Orientation Procedure Check List
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1 Orientation Check List Name: Preceptor(s): Place tally marks in proper boxes for each procedure. When orientee is competent in particular procedure then, date & initial next to procedure (both preceptor & orientee to initial). General Abscess I & D Amputation, Above Knee Amputation, Below Knee Amputation, Toe Amputation, Trans metatarsal Appendectomy, Laparoscopic Appendectomy, Open Axillary Dissection Axillary Node Biopsy Bariatric, Gastric Sleeve, Laparoscopic Bariatric, Gastric Sleeve, Robotic Bariatric, Lap Band Removal Bariatric, Roux-en-Y, Laparoscopic Bowel Resection, APR (Abdominal Perineal Resection) Bowel Resection, Colostomy / Ileostomy Creation Bowel Resection, Colostomy Closure Bowel Resection, Left Hemicolectomy, Lap Hand Assisted Bowel Resection, Left Hemicolectomy, Open Bowel Resection, Left Hemicolectomy, Robotic Bowel Resection, Low Anterior Resection Bowel Resection, Right Hemicolectomy, Lap Hand Assisted Bowel Resection, Right Hemicolectomy, Open Bowel Resection, Right Hemicolectomy, Robotic Bowel Resection, Small, Lap hand Assisted Bowel Resection, Small, Open Bowel Resection, Small, Robotic Bowel Resection, Transverse, Laparoscopic Bowel Resection, Transverse, Open Bowel Resection, Transverse, Robotic Breast, Biopsy Breast, Mastectomy Breast, Mastectomy, Expanders Breast, Mastectomy, Free Flap Breast, Mastectomy, Latissimus Dorsi Catheter Placement, IVC (Inferior Vena Cava) Filter, Femoral Catheter Placement, IVC (Inferior Vena Cava) Filter, Jugular
2 General (continued) Catheter Placement, Peritoneal Dialysis Catheter Placement, Port-a-Cath Cholecystectomy, Laparoscopic Cholecystectomy, Open Common Duct Exploration Excision of Mass (Anywhere) Exploratory Laparoscopy Exploratory Laparotomy Feeding Tube Placement, G or J Tube, Laparoscopic Feeding Tube Placement, G or J Tube, Open Feeding Tube Placement, G or J Tube, Percutaneous Hernia, Component Separation Hernia, Inguinal, Laparoscopic Hernia, Inguinal, Open Hernia, Inguinal, Robotic Hernia, Umbilical, Laparoscopic Hernia, Umbilical, Open Hernia, Umbilical, Robotic Hernia, Ventral / Incisional, Laparoscopic Hernia, Ventral / Incisional, Open Hernia, Ventral / Incisional, Robotic Lymph Node Dissection Lysis of Adhesions, Laparoscopic Lysis of Adhesions, Open Muscle Biopsy Nissen Fundoplication, Laparoscopic Pacemaker Insertion / Battery Pack Change Pilonidal Cyst Excision Rectal, Anal Fissure Rectal, Anal Fistula Rectal, Hemorrhoidectomy Rectal, Proctosigmoidoscopy, Flexible Rectal, Proctosigmoidoscopy, Rigid Skin Graft, Split Thickness Splenectomy Temporal Artery Biopsy Tracheostomy, Percutaneous Tracheostomy, Traditional Wound Vac Placement
3
4 Plastics Abdominoplasty Breast, Augmentation Breast, Implant Exchange Breast, Reduction Mammoplasty Breast, Removal of Expanders Excision of Lesion Face Lift Liposuction Scar Revision
5 Gynecology Anterior Repair (Cystocele) Bartholin Cyst Excision Cervical Cerclage, Cervical Cerclage, Shirodkar Cone Biopsy, Cold Knife Cone Biopsy, Leep D & C D & C, Hysteroscopy D & C, Suction Ectopic Pregnancy Excision Hysterectomy, Abdominal Hysterectomy, Lap Assisted Vaginal Hysterectomy, Robotic Hysterectomy, Vaginal Laparoscopy, Diagnostic Laparoscopy, Operative Myomectomy, Open Myomectomy, Robotic Posterior Repair (Rectocele) Salpingectomy / Oophorectomy, Laparoscopic Salpingectomy / Oophorectomy, Robotic Urinary Sling
6 Vascular AAA (Abdominal Aortic Aneurysm), Endoscopic AAA (Abdominal Aortic Aneurysm), Open A-V Fistula, Creation A-V Fistula, Embolectomy A-V Fistula, Ligation A-V Fistula, Revision Bypass, Aorta-Bi-Femoral Bypass, Femoral - Popliteal Bypass, Femoral -Femoral Bypass, Femoral -Tibial Carotid Endarectomy Lower Extremity, Angioplasty & Stenting Lower Extremity, Embolectomy Upper Extremity, Angioplasty & Stenting Upper Extremity, Embolectomy Vein Ligation / Stripping
