Post on 09-Feb-2016
description
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