Elective Surgery Programme Implementation Support Guide

Stage four: information collating
Stage five: information giving
Stage one: medical and social history
On arrival at the clinic patients should have a GP referral letter which has been agreed with the
GP liaison committee. Patients are then given a health questionnaire that is designed to
address each system of the body. For booked appointments a health questionnaire can be
completed in advance and sent out with the appointment. This is not a substitute for the preoperative
interview but acts as a source of additional information and reduces time spent asking
basic questions. However, telephone and web-based interviews are being used more commonly
as time-saving devices.
In the clinic, while the patient completes the questionnaire, the nurse reads through the patient's
notes and surgical care plan sheet checking for any relevant information. Once the
questionnaire has been completed the nurse validates the information given and questions
further any areas of potential anaesthetic or surgical risk that have been identified. (See:
APPENDIX 3 – Sample history form for the pre-admission nurse assessor; and,
APPENDIX 4 – Pre-admission questionnaire for children) The ultimate questionnaire
including a drug and allergy history is then filed in the patient's notes and forms part of the
nursing documentation. This can then be accessed by all members of the team. Adequate
training is essential to ensure that nursing staff are competent to elicit enough information about
the patient's symptoms to allow the anaesthetist to begin to quantify risk. Of particular
importance is the ability to assess a patient's exercise tolerance or functional capacity. Stair
climbing capacity has pre-operative prognostic importance and may even predict the risk of
complications post-operatively.
The nurse should also inquire concerning the infectious disease status of the patient and
assess risk factors for colonisation with multidrug resistant organisms, such as MRSA, in order
to decide if screening is indicated at this stage. National guidelines recommend that the
following patients are screened for MRSA colonisation: (13,14)
Patients previously MRSA colonised
Patients being admitted from another health-care facility (e.g. long term care
facility/hospital)
Patients with non-intact skin, including wounds and ulcers
Patients due to undergo elective, high-risk surgery (e.g. cardiothoracic or orthopaedic
implant surgery)
Patients requiring renal dialysis
41 Model of Care for Elective Surgery