¶ … Theatre Nurses Equipped With the Skills Required to Perform Pre-Operative Visits To Perform Pre-Operative Visits?

Are Theatre Nurses Equipped With the Skills Required

To Perform Pre-Operative Visits?

Dissemination

Are Theatre Nurses Equipped With the Skills Required

To Perform Pre-Operative Visits?

Pre-operative assessment is part of the ER process that many medical professionals believe can be accomplished on the part of nurses in the unit.. The objective listed for pre-operative assessment is that special requirements for the surgery as well as the peri-operative stay should include identification and coordination of all essential resources, should inform the patients and prepare them to proceed and to ensure the patient's fitness for the procedure(s) scheduled. . The nursing team clinically examines as well as assessing all emergency patients before surgery to ensure the fitness of patients to the greatest possible extent. Strategies include, "redistributing cases from emergency to elective theatre schedules, day case emergency surgery, and booking parts of the emergency care process." Stated is that, "these strategies have resulted in significant operational clinical improvements in the care delivery for emergency and surgical patients." (NSH, 2005) Care delivery, autonomy, culture management, information managements, leadership, psychologic management and relationship management processes are all listed as core components in the rose of the critical care nurse"

Are Theatre Nurses Equipped With the Skills Required

To Perform Pre-Operative Visits?

- Research Proposal

Introduction

Pre-operative assessment prior to the patient receiving anesthesia is the responsibility of the anesthetists however, pre-operative screening prior to assessment achieves "several desirable objectives." It ensures that patients are prima facie fit for anesthesia and surgery and that all likely investigations will be completed and available at the time of the pre-operative assessment. Screening first takes place in the general practitioner's surgery or outpatient department, pre-admission screening clinics employ nurses who have been provided with special training and organized by surgical teams or by the anesthesia department. It is crucial that the boundaries between the remit of the pre-anesthesia screening team and the responsibility of the anesthetist be clearly set out.

The aims of pre-anesthesia screening are:

(1) To provide the anesthetist with basic information on the patient's health status which will enable a meaningful assessment of fitness for anesthesia to be made;

(2) To identify and instigate relevant investigations, according to pre-determined protocols;

(3) To increase the patients' understanding of the pre-operative, intra-operative and postoperative care being planned;

(4) In patients scheduled for day surgery to assess the home situation, social circumstances and the availability of support.

(5) Screenings are often conducted through the use of a questionnaire which the patients complete and a checklist completed by a nurse with relevant training and experience for filling this role.

A brief history of medical information concerning the patient along with any allergies to medications or adverse reactions experienced to anesthesia are notes. Other relevant information such as the height, weight, pulse rate and blood pressure of the patient are taken as well as a urinalysis performed. Pre-operative assessment is stated to, "Establish that the patient is fully informed and wishes to undergo the procedure. It ensures that the patient is as fit as possible for the surgery and anesthetic. It minimizes the risk of late cancellations by ensuring that all essential resources and discharge requirements are identified and coordinated."(NHS, 2005) The guide developed by the NHS Modernisation Agency's Operating Theatre & Pre-operative Assessment Programme (the Theatre Programme) is for the purpose of providing guidance before admission for inpatient surgery in the area of pre-operative assessment and is stated to, "Build on the work of the pilot sites that were involved in developing and testing ways to implement pre-operative assessment." (NHS, 2005)

It is the desire of patients that they be informed fully in relation to their operation and that they are fit for surgery on the scheduled date. In order to improve the patient's surgery experience the implementation of pre-operative planning and assessment should be before admission because the patient is allowed the opportunity to receive information and to ask any questions they might have. Hospital efficiency could very well be improved through "ensuring patients are as fit as possible, and identifying any resource requirements for the operation, peri-operative stay and subsequent discharge." (NHS, 2005)

The objective listed for pre-operative assessment is that special requirements for the surgery as well as the peri-operative stay should include identification and coordination of all essential resources, should inform the patients and prepare them to proceed and to ensure the patient's fitness for the procedure(s) scheduled.

Research Questions

This study asks the questions of:

1. Are nurses in the emergency room capable through training to perform pre-operative assessment in lieu of the attending physician doing so?

