Revised: 10/81; 9/85; 1/87; 10/89; 7/96; 11/97; 6/99 Revised: 6/00 ; 9/00; 11/02; 4/05; 2/07; 5/09;

11/10 Reviewed: 11/88; 11/90; 10/91; 12/92; 5/03; 2/08

Nursing Policy: P-64 LSUHSC-Shreveport, LA

PRE-OPERATIVE PATIENT PREPARATION PURPOSE: To provide guidelines for patient preparation and education prior to surgery, including completion of the Pre-op Checklist. POLICY: 1. Pre-Operative Preparation Patients scheduled for surgery, cardiac cath, or special procedures shall receive a preoperative preparation for surgery prior to the scheduled surgery time. Exception: Emergency "rush rollers." 2. Pre-Operative Checklist (SN 1185) A. The Pre-op Checklist shall be initiated by the nurse transcribing the pre-operative orders or orders for cardiac cath /special procedures (see attached). B. The nurse shall check the operative permit for completion, to include documentation of the operative site location and appropriate signatures. 1. The nurse shall check the patient for a mark on the operative site to designate the appropriate surgical site. 2. The nurse shall check the anesthesia consent form (SN 6893) for completion. 3. If the surgical site is not noted or the anesthesia consent form is not completed, the nurse shall write INCOMPLETE in the column under initials next to the item that is not complete and place initials; then notify the Operating Room. C. The nurse shall complete appropriate sections applicable on the Pre-Op Checklist for patients going to surgery, cardiac cath, or special procedures. Each item on the Pre-op Checklist shall be verified by a check mark ( ) under the "Yes" column and initialed by the verifying nurse. The Pre-op Checklist shall be dated and signed with the transferring nurse's legible full legal signature prior to sending the patient to surgery and placed in the front of the chart so that it is readily available. The patients MAK generated medication administration record or the computer generated Transfer Medication Reconciliation Report and current lab shall be placed in the front of the chart. This form is a permanent part of the medical record and shall be placed with the 24 Hour Nurses Note upon return to the unit.

D.

E.

F.

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3. Operative Consent If the operative consent has not been signed and/or otherwise completed, the nurse shall notify the physician and the O.R., and the patient shall be kept on the unit until the problem is resolved. 4. Potential Problems Prior to Surgery Nursing personnel shall be responsible for notifying the physician and or appropriate department of any potential problems prior to sending the patient to surgery. 5. Pre-Operative Teaching Pre-operative teaching shall be documented on the Knowledge Problem/Priority section of the 24 Hour Nurses Note, Interdisciplinary Patient Education Form (IPEF SN 1102), or Pre-operative Teaching Form (SN 1086) along with evidence of the patient's understanding and/or return demonstration of instruction. The Surgical Site Infection Prevention Education FAQs should be reviewed with all patients who will have a surgical incision (Available from the Print shop or printed from the CDC website: http://www.shea-online.org/Assets/files/patient%20guides/SSI.pdf). 6. Pre-Operative Shower or Bath A. A physicians order is not necessary in order to administer a Chlorhexidine/ Betadine bath as a part of patient preparation for surgery. B. Pre-op preparation for surgery patients shall include a shower or bath with chlorhexidine soap the night prior to and the morning of the scheduled surgery. Exception: Patients who have emergent surgical procedures and those with a known allergy to chlorhexidine. If a patient is allergic to chlorhexidine, betadine should be used. If allergic to betadine, regular liquid soap shall be used. 1. Chlorhexidine shall not be used for cleansing vaginally, as well as any area above the shoulders, i.e.face, head, hair, ears, eyes, mouth and neck. Regular soap/shampoo may be used to cleanse these areas. Hair shall be washed the day before or morning of surgery using shampoo, if at all possible. 2. Chlorhexidine scrub brushes shall be used for showering (preferred) or bathing. These are available from Central Medical Supply. 3. In-House patients shall have a shower/bath the night prior to and the morning of the scheduled surgery. The patient may shower/bathe himself or herself provided instructions are given and the patient provides evidence of understanding such instructions. Note: If a patient is to have abdominal surgery, the shower or bath shall include cleansing of the umbilicus with cotton tip applicators. 4. Day surgery patients shall be given chlorhexidine scrub brushes and two cotton tip applicators with written instructions at the time pre-op teaching is done.

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C.

Instructions for pre-op chlorhexidine cleansing shall include: 1. The reason for pre-op chlorhexidine cleaning (i.e. to reduce the risk of infection). 2. Chlorhexidine shall not be used to cleanse areas above the shoulders or used vaginally. 3. The shower (preferred) or bath shall be followed by rinsing with clean water. ACTION Transcribes pre-op orders for surgery or orders for cardiac cath or special procedures. Initiates a Pre-op Checklist (SN l185). Explains "NPO" to patient. Documents instructions and evidence of the patient's understanding and/or return demonstration of instructions, utilizing either the IPEF(SN1102), Knowledge Problem/Priority section of the 24 Hour Plan of Care, or the Preoperative Teaching Form, (SN 1086). Verifies, initials and documents all items as completed. Dates and signs Pre-op Checklist with full legal signature prior to sending the patient to surgery, cardiac cath, or special procedures. Notifies physician and operating room, cardiac cath or special procedures if informed consent is not signed and/or completed, and maintains the patient on the unit until the issue is resolved. Notifies physician and/or appropriate department or persons of any potential problems prior to sending patient to surgery, cardiac cath, or special procedures. Assists patient onto OR stretcher if needed by OR personnel. If patient is going to cardiac cath or special procedures, assist patient onto a stretcher if needed by transport or nursing assistants from the unit.

RESPONSIBLE PARTY 1. RN, RN Applicant, LPN 2. 3. 4.

5. 6.

7.

8.

9.

10. Places Pre-op Checklist in the front of the medical record prior to transport: a. to surgery and gives completed chart to OR transport personnel. b. to cardiac cath or special procedures and gives completed chart transport or nursing assistants. 11. Upon return to nursing unit, places Pre-Op Checklist in the section with the 24 - Hour Nurses Note as a permanent part of the medical record.

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References: 1. Center for Disease Control and Infection: Surgical Site Infection - FAQ | CDC Infection Control in Healthcare, Accessed 5/27/09 2. Hospital Policy 5.32.0 Site Marking http://www.sh.lsuhsc.edu/policies/policy_manuals_via_ms_word/hospital_policy/h_5.32.0.pdf 3. Hospital Policy 5.16.1 Informed Consent for Medical Treatment http://www.sh.lsuhsc.edu/policies/policy_manuals_via_ms_word/hospital_policy/h_5.16.1.pdf

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Jamie Jett, MBA, RN Administrative Nursing Director Psychiatry, Coordinated Care and Professional Practice

_________________________________ Signature

____________ Date

Jean DiGrazia, MBA, RN Assistant Hospital Administrator and CNO Patient Care Services

________________________________ Signature

____________ Date

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