ASC TRAININGThe ”Must Do(s)” for every surgical patient.

Prepared by: Troy Lair, PhD- Accreditation Consultant

PRIOR TO THE SURGICAL PROCEDURE TAKING PLACE, WE DO THE FOLLOWING:

Pull the surgeons’ privileges to ensure she/he has privileges to surgerize as the surgical order denotes Pull the instruments to determine if you have everything you need for the case to proceed Pull the medical record and collect the H/P and Labs, r/o the need for EKG and review Ensure the physician and anesthesia provider has the results of the tests if there are any results that are outside the normal range Look at staffing for the surgery day, ensure you have the right people on the surgical team that can do the best job Prepare the patient for surgery day by calling them and reminding them of the case, their NPO status, documents needed (advance

directives), etc. Remember to ask them to leave their valuables at home where they are safe and to bring some clothing with them, something easy on and off and comfortable for the ride home

Ensure the patient has an adult to take them home and remain with them for the next 24 hours post operatively

MUST HAVE A CURRENT H&P ON THE CHART PRIOR TO SURGERY!

The history and physical must be within 30 days of being written or dictated/transcribed. Any H&P > 72 hours, it must contain a written statement that no changes to the original H&P and then this statement gets signed/dated/time stamped.

If another surgeon performs the history/physical, this is allowed only if the surgeon signs off on it, attesting to it and agreeing to the information. He/she will sign and date/time stamp this history/physical.

If a patient does not have an H&P the day prior to the surgery date, then the case must be cancelled and rescheduled when it is present.

A proper history and physical cannot be performed the same day of the surgery day, No pre-surgery morning of surgery histories. The only exception to this is for pain management cases or any other case that is ONLY done under local anesthesia.

THE PHYSICIAN MUST HAVE REVIEWED THE LABS/CHART PRIOR TO SURGERY!

Whether the labs are within or outside the normal limits, they must be reviewed by at least the surgeon.

Anesthesia providers will also do this most times. The only way to document that they did review the

labs/x-rays/or EKG is to get their initials, date, and time stamp on the lab results.

This is a highly valued regulation that can cost a center its accreditation if you fail to obtain this, not to mention the lives you place in jeopardy by not complying.

If the history and physical with the lab draws occur 24-48 hours prior to the scheduled procedure day, then correctional therapies can be given to correct issues with results, thus eliminating the cancellation of the surgery.

ALERT. ALERT! ALERT!! ALERT!!!

Sentinel event alert!

MEDICATION RECONCILIATIONDon’t forget to tell the patient to bring either their meds with them, or bring the list of meds, the frequency they take the medications, and how often it is taken.Then reconcile this list with the surgeon on what meds the patients are to resume immediately post operatively, or wait until their follow up visit with the surgeon. Either way, the patient needs to know it is or is NOT ok to take certain meds the day of surgery. BEWARE of blood thinning agents/fear of a bleeder.

MORNING OF SURGERY {PATIENT FLOW}

Check InConsent Forms are Verified & Consistent on all documentsNursing Pre-Op AssessmentPatient EducationHome InstructionsANESTHESIA Evaluation & Alternatives SURGEON Assessment & Evaluation with alternatives

MORNING OF SURGERY {SURGERY CENTER FLOW}Next, we look at all the processes & tasks that must be completed prior to anesthesia being induced. These are the administrative operatory functions that assesses the surgery centers ability to perform surgery while safely doing the procedure and recovering the patient. These tasks are:

Check the equipment of the ORs Check anesthesia machines Check gases ensuring no leaks and plenty of gas

in the cylinders to where you always have a back up that is full capacity

Check the refrigerator with the meds, logging in the temperatures

Check the humidity and temperature of the operatory spaces

Check the bovie Check the procedure light and light sources Radiology lightbox for lumination Check the crash cart for tampering since last full

count

Check the equipment of the PACU PACU Monitor Suction O2 Cannulas/Face Masks Nurse Call Lights

EVERY SURGERY DAY, WE DO THE FOLLOWING:

Q: WHAT’S THE REASONING BEHIND THE DAILY CHECKS?A: The reason why we check all the equipment daily is to ensure everything works properly before the first patient gets to the operating room table. This is very important and must be followed in order to ensure patient safety.

ONCE THE PATIENT GETS ON THE OR TABLEAnesthesia provider begins their processing, hooking up the monitor, and getting them prepared to go under. But, just prior to going under something really Major needs to occur. What is this that must occur?

• TIMEOUT.

THE SURGERY MARKINGS ARE CONFIRMED WITH THE PATIENT, STAFF, AND SURGEON

THE PATIENTS NAME IS CONFIRMED

THE CONSENT FORMS ARE VERIFIED TO ENSURE THAT THEY MATCH TO THE PROCEDURE BEING PERFORMED

THE SIDE/APPROPRIATE LOCATION OF THE PROCEDURE ALL MUST BE IN AGREEMENT

AND THE FORM IS SIGNED DEMONSTRATING COMPLETED.

THE PATIENT IS INDUCEDTHE ANESTHESIA TIME AND NOW THE CUT TIMES ARE RECORDED IN THE MEDICAL RECORD.

INTRA-OPERATIVELY CIRCULATOR ENSURES THAT ALL MEDICATIONS GIVEN ARE UNDER THE

ORDER OF THE PHYSICIAN

IMMEDIATELY POST-OPERATIVELY

SURGEON DICTATES HIS/HER OPERATIVE NOTES

PATIENT IS TAKEN TO RECOVERY ROOM BY ANESTHESIA

HAND-WRITTENOP NOTEGETS CHARTED

RECOVERY-Patient is on a continuous monitor, monitoring for:

saturationHRBP

Temp (once unless febrile)Respirations

Pain Control: Assessment and acknowledgment of patient’s pain. Q 15 minutes.

PHYSICIAN OR ANESTHESIA MUST MAKE FINAL DISCHARGE ASSESSMENTThen accordingly, the aldrete scoring guidelines can be used to determine their readiness for the surgeon to make the final assessment. Final assessment must be done face to face, not over the phone and not through walls of space. Face to face.

PATIENT IS DISCHARGED:TO HOMEWITH AN ADULTIN A WHEELCHAIRTO THE CARWITH DISCHARGE INSTRUCTIONSMEDICATION RECONCILIATIONSPOST OP APPOINTMENT

REMINDER