Standards › Standard 31 › Forms
Form · DEN-FRM-004 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 31.14
Purpose
Records the local anaesthetic agent, the calculated dose and the total given, to keep each dose within the maximum.
How to complete
- Calculate the dose against the patient’s weight and the maximum for the agent.
- Record the agent, dose and volume given.
- For a repeat dose, check it against the total already given.
Checks
| Check | Entry |
|---|---|
| Patient, weight and date | Yes |
| Agent, concentration and maximum dose | Yes |
| Calculated dose and volume given | Yes |
| Total given and repeat dose check | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | |
| E-006 | ASF Policy Framework v1.2. Adapted. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | set Expert Committee approval |
E-learning for this document
References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)