J O U R N A L O F WO U N D C A R E Vo l 2 2 . N o 1 . E W M A D o c u M E N t 2 0 1 3
Appendix3. Safety checklist for clinician before commencing
debridement procedure
Patientaddresslabel
Hospitalno.:
DOB:
Dateofprocedure:
Timeofprocedure:
Typeofprocedure:
Debridement checklist
Completeeachbox:Yes=YNo=NNotapplicable=N/A
Verificationofpatient
Holisticpatientassessment
Woundassessmentcomplete
Methodofdebridement:Informationprovidedanddiscussed
Writteninformedconsentsigned
Equipmentsetup
Relevantlabreportsavailable(Hb,Coagetc)
Vascularassessment(ABPI,toepressuresetc)
Analgesiadocumented
Anyknownallergiesnoted
Proceduretobeperformeddocumented
Sitemarking,notingpatientposition
Proceduredocumented
Signature:_____________________________________________________________________________________________
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