Previous section | Next section

Clinical governance

The POA should generally only be performed by one of the following trained professional groups:
  • a nurse or operating department practitioner
  • an anaesthetist
  • a doctor.
However, this list is not exhaustive due to the ever‐expanding clinical complexity of surgical patients. The role of a POA practitioner is broad (Box 16.2), and they should be competent in the following three principles of care (as previously outlined):
  • conducting a comprehensive health history