- Safe practice
Before surgery the nurse assesses the patient, teaches them what to expect, and prepares their body and records so the operation starts safely.
What it is
The preoperative period runs from the decision to operate until the patient enters the operating room. Nursing care in this phase has three aims: to find risks that can be corrected (infection, uncontrolled blood glucose, anaemia, smoking, allergies, a difficult airway), to prepare the patient with teaching that reduces anxiety and complications, and to make sure that identity, site, consent, fasting and skin preparation are correct before transfer. The WHO surgical safety checklist then takes over in the operating room; this page covers what happens before it.
What it requires
- The aim is a patient who arrives in the operating room informed, prepared, correctly identified and with risks known to the team.
- Fasting instructions are individual: they depend on the time of surgery and on the anaesthesia team's orders; prolonged fasting is avoided.
- Shaving with a razor causes small skin cuts that raise the risk of surgical site infection.
- Teaching works best when given before surgery, when the patient is alert and not in pain.
- The preoperative checklist of the ward or unit is filled in before transfer; it does not replace the WHO checklist in the operating room.
Components
- Assessment: health history, allergies, medicines (including anticoagulants and supplements), previous anaesthetic problems, airway, loose teeth or dentures, nutrition, skin, cognition, support at home.
- Teaching: what will happen, deep breathing and coughing with the incision supported, incentive spirometry if ordered, leg exercises, getting out of bed early, pain reporting.
- Physical preparation: fasting per protocol, bath or shower, hair left in place or clipped, voiding before transfer, removal of jewellery, make-up, nail varnish and removable prostheses per protocol.
- Safety and records: identification band, consent, site marking, allergies recorded, results and images available, preoperative checklist complete.
How it is applied (and why)
- Confirm identity with two identifiers and the wristband: every later check depends on the right patient.
- Take a history and baseline vital signs, and note allergies: the team needs a baseline to compare after surgery.
- Ask about medicines, anticoagulants and previous anaesthesia and report them: some must be adjusted by the medical team before surgery.
- Check the airway notes, loose teeth and dentures: they matter for intubation and must be known to anaesthesia.
- Teach deep breathing, coughing with the wound supported and early walking: these help prevent atelectasis, pneumonia and clots.
- Explain the fasting instructions of the anaesthesia team and check they were followed: fasting reduces the risk of aspiration.
- Check the bath or shower with soap; leave hair in place or clip it, never shave: this lowers surgical site infection.
- Verify signed consent and the site mark made by the surgeon: this prevents wrong-site or wrong-procedure surgery.
- Remove and record jewellery, piercings, dentures and other prostheses per protocol: this prevents loss, injury and airway problems.
- Complete the preoperative checklist and hand over with SBAR: the operating room team receives a complete, checked picture.
In nursing practice
- Report at once: a fever, a new infection, very high blood glucose, a patient who ate against instructions, or a missing or unclear consent.
- Anxiety is common; clear explanations and time for questions reduce it.
- Older adults and people with cognitive impairment need simple, repeated teaching and a family member involved when possible.
- Continue in the operating room with the WHO surgical safety checklist (sign in, time out, sign out).
Common mistakes
- Shaving the surgical site «to make it clean».
- Giving the same fasting instruction to every patient instead of checking the anaesthesia team's orders.
- Teaching breathing exercises only after surgery, when the patient is drowsy and in pain.
- Sending the patient without the site marked or without checking the consent.
- Not recording which prostheses or valuables were removed and where they were stored.
Test yourself
Think of the answer, then tap the question to see it.
How should hair at the surgical site be managed?
Ideally it is not removed. If removal is necessary, a clipper is used, never a razor, because shaving causes small cuts that raise the risk of surgical site infection.
What do enhanced recovery guidelines say about fasting in general terms?
Clear fluids are usually allowed until about 2 hours and solids until about 6 hours before anaesthesia, following the anaesthesia team's instructions and the institutional protocol.
Why is breathing and mobility teaching given before surgery?
Because the patient learns better while alert and pain-free, and the exercises help prevent atelectasis, pneumonia and venous thromboembolism after surgery.
Why are removable dentures and loose teeth recorded before surgery?
Because they matter for airway management during anaesthesia and must be known to the anaesthesia team; dentures are removed per protocol.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Global guidelines for the prevention of surgical site infection, second edition (World Health Organization (WHO), 2018); WHO guidelines for safe surgery 2009: safe surgery saves lives (World Health Organization (WHO), 2009); Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations (Acta Orthopaedica, open access (Europe PMC), 2020); Mejorar la seguridad en los procedimientos quirúrgicos. Paquetes instruccionales, versión 2.0 (Ministerio de Salud y Protección Social (MinSalud), Colombia, 2015).
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Representative model, for educational purposes only.