7 GU (Genitourinary) Bladder Distension Bladder Suspension Circumcision Cystoscopy ESWL (Extracorporeal Shock Wave Lithotripsy) Hydrocelectomy Hypospadias Repair Ileoconduit / Cystectomy Nephrectomy, Lap Hand Assisted Nephrectomy, Open Nephrectomy, Robotic Nephrolithotripstsy Orchiectomy Orchiopexy Pelvic Lymph node Dissection Penile Prosthesis Prostatectomy, Lap Hand Assisted Prostatectomy, Open Prostatectomy, Robotic Reimplantation Ureter Testicular Torsion TURBT (Trans Urethral Resection Bladder Tumor) TURP (Trans Urethral Resection Prostate) Ureteroscopy
8 ENT (Ears, Nose, Throat) Adenoidectomy DCR (Dacryocystorhinostomy) FESS (Functional Endoscopic Sinus Surgery) Laryngoscopy Myringotomy Tubes Orbital Decompression Parathyroidectomy Parotidectomy Septoplasty Submandibular Gland Excision Thyroidectomy Tonsillectomy Tympanoplasty
9 Ophthalmology Blepharoplasty Cataract Extraction w/ IOL (Intra Ocular Lens) Corneal Transplant, (Descemets Stripping Endothelial Keratoplasty) Corneal Transplant, Full Thickness DCR (Dacryocystorhinostomy) Ectropion Repair Entropion Repair Enucleation Orbital Decompression Pterygium Excision Ruptured Globe Repair Temporal Artery Biopsy Vitrectomy, Anterior
10 Neuro Burr Holes Cervical Fusion, Anterior Cervical Fusion, Posterior Craniotomy Lumbar Fusion, ALIF (Anterior Lumbar Interbody Fusion) Lumbar Fusion, DLIF (Direct Lateral Interbody Fusion) Lumbar Fusion, PLIF (Posterior Lumbar Interbody Fusion) Lumbar Fusion, TLIF (Transforaminal Lumbar Interbody Fusion) Lumbar Laminectomy / Discectomy Thoracic Fusion Trans Sphenoidal Hypophysectomy V-P Shunt (Ventricular - Peritoneal)
11 Cardiac Aortic Arch Aneurysm CABG (Coronary Artery Bypass Graft) off Pump CABG (Coronary Artery Bypass Graft) on Pump MAZE Pericardial Window Valve, Aortic, Repair / Replacement Valve, Mitral, Repair / Replacement Valve, Tricuspid, Repair
12 Thoracic Empyema Mediastinoscopy Mediastinoscopy, Chamberlin Thoracoscopy, Wedge Resection / Lobectomy Thoracotomy, Wedge Resection / Lobectomy
13 Podiatry Bunionectomy Debridement of Wound Plantar Fasciotomy Hammer Toe Repair
14 Orthopedics Ankle, Arthroscopy Ankle, ORIF (Open Reduction Internal Fixation) Cerclage w/ Cables & Wires Clavicle, ORIF Closed Reduction w/ Cast Application Elbow, Olecranon ORIF Femur, IM Rodding, Antegrade Femur, IM Rodding, Retrograde Femur, ORIF Hand, Carpal Tunnel Hand, Ganglion Cyst Excision Hand, Metacarpal, ORIF Hand, Metacarpal, Percutaneous Pinning Hand, Tendon & Nerve Repair Hip, AMBI Hip, DHS Hip, Hemiarthroplasty, Bipolar Hip, Hemiarthroplasty, Unipolar Hip, IM Rodding, InterTAN Hip, Knowles Pins Hip, Percutaneous Pinning Hip, Total Arthroplasty Hip, Total Arthroplasty, Revision Humerus, IM Rodding Humerus, ORIF Knee, ACL Reconstruction Knee, ACL Repair Knee, Arthroscopy Knee, Patellar-Femoral Replacement Knee, Total Arthroplasty Knee, Total Arthroplasty, Revision Knee, Uni-Compartmental Replacement Radius, Distal ORIF (Wrist) Radius, Proximal ORIF (Elbow) Shoulder, Arthroscopy, Capsular Release Shoulder, Arthroscopy, Capsular Repair Shoulder, Arthroscopy, Labral Repair Shoulder, Arthroscopy, Rotator Cuff Repair Shoulder, Arthroscopy, Sub acromial Decompression Shoulder, Humeral Head ORID Shoulder, Total Arthroplasty Shoulder, Total Arthroplasty, Reverse Tendon Repair, Achilles Tendon Repair, Biceps, Distal Tendon Repair, Biceps, Proximal Tendon Repair, Hamstring Tendon Repair, Patella
15 Orthopedics (continued) Tendon Repair, Pectoral Tendon Repair, Quadricep Tibia, IM Rodding Tibia, ORIF Tibia, Plateau ORIF
Policy/ Purpose: Definitions: (Definitions of acronyms or specialized terminology) Instructions:
Title: Surgical Procedure Scheduling After 2200 Hours by Central Processing Document #: 5962 Version: 1 Facility: St. Charles Bend Page 1 of 5 Owner: Roberts, Andrew,Manager Central Processing Effective
Total NRS 0 NRS 1 NRS 2 NRS 3 NRS 4 NRS 5 NRS 6 NRS 7 NRS 8 NRS 9 NRS 10
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