1. Preparing for your Surgical Experience at Memorial Hospital West
Presented by:
Memorial Hospital West Surgical Services

2. The Memorial Experience
Patient First
Safety is our first priority
Quality of Care
Patient Family Centered Care
You and your family / loved ones are at the center of your care
We want you / them involved
Visitation – Whatever is right for the patient

3. Goals and Objectives
Our goal as a Healthcare System is to give you proper education and preparation before your surgery
Improve lines of communication
Reduce anxiety
Provide clear explanations
Decrease the potential for complications
At the end of this session, you should know the following:
What to expect at each step of your care
Things you will need to do

4. Patient Safety Initiatives
Crew Resource Management
HELP ALERT
Safety First
Introduction of the health care providers
Checking of your name band
Hand washing
Site marking

5. Crew Resource Management
Combination of
Teamwork
Communication Behaviors
Safety Tools
Procedures, protocols, checklists
Purpose:
Create culture of open communication among team members
Standardize processes
Promote an optimally safe environment for patient care

6. Crew Resource Management
Components
Pre Procedure Time Out or Pre-brief
Post Procedure Debrief
Assertive Communication to escalate concerns and time critical information
Guidelines to “See it, Say it, Fix it!”
Standardized “Hand off” tools for health care providers

7. HELP ALERT An Additional Safety Initiative
Memorial Healthcare System is partnering with patients and families for safe healthcare
HELP ALERT
Created to address needs of patient in case of an emergency or when the patient is unable to get the attention of the Health Care Provider
Calling a HELP ALERT provides our patients/families a resource for immediate help when they feel they are not receiving adequate medical attention

8. HELP ALERT DIAL 88 When to call 88
A noticeable medical change occurs and the healthcare team is not recognizing the concern
If there is a breakdown in how care is being given and/or confusion over what needs to be done

9. Preparing for your surgical procedure Lets Get Ready!
7-10 DAYS BEFORE SURGERY
Preoperative visit to the Medical doctor (This may not be requires for all patients)
It is important to be in your best physical condition
The hospital will need a history, physical, and clearance from your medical doctor / specialists and a copy of all of your most recent tests
Blood work
X-rays
CT results
Cardiac workup
Pulmonary work up

10. Preparing for your surgical procedure Lets Get Ready!
Avoid infections
Good hand washing practices! All the time!
Wash the area with antibacterial soap
Do not shave anywhere close to the operative site
Notify your surgeon if there are any breaks in the skin
Scratches, insect bites

11. Preparing for your surgical procedure Lets Get Ready!
Discuss with your surgeon/physician which medications can be taken the morning of surgery
Ask your physician and/or cardiologist about stopping medications that may cause bleeding
Some patients may need to continue those medications
Preoperative visit to the surgeon
Usually one week prior to surgery

12. Preparing for your surgical procedure Lets Get Ready!
Family members or friends need to be available to help you at home after your procedure
Make those arrangements now!
Help with laundry
Cleaning the house
Changing linens on the bed
Preparing your meals
Going to the drug store, grocery store
Getting to appointments
Going to the doctor
Care for your pets

13. Preparing for your surgical procedure Make your home safe
Keep items that you use frequently within easy reach
Keep floor free from small objects
Pets?
Remove throw rugs
Add a firm pillow to low chairs
Move electrical cords out of the way

14. Preparing for your surgical procedure Make your home safe
Install a hand held shower head for easier bathing
Be sure to have a rubber backed bath mat
Use a long handled sponge to wash hard to reach areas

15. Preparing for your surgical procedure Be prepared!
Check with your insurance company now
Is a deductible, co-payment and/or co-insurance amount required before or when you receive services?
Check your benefit booklet/certificate of coverage
Do you need pre-authorization or a referral for your tests or surgery
Coverage varies with each insurance company
Ask what services are covered
Equipment for your home
Home Health
Help at home
Questions?
Call Memorial Healthcare System Pre-Services/Advance Registration
, prompt #3

16. A day or two before surgery What to Expect
Confirmation of your arrival time at the hospital
You will receive two phone calls from the hospital
One from Pre-Services/Advance Registration
One from Pre Admission Testing Nurse
Please arrive on time to the hospital
Do not eat or drink anything after midnight

17. Special Instructions
The nurse from the Pre Admission Testing area and/or the Anesthesiologist will review with you any medications you should take on the morning of surgery
Remember!
Leave ALL VALUABLES at home
Do not wear any make-up
Remove artificial nails
Acrylics, wraps and tips

