Elective Surgery Programme Implementation Support Guide

Other patient groups may also be included in a pre-operative screening programme, as
determined by local risk assessment.
The GP referral letter will be reviewed to document the current medication and allergies. A drug
history will also be taken at this stage and documented on the patient's questionnaire. The
information serves to inform the nurse of the patient's current health status and enables any
alterations to medication regimens to be made pre-operatively. Hospitals need local policies
written by anaesthetists that allow nurses to advise the patient to stop taking drugs such as
aspirin, clopidogrel and metformin in the immediate pre-operative period. The policies should be
specific regarding the circumstances in which members of the nursing team are allowed to
provide such advice. For example, if the patient has a complex medical history the nurse must
seek instruction from the anaesthetist, surgeon or cardiologist before altering any medication
regimens. The risk of continuing to take the drug is carefully assessed against that of increased
intra-operative risks.
The identification of patients' needs during pre-operative assessment means that most
individuals can be discharged as soon as they are medically well and with the best possible
support at home already in place. (see Chapter 5 Discharge Planning)
Stage two: physical examination
Pre-operative assessment will include the patient's baseline measurements including pulse,
blood pressure, temperature, height, weight, body mass index, neck movement, airway
assessment, auscultation of the heart and lungs and oxygen saturations on air as well as their
normal capabilities. This is usually the first contact that nursing staff and the anaesthetist will
have with the patient and is an ideal opportunity to observe the individual's normal physical
function, for example, as he or she mobilises or gets changed for the ECG. Problems can be
identified at this stage and AHP‟s may need to be involved with for example, physiotherapy to
assess function mobility and exercise tolerance or occupational therapy to assess for assistive
technology and or adaptations. This can be planned for in advance. Allied Health Professional
assessment may include referral preoperatively to primary care services in order to optimise the
patient‟s health function and mobility and to put in place systems to support their discharge.
Pre-operative assessment should also include documentation of any potential source of
infection, or underlying condition that might increase the risk of surgical site infection (e.g.
colonised venous ulcers, exfoliative skin condition).
Stage three: investigations and clinical scores
Patients may require routine investigations such as ECG and blood tests according to local
guidelines. However, evidence suggests that 60-70% of pre-operative testing is unnecessary,
expensive, labour intensive and of questionable value if a proper history and physical
examination are carried out. (15) Although pre-operative assessment is valuable, a thorough
clinical assessment ensures that tests requested are based solely on clinical need.
42 Model of Care for Elective Surgery