CPSO Peer Assessment Form History & Physical (Items 2 - 8) Covered by PAU visit and you need to indicate you reviewed OR – you need to complete in Preop Manager in OR corridor (#8 – VS done in SDCU)            Airway Exam & ASA (Items 9 - 11) Although covered by PAU visit, as attending Anesthetist you need to record your own A/W & ASA assessments.

Medications (Item 12) Covered by Medication Reconciliation List and you need to indicate you reviewed      Premedication (Item 13) Documented in SDCU notes      NPO Status (Item 14) Indicate that you confirmed this yourself      Investigations (Item 15) Review in Preop Manager or in vOacis – need to say you did it.

Anesthetic Plan (Item 16) You need to document what the Anesthetic Plan is that you have recommended      Anesthetic Problems (Item 17) List problems identified      Patient Discussion - Risks/Benefits & Options (Item 18) Indicate that you have discussed these issues with the patient        

Equipment Check (Item 2) Needs to be documented, including Gas Machine ID#      GA Induction (Item 3) Technique, drugs, etc  Airway Management (Items 4 & 5) Documenting routine and difficult airway management Mechanical Ventilation (Item 6) Ventilator Mode and physio- logic parameters associated

Invasive Monitoring (Item 7a) Needs to be documented: insertion, data      Capnography Inhalational Agents (Items 7b & 7d) Evidence of use     Temperature / Urine Output (Items 7c &7e) Needs to be documented    Depth of Anesthesia (Item 7f) Unclear how this is to be done

Patient Position (Item 8) Documented; possible injury risks addressed      Eye Care (Item 9) Documented    IV Lines: Sites & Sizes (Item 10) Documented     IV Fluids / Fluid Plan (Items 11 & 12) Documented       Blood Loss / Replacement (Item 13) Documented

Neuraxial & Peripheral Blocks (Items 15 & 16) Documented in detail – with technique, equipment and adequacy of block; Include complications, if present       Monitoring after Blocks (Item 17) Documented in PACU Drug Administration (including Narcotics) (Items 18 & 19) Fully documented Operative / Emergent Events (Item 20) Fully documented