Preoperative Patient Preparation

Kaleida Health Operating Room Nurses

Hand Off of CareHand Off of Care

Include the “TICKET TO RIDE” DTKH0952.Include the “TICKET TO RIDE” DTKH0952. The transporter must deliver the “TICKET TO RIDE” to The transporter must deliver the “TICKET TO RIDE” to

the Operating Room/Urology /Interventional Radiology/ the Operating Room/Urology /Interventional Radiology/ GI unit staff.GI unit staff.

Consent should be signed prior to sending patient to the Consent should be signed prior to sending patient to the OR/Procedure.OR/Procedure.

Latex AllergyLatex Allergy

It is preferred that latex sensitive/allergic patients be It is preferred that latex sensitive/allergic patients be scheduled as the first case of the day in the Operating scheduled as the first case of the day in the Operating Room.Room.

Refer to policy CL.45.Refer to policy CL.45. Call the OR as early as possible if you discover that your Call the OR as early as possible if you discover that your

patient has an allergy and is scheduled for surgery.patient has an allergy and is scheduled for surgery.

Informed Consent Policy LE.9Informed Consent Policy LE.9

It shall be the policy of KALEIDA HEALTH, in all non-It shall be the policy of KALEIDA HEALTH, in all non-emergent situations, to obtain express consent for all emergent situations, to obtain express consent for all operative procedures…consent should be recorded on the operative procedures…consent should be recorded on the written patient consent form(KH00049). This express written patient consent form(KH00049). This express consent must be informed consent…Obtaining the consent must be informed consent…Obtaining the informed consent is the responsibility of the physician.informed consent is the responsibility of the physician.

Once consent is obtained there needs to be a witness, the Once consent is obtained there needs to be a witness, the witness is ONLY verifying the patient’s signature. witness is ONLY verifying the patient’s signature.

Any hospital employee besides the MD/resident/patient Any hospital employee besides the MD/resident/patient involved in the case may serve as a witness to consent.involved in the case may serve as a witness to consent.

Informed Consent Policy LE.9Informed Consent Policy LE.9

Physician Partnership- Physician/Proceduralist who will Physician Partnership- Physician/Proceduralist who will perform the procedure/treatment should be the one perform the procedure/treatment should be the one designated on the consent form. If any partner may designated on the consent form. If any partner may actually perform the procedure, the consent should read, actually perform the procedure, the consent should read, “Dr. Henry Smith, OR Dr. John J. Doe”, corporate titles, “Dr. Henry Smith, OR Dr. John J. Doe”, corporate titles, (Example- Buffalo Niagara Western New York Surgical (Example- Buffalo Niagara Western New York Surgical Group)should NOT be used. The term “AND” should only Group)should NOT be used. The term “AND” should only be used if they will be operating together.be used if they will be operating together.

Informed Consent Policy LE9Informed Consent Policy LE9

Patients Who Lack Capacity:Patients Who Lack Capacity:– If it is determined that the patient lacks capacity to If it is determined that the patient lacks capacity to

make health care decisions, then a legally authorized make health care decisions, then a legally authorized individual ~ parent{minors}, health care agent{proxy}, individual ~ parent{minors}, health care agent{proxy}, legal guardian may consent on behalf of the patient.legal guardian may consent on behalf of the patient.

Informed Consent Policy LE.9Informed Consent Policy LE.9

However, if no such authorized person exists, or if such However, if no such authorized person exists, or if such person cannot be contacted despite reasonably diligent person cannot be contacted despite reasonably diligent efforts, then the consent may be obtained by a patient’s efforts, then the consent may be obtained by a patient’s representative. representative.

The following is a listing, in the order of preference, of The following is a listing, in the order of preference, of qualified patient’s representatives:qualified patient’s representatives:– spouse of patientspouse of patient– adult child of patientadult child of patient– parent of patientparent of patient– adult sibling of patientadult sibling of patient

Informed Consent in GeneralInformed Consent in General

Patients sign their own consent if they are able.Patients sign their own consent if they are able. If the patient is unable to sign, look for a Health Care If the patient is unable to sign, look for a Health Care

Proxy or designee.Proxy or designee. Call Risk Management for assistance on a case by case Call Risk Management for assistance on a case by case

basis at 859-8620 or call the operator for department basis at 859-8620 or call the operator for department personnel’s pagers.personnel’s pagers.

Informed Consent: DNR/Vendor PresenceInformed Consent: DNR/Vendor Presence

Please be aware patients may need to sign the Please be aware patients may need to sign the manufacturer’s rep area of the consent if they are having manufacturer’s rep area of the consent if they are having any devices implanted or if there is new equipment being any devices implanted or if there is new equipment being trialed in the OR. Check orders for manufacturer rep. trialed in the OR. Check orders for manufacturer rep. consent.consent.

Patients who have an existing DNR going to OR can have Patients who have an existing DNR going to OR can have the DNR continued through the surgical process and the DNR continued through the surgical process and should validate this by signing the DNR portion of the should validate this by signing the DNR portion of the consent. These are the only patients who should be consent. These are the only patients who should be signing the DNR area on consent.signing the DNR area on consent.