2. Are the pre-operative assessments of nurses thorough enough to avoid liability and medical error?

Are...

Number 19, June 30, 1997, in the article entitled "Nurses Could Help Cut Junior Doctors' Hours" states that, "the results of a new study could have far reaching implications for the future roles of doctors and nurses and for the structure of general surgery. " As stated in the report there is not a "career structure for nurses in this area of practice" It was however, "found that nurses can effectively take on the role" which will not only increase their opportunities and bring benefits to the realm of general surgery.
Objectives of Pre-Operative Assessment

Consideration of the objectives of pre-operative assessment are as follows according to the NHS in their work entitled, "Pre-Operative Assessment for Inpatient Surgery" the "Pre-operative Assessment Should:

"Provide the opportunity for further explanation and discussion of the information given by the surgeon. This should minimize fears and anxieties through ensuring the patient's full comprehension of the scheduled procedure.

Assess the fitness for surgery of the patient and as well the patients' fitness for anesthesia and finally make provision of an assessment of the risks and benefits of the proposed procedure and confirming that the patient wishes to have the operation even after having been make aware of the risks and benefits of the procedure.

Make identification of any and all conditions requiring intervention before admission and surgery and take required action. (Example: Patients taking blood thinner, oral contraceptives, etc.)

Refer the patient for optimization of their health prior to surgery if necessary. (Primary Care and/or secondary care specialist)

Make sure that all necessary investigations are conducted with results being available and any necessary action taken thereby reducing any unnecessary dluplication of investigations.

Assess the suitability of the patient for day surgery and assess whether the scheduled procedure can be performed as a day surgery procedure.

Make identification of requirements to aid in the scheduling of the surgical procedure to include specialist equipments, the approximate length of the surgery as well as any other requirements for the post-operative stay. (Critical care beds)

Make provision of information in relation to pre-operative instruction of a specific nature. (e.g. fasting, etc.)

Provide a contact for any further questions, concerns or cancellation of the scheduled procedure.

Information concerning the post-operative recovery, mobilization rate, pain reliever options. Videos, leaflets and picture diaries are suggested as being effective in providing information and relieving anxiety of patients.

Make provision of the opportunity to have a discussion with patients in relation to self-help matters toward improving their surgery outcome. (e.g. stopping smoking, losing weight, etc.)

Identification of cultural requirements and communication and other special need requirements is done in the pre-operative period.

Make assessment of the available home support to the patient post-discharge.

Preparation of the multi-disciplinary pre-operative documentation." (NHS, 2005)

Role of the Pre-Operative Assessor -- Pre-Operative Assessment

Secondly comprehension of the scope of the role of the pre-operative assessor is important in grasping the prevailing issues in the proposed research. Those pre-operative assessors are stated by the NHS to be as follows:

"Work to guidelines and competencies agreed by the anesthetists, surgeons and other allied health professionals to ensure a consistent approach.

Take a targeted history and conduct a relevant physical examination of the patient, including airway assessment.

Refer patients who fall outside the agreed criteria to an anesthetist, who may then make further referrals.

Arrange and perform investigations in accordance with NICE guidelines.

Ensure that the results of tests are evaluated and refer abnormal investigations results to the available anesthetist, surgeon and/or primary care, according to local guidelines.

Refer a patient back to primary care or another healthcare professional to optimize the patient's medical conditions, according to local guidelines.

Take responsibility for following up referrals to ensure the patient remains in the pre-operative system.

Liaise actively with the anesthetic department.

Arrange and co-ordinate for all communication

Take responsibility for all communication with the patient throughout their pre-operative stay and ensure a timely discharge.

Commence necessary planning for the per-operative stay and to ensure a timely discharge

Identity factors that may influence the dates of surgery offered, e.g. school holydays

Collate all information prior to surgery and ensure that the multi-disciplinary documentation is available for anesthetists to see at least 48 hours prior to admission.

Communicate approximate length of operation, any requirement and essential resources to the waiting list office, bed management, operating theatre department and/.or theatre scheduler.

Contact all patients failing to attend pre-operative assessment to identify the reason. Act on the reason, following local protocols…