Safety issues when booking for surgery

Question 1

Outline safety issues which should be considered when booking patients for surgery; including investigations, operative site marking, blood cross-match, bowel preparation and anaesthesia premedication

Answer 1

Introductory
There are a number of safety issues involved in booking a patient for surgery, the most important being whether the patient is fit for surgery, and the most common issues being identification error. These risks are minimised by numerous safety checks that occur throughout the patients surgical journey.

Question 2

Safety issues - investigations

Answer 2

Investigations

• pre-admission clinical + anaesthetics + pharmacist review, detail a pre-op medications plan.
• ECG, FBC, cags +/- G & xmatch if high bleeding risk (patient vs procedure), ECG, pre-op imaging for surgical planning

Question 3

Safety issues - preparation

Answer 3

Preparation

• outpatient vs inpatient bowel-pre. If patient is higher risk then admit for bowel prep prior to the surgery
• BSL control while fasting needs to be established prior to surgery

Question 4

Safety issues - identification

Answer 4

Identification
Includes correct patient identification and pre-op marking.

There are 3 points of ID that are checked sequentially throughout surgical journey to ensure correct patient, fully consented and prepared for theatres
- time-out whilst in op room

Operative site marking needs to be done pre-anaesthetic administration as the patient must be aware at this time to contribute to this process (L vs R leg operation!).

Question 5

Safety issues - anaesthetic pre-medication

Answer 5

Pre-medicaiton
- consider administration of anxiolytics for patients who’re particularly anxious pre-operation, administer prior to anaesthetic meds.