Surgical Patient Preparation and Process

Preadmit > Preop > Postop/Discharge

Purpose of the presentation

To provide a framework for the facilitation of: Comprehensive preoperative workup

and postoperative connection/continuity

Closed-loop communication between provider facilities

Continued dialogue on process improvement

Helpful terminology

Transitional care refers to the critical actions of healthcare professionals designed to ensure the coordination and continuity of health care during the movement of patients,

Helpful terminology

called care transition, to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location.

Where do we start?

It starts with your… facility & surgeon

Scheduling

Scheduling process:• The surgeons office faxes a surgery

reservation to scheduling• An account is made in SCM• The patient is placed on the schedule• Scheduling notifies preadmit concerning

surgery, time, date, and location of patient

Preadmit

Preadmit calls facility to:• Gather patient medical/surgical history and

current medication list• Give preop instructions including preop

labs, NPO status, preop medications

Preadmit

Preadmit will begin to fax• Consents to be signed• Lab orders• Preop instructions

Draw a line &

have the patient or designee

initial here and circle “I” or “we” “do” or “do not”

Consent

The patient or signatory

signs here

Enter date & time here. Circle A.M. or P.M.

The nurse who witnesses the signing of the consent places their signature here

The nurse who witnesses the signing of the consent prints

their name here

Consent

Preop instructions                   

    DO'S         DO NOT'S         DO arrive at the time designated by DO NOT eat or drink after midnight  your surgeon   (this decreases the risk for   DO shower morning of procedure problems such as vomiting during  DO brush your teeth morning of surgery)  

  surgery and rinse with a   DO NOT chew gum the morning  small amount of water (do not of surgery  

  swallow)   DO NOT wear make-up, lotion,  DO wear comfortable clothing powder, deodorant, or nail  that is easy to put on and take off polish  

  DO wear glasses    

  DO bring your medications (in their DO NOT bring jewelry or valuables  appropriate containers), inhalers DO NOT drink alcohol 48 hours  and CPAP machines, if applicable prior to your procedure  

  DO take the following medications DO NOT take your daily medications  with a small sip of water as soon except those specified   as you wake up    

    DO NOT shave  

  Any medicine that you take for DO NOT wear contact leanses  your heart or blood pressure,  

  except for blood thinners                            

Preop instructions

Preop instructions

Preop

Preop is the patient intake for the day of surgery. To ensure a successful transition of care please call report to our charge nurse at: 764-6340

Preop report

• LOC• Admit dx• Allergies• O2: Flow rate ______ via ______• IV site/fluids• DM: Last BBG ______• Isolation precautions

Preop report

• Level of ambulation• Last time each med was taken• Last set of VS:

Temp, HR, BP, Resp, 02 Sat

Surgery

The easiest part!

Recovery

Patients will stay a minimum of 1 hour in the PACU where we will ensure: • Adequate breathing• VS remain stable and/or at baseline• Achieve baseline LOC• Pain is under control• Gag reflex has returned

Dishcarge

Patients will stay a minimum of 30 minutes in discharge and until discharge criteria is met:• VS at baseline• Gag reflex• Ambulation• PONV• Fluid I/O

Discharge

• Adequate airway• LOC at baseline• Pain controlled• Minimal surgical bleeding• Sensation and movement• Discharge order

Nurse-to-Nurse Report

A discharge nurse will call your facility and ask for the nurse caring for surgery patient in our care.

Nurse-to-Nurse Report

1. Access United Regional portal

2. Click on “Clinical” Summary” tab

3. Click on drop down to “Transfer to Outside Facility”

4. Receive report

Patient Transfer Summary

Transport Form

TransportThe patient is transported back to your facility.

When you receive the patient please call with any questions. 764-6340

If you don’t remember the name of the nurse you spoke to the charge nurse will help.

Have we closed the loop?

One more question…

What is continuity of care?

Continuity of care

Continuity of care is concerned with the quality of care over time. There are two important perspectives on this. Traditionally, continuity of care is idealized in the patient's experience of a 'continuous caring relationship' with an identified health care professional. For providers in vertically integrated systems of care, the contrasting ideal is the delivery of a 'seamless service' through integration, coordination and the

Continuity of care cont’d…

sharing of information between different providers. As patients' health care needs can now only rarely be met by a single professional, multidimensional models of continuity have had to be developed to accommodate the possibility of achieving both ideals simultaneously. Continuity of care may, therefore, be viewed from the perspective of either patient or provider. Continuity in the experience of care relates

Continuity of care cont’d…

conceptually to patients' satisfaction with both the interpersonal aspects of care and the coordination of that care. Experienced continuity may be valued in its own right. In contrast, continuity in the delivery of care cannot be evaluated solely through patients' experiences, and is related to important aspects of services such as 'case-management' and 'multidisciplinary team working'. From a provider perspective, the

Continuity of care cont’d…

focus is on new models of service delivery and improved patient outcomes. A full consideration of continuity of care should therefore cover both of these distinct perspectives, exploring how these come together to enhance the patient-centredness of care.Gulliford M1, Naithani S, Morgan M.Division of Health and Social Care Research, King's College London, London, UK. martin.gulliford@kcl.ac.ukJ Health Serv Res Policy. 2006 Oct;11(4):248-50.

Thank you!

We want to help you:

Jeremy Watkins – 764-6736Manager of Preadmit & Outpatient Day Surgery

Preadmit – 764-6148Preop – 764-6340