Please check N/A for any areas on the back of the consent Please check N/A for any areas on the back of the consent that do not apply.that do not apply.

Transfusion ConsentTransfusion Consent

Did you know Type and Screen along with cross matching Did you know Type and Screen along with cross matching must be done at the Kaleida site where the patient is to must be done at the Kaleida site where the patient is to have the surgery/procedure?have the surgery/procedure?

If a patient has been transfused within the last 72 hours If a patient has been transfused within the last 72 hours during hospitalization a new T&S must be ordered and during hospitalization a new T&S must be ordered and repeated.repeated.

Any question or concerns contact the Blood Bank.Any question or concerns contact the Blood Bank.

Lab WorkLab Work

Did you know that abnormal lab results require MD Did you know that abnormal lab results require MD notification and follow-up documentation in the chart?notification and follow-up documentation in the chart?

The most recent results must be in the chart. Check for the The most recent results must be in the chart. Check for the most recent orders and make sure recent results are most recent orders and make sure recent results are available online. Check that on the day of surgery, a finger available online. Check that on the day of surgery, a finger stick has been done and charted on insulin dependent stick has been done and charted on insulin dependent patients.patients.

Refer to grid of policy CL 46. Attached here.Refer to grid of policy CL 46. Attached here.

KALEIDA Health MINIMAL ANESTHESIA PRE-OPERATIVE TESTING REQUIREMENTS

CBC

ECG

HCG

(Unless postmenopausal, or Bilateral Oophorectomy, or

Hysterectomy) (See Pregnancy Test pg. 3)

PT/INR

APTT

BASIC METABOLIC

PROFILE (Na+, K+,CO2,

Cl, Creat, GLC, BUN))

HEPATIC PANEL (AST, ALT, ALP,

ALB, T.BILI, DBILI)

CXR

COMMENTS

Male Female Male Female Female

AGE

Neonates + +

6 mo. – 8 years

9 years-39 years + +

40 - 49 + + + +

50 - 64 + + + +

65 and above + + + +

DISEASE

Cardiovascular + + + + +

Pulmonary + + +

Malignancy + + + + +

Liver Disease + + + + +

Renal Disease + + +

Bleeding Disorder + + See Comments Coagulation studies should be ordered as indicated.

Diabetes + + + + +

CNS Disease + + + + +

MEDICATIONS

Synthroid TSH and/or Free T4 within 12 mo. or symptomatic

Coumadin +

Diuretics +

Digoxin + + + Digoxin level within 6 mo. or HR < 60

Heparin - IV +

Heparin - SQ Coagulation studies not indicated.

Nonsteroidal anti-inflammatories Coagulation studies not indicated.

Steroids +

Intravenous Drug Abuse + + +

These labs represent minimal requirements. It remains the surgeon’s responsibility to order additional studies, as indicated, based upon the patient’s H&P, as well as those studies unique to the planned procedure.

All blood tests are good for 1 month, except:

1. In patients with renal failure, potassium levels should be drawn within 24 hours of surgery. 2. In patients on insulin therapy, a finger stick glucose level should be drawn on the morning of

surgery. 3. The maximum number of days between collection and surgery for Blood Bank specimens to

be acceptable is currently site specific (see narrative) 4. HCG will be obtained within 7 days of procedure ( see page 3 of 5) All CXR’s and EKG’s are good for 3 months, provided the patient has had no apparent change in health.

Make sure labs are drawn in a timely manner and are Make sure labs are drawn in a timely manner and are posted before transferring the patient to the OR.posted before transferring the patient to the OR.

Check that a K+ has been drawn and results are charted for Check that a K+ has been drawn and results are charted for renal/post dialysis patients.renal/post dialysis patients.

Pending should only be used after checking for lab Pending should only be used after checking for lab results immediately prior to patient going to OR and they results immediately prior to patient going to OR and they are not yet available.  It is best for lab results be in the are not yet available.  It is best for lab results be in the chart prior to patient going to OR holding area.  A true chart prior to patient going to OR holding area.  A true emergency would be the exception. “Pending” should be emergency would be the exception. “Pending” should be dated and timed.dated and timed.

All female patients 9 years and older require an HCG. See All female patients 9 years and older require an HCG. See policy for exceptions.policy for exceptions.

Lab WorkLab Work

Removal of Personal ItemsRemoval of Personal Items

Remember that the patient will be sedated/anesthetized Remember that the patient will be sedated/anesthetized and that removal of items is essential for safety and and that removal of items is essential for safety and positioning.positioning.

All patients should be encouraged to safeguard all personal All patients should be encouraged to safeguard all personal belongings with a designee.belongings with a designee.

Dentures/partials can compromise the patients airway Dentures/partials can compromise the patients airway when sedated/anesthetized, they must be removed prior to when sedated/anesthetized, they must be removed prior to OR arrival.OR arrival.