18. Day of Surgery What should I bring?
Personal hygiene items
Snug-fitted slippers and/or flat shoes or tennis shoes
Consider velcro straps
Do NOT bring valuables!
A copy of advance directives

19. Day of Surgery What should I bring?
Insurance card, driver’s license or photo ID
Any co-payment that is required
Printed list of all medications including dosages, names, frequency
Include ALL over-the-counter medications, herbal supplements and other health related medications you are taking

20. Day of Surgery What will happen?
Arrive to the Hospital 2 hours prior to scheduled start time
A complete nursing assessment will be done
Lab work will be repeated if necessary
An intravenous (IV) will be started
Visit with the Anesthesiologist and OR nurse

21. Day of Surgery What will happen?
Safety First – Prevention of Wrong Site surgery
Nurse will confirm site & type of surgery with you
If laterality is involved, the site will be marked with a “yes”
Surgeon will initial the site near the “yes”
Final “time out” or “prebrief” will be done in the OR

22. Safety First Safety is our highest priority
All Health Care providers should introduce themselves
Explain their role
Explain what they will be doing
Check your name band each and every time
Wash their hands!
Don’t be afraid to ask questions

23. Day of Surgery What will happen?
You will be in the PACU ( Post Anesthesia Care Unit or Recovery Room) for approximately 1 ½ hours following completion of the surgery
Begin your breathing exercises
Begin ankle pump exercises 10 times each hour
Pain medication as needed

24. Day of Surgery What will happen?
Outpatients – going home the same day
When you are awake and able, you will move to our Phase II Recovery area
Sit in a recliner chair
Be able to tolerate fluids and light food
Be able to urinate
Be able to ambulate
Receive verbal and written discharge instructions
You will receive a phone call the following day from our staff

25. Inpatient or staying overnight
When the room is available, you will be transported by 2 staff members
Safety First
Hourly Rounding
You can expect to see your nursing staff
every hour until 10 pm
every 2 hours during the night
They will check
to ensure your pain is adequately managed
if you need to use the bathroom/bedpan
If you need to be repositioned
Your call bell should always be within your reach and answered promptly
Expect to sit on the edge of the bed on the evening of surgery unless contraindicated by your physician

26. After surgery What next?
Blood work, if ordered, will be drawn early in the morning
Intravenous pain meds may be stopped and oral pain meds (pills/liquid) may be started
Expect to be out of bed into a chair for all meals
Case Manager will talk with you about your discharge plan

27. After surgery What next?
You may experience a decrease in appetite
It is important to try to eat as much of the meal as possible to assist with proper healing
A nutritional consult with a dietitian can be provided if necessary
A sample menu can be provided for you at discharge

28. Going Home - Discharge
Your length of stay is dependent on your progress
Going home:
Make arrangements for pick-up
Written discharge instructions for medications, activity level, diet, special precautions and exercises

29. When you go home Bodily changes may occur
Poor appetite
Difficulty sleeping
Decreased energy level
Constipation
Drowsiness
It is important to eat properly, to breathe deeply and to move!

30. When you go home
Blood Thinners may be ordered by your physician to avoid complications from blood clots
May be required to take them for three to six weeks
Blood tests 2 times a week

31. When you go home Compression stockings (support hose) may be ordered
Reduces the chance for blood clots
Keeps swelling down
If swelling persists, elevate the leg for short periods throughout the day
Wear stocking continuously, removing one to two hours 2x/day
Notify the doctor if increased swelling
Ask when you can discontinue wearing of the stockings

32. When you go home Incision care Keep incision dry
Cover with light dry dressing
Your physician will inform you when it is ok to shower
After showering, apply dry dressing

33. POSSIBLE COMPLICATIONS What should I watch for?
INFECTION- Call the doctor if any of the following occur
An increase in the amount of drainage, bleeding or change in color and/or odor of the drainage
A significant increase in the amount of swelling accompanied by redness at the incision site
Temperature of more than degrees
Significant increase in pain level

34. POSSIBLE COMPLICATIONS What should I watch for?
BLOOD CLOTS - Call the doctor if any of the following occur :
Pain, warmth and tenderness in the calf, behind the knee or the groin area
Localized swelling in the thigh, calf or ankle
PREVENTION OF BLOOD CLOTS
Exercise
Use of compression stockings (support hose)
Leg elevation

35. POSSIBLE COMPLICATIONS What should I watch for?
PULMONARY EMBOLUS
( Blood clot in your lung)
Requires immediate medical attention
Check for the following
Sudden chest pain/pressure
Difficulty breathing
Sudden shortness of breath
Sweating
Confusion

36. THANK YOU VERY MUCH!

37. ANY QUESTIONS