Perioperative Care; Fluid and Electrolyte

The principles of preoperative assessment are:

• To identify before surgery a patient’s medical, physical, psychological and spiritual needs;
• To liaise, where appropriate, with external agencies to implement discharge planning;
• To ensure a more effective use of hospital resources such as theatre time and bed occupancy by reducing the number of patients who do not attend scheduled surgery, the number of cancelled operations, and the length of time patients spend in hospital, thereby having a positive impact on waiting list

Medical history

The assessment is divided into three parts. The first involves taking a full medical history, with particular attention to any complications following previous operations/anaesthetics. When indicated, appropriate tests will be performed such as bloods, X-ray and electrocardiogram. Routine investigations are efficient, expensive and unnecessary (Association of Anaesthetists, 2001).

If any abnormalities are detected, these can be addressed before surgery, discussed with the anaesthetist and, if necessary, surgery can be deferred until the patient has reached optimum health.

The use of medications and herbal preparations before surgery

The pharmacist plays an important role in the first part of the assessment, by giving advice on changing treatments or stopping medications, such as the contraceptive pill, aspirin and warfarin, which need special consideration before a patient has scheduled surgery. Herbal preparations do not provoke drug interactions, although this will need to be checked in each individual case. It is important to consider carefully the continuing use of certain herbal remedies.

For example, garlic inhibits platelet aggregation, which may increase the risk of bleeding after surgery the patient needs to be told that any garlic supplements should be discontinued at least seven days before the date of the scheduled surgery.

If the patient is taking an echinacea preparation, which is used primarily as an immunostimulant, this must be discontinued as far in advance of surgery as possible. It may lead to an allergic reaction, the reduction of the effectiveness of immunosuppressant drugs, and subsequent poor wound healing, which could result in an increased risk of infection.

Information Exchange

The third part of the assessment is the information exchange that takes place preoperatively between the staff and the patient/carer. It offers an ideal opportunity to establish that the patient still wants the operation to go ahead and that he or she fully understands why they are having the procedure; the benefits and disadvantages of having the surgery; what will happen in hospital in terms of any drips, drains or pain control they may need; and details of the surgical procedure.

Written information about the operation/hospital stay is given to the patient and any carers. If patients require a blood transfusion as part of their surgery, autologous blood donation can be discussed if this service is available.

A systematic approach

Staff members must be able to disseminate accurate up-to-date information about the operation and the hospital stay and provide appropriate discharge advice.

A preoperative assessment service is a valuable and important part of the care of patients having elective surgery. The care is carefully planned and offers nurses the opportunity to ensure that patients will be as comfortable as possible. The effective introduction of a preoperative assessment service not only increases patient satisfaction.