Wigs, barrettes, elastic bands and other hair ornaments can Wigs, barrettes, elastic bands and other hair ornaments can be a source of pressure points and may interfere with be a source of pressure points and may interfere with intubation.intubation.

Jewelry can also be a pressure point, as well as, a burn Jewelry can also be a pressure point, as well as, a burn hazard due to electrocautery use. Body piercing included. hazard due to electrocautery use. Body piercing included. Policy SS_37.Policy SS_37.

Rings can cause ischemia.Rings can cause ischemia. Hearing aide may be left in, document the disposition. See Hearing aide may be left in, document the disposition. See

preop checklist.preop checklist.

Removal of Personal ItemsRemoval of Personal Items

Universal Protocol: Verification CL.54Universal Protocol: Verification CL.54

Prior to the start of ANY surgical/invasive procedure a Prior to the start of ANY surgical/invasive procedure a verification process is to be completed.verification process is to be completed.

Accurately identify patient.Accurately identify patient. Confirm the procedure, surgical site(s), and side.Confirm the procedure, surgical site(s), and side. Documentation in patient medical record.Documentation in patient medical record. Form #KH01084 Rev.01/06/2011.Form #KH01084 Rev.01/06/2011.

Universal Protocol RecordUniversal Protocol Record

Completing this recordCompleting this record Level 1: Must be completed prior to transfer and if incomplete Level 1: Must be completed prior to transfer and if incomplete

the transferring nurse will be expected to complete in OR the transferring nurse will be expected to complete in OR holding.holding.

The unit/floor staff will verify the patient’s identity with the The unit/floor staff will verify the patient’s identity with the patient, and or, the patient’s family/guardian and the patient, and or, the patient’s family/guardian and the identification band.identification band.

The unit staff will verify, as appropriate, the side, right or left The unit staff will verify, as appropriate, the side, right or left designation for the procedure.designation for the procedure.

The nurse verifies the surgical site with the OR schedule and/or The nurse verifies the surgical site with the OR schedule and/or consent form.consent form.

Pre-operative checklist is complete prior to patient coming to Pre-operative checklist is complete prior to patient coming to surgery.surgery.

Call OR if there is a discrepancy.Call OR if there is a discrepancy.

Please RememberPlease Remember

Please make sure the verification form is completed with Please make sure the verification form is completed with the appropriate INITIALS and signatures.the appropriate INITIALS and signatures.

NO checkmarks…initials only.NO checkmarks…initials only. Level 1 must be completed BEFORE patient can be sent to Level 1 must be completed BEFORE patient can be sent to

the OR.the OR. Attestation on consent to be completed in level 2 of Attestation on consent to be completed in level 2 of

Universal Protocol.Universal Protocol.

Interpreter/Translator Services PT.9Interpreter/Translator Services PT.9

The department where the patient presents is responsible to The department where the patient presents is responsible to obtain interpreter services as outlined in Policy PT.9.obtain interpreter services as outlined in Policy PT.9.

Any department sending an LEP/hearing impaired patient Any department sending an LEP/hearing impaired patient to another department will notify the receiving department to another department will notify the receiving department of the patient’s identity and the language the patient of the patient’s identity and the language the patient speaks.speaks.

Please send Language Line phone (obtained through the Please send Language Line phone (obtained through the hospital operator) with the patient.hospital operator) with the patient.

Please make sure interpreter comes with patient and Please make sure interpreter comes with patient and document log in chart of each interpreter used.document log in chart of each interpreter used.

Please RememberPlease Remember

Hospital staff CAN NOT act as interpreters, unless they Hospital staff CAN NOT act as interpreters, unless they have been approved.have been approved.

Patient(s) must sign a waiver if a family member is going Patient(s) must sign a waiver if a family member is going to interpret for the patient. The waiver can be obtained to interpret for the patient. The waiver can be obtained through KaleidaScope, Policy PT.9.through KaleidaScope, Policy PT.9.

The use of minors(under age 16) as an interpreter should The use of minors(under age 16) as an interpreter should be avoided unless in urgent/emergent situations, or if be avoided unless in urgent/emergent situations, or if communication is limited to simple, non-clinical matters.communication is limited to simple, non-clinical matters.

Chart Assembly/ Form IndexChart Assembly/ Form Index

Please refer to the SURGERY/PROCEDURAL CHART Please refer to the SURGERY/PROCEDURAL CHART INDEX or the INDEX FOR INPATIENT GOING TO INDEX or the INDEX FOR INPATIENT GOING TO OPERATING ROOM for the format for chart assembly.OPERATING ROOM for the format for chart assembly.

Assembly of the chart/forms will facilitate documentation Assembly of the chart/forms will facilitate documentation and patient safety.and patient safety.

Thanks For Your HelpThanks For Your Help

Thanks for your help in making sure the proper procedures Thanks for your help in making sure the proper procedures and forms are completed prior to the patient coming to and forms are completed prior to the patient coming to surgery.surgery.

Please know that if you should need any help in preparing Please know that if you should need any help in preparing your patient for surgery the OR staff is ready to help.your patient for surgery the OR staff is ready to help.