Surgical Care

Question 1

Define SCIP

Answer 1

surgical care improvement project

Measures:
- infection
- cardiac
- VTE
- global (death/readmit)
- vascular
- respiratory (HOB elevation, ventilation)

Question 2

Define SCIP Inf-1

Answer 2

prophylactic abx received within one hour prior to surgical incision (except vanco & FQs d/t longer infusion time)

Question 3

Define SCIP Inf-2

Answer 3

prophylactic abx selection for surgical patients (almost always ancef, check current list for appropriate prescribing)

Question 4

Define SCIP Inf-3

Answer 4

prophylactic abx d/c within 24 hrs s/p surgery end time (48 hrs if vascular surgery)
- may need re-dosing througout procedure if it is long

Question 5

Define SCIP Inf-4

Answer 5

cardiac surgery patients with controlled 6am post-op glucose

Question 6

Define SCIP Inf-6

Answer 6

Surgery pts with appropriate hair removal (clipping not shaving)

Question 7

Define SCIP Inf-7

Answer 7

Colorectal surgery pts with immediate post-op normothermia (greater than or equal to 96.8)

Question 8

Define SCIP Card-2

Answer 8

surgery pts on a beta blocker therapy prior to arrival who received a beta blocker during the perioperative period
- helps regulate heart rate variation & decreases mortality

Question 9

Define SCIP VTE-1

Answer 9

surgery patients with recommended VTE prophylaxis ordered

Question 10

Define SCIP VTE-2

Answer 10

surgery patients who received appropriate VTE prophylaxis within 24 hrs prior to surgery to 24 hours after surgery

Question 11

Define SCIP Inf-9

Answer 11

urinary catheter removed on POD 1 or POD 2 with day of surgery being day zero

Question 12

List the goals of surgical anesthesia

Answer 12

Establish a reversible state of: analgesia, amnesia, and akinesia

Question 13

Describe general anesthesia

Answer 13

• intubation
• close monitoring with end tidal CO2, pulse, ox

Question 14

Describe monitored anesthesia care

Answer 14

• spectrum
• may have intraoperative recall
• need appropriate local anesthetic
• patient able to move

Question 15

Describe neuraxial anesthesia

Answer 15

spinal/epidural

Question 16

List the common complications of anesthesia

Answer 16

• PONV
• upper airway problems/hypoxia
• HoTN
• dysrhythmia
• AMS
• urinary retention
• cardiac events

Question 17

List the steps of a surgical time-out

Answer 17

• purpose to reduce wrong site surgery
• team participation & surgeon led
• stop activity

STEPS
- verify pt, DOB, allergies
- verify procedure
- verify needed equipment/implants available
- specimens
- discuss expected complications
- fire risk

Question 18

List the components of a post-op note

Answer 18

• pre & post op diagnoses
• procedure
• surgeon/assistant
• anesthesia
• estimated blood loss
• drains
• specimen removed
• complications
• findings
• condition to recovery

Question 19

List the 6 W’s of post-op fever

Answer 19

• waves: MI (POD#0)
• wind: pneumonia (POD#1-2), encourage sitting up & IS use
• water: UTI, pneumonia (after POD#3)
• wound: SSI (after POD#4-5)
• walk: PE/DVT (POD#7-10)
• wonder drugs: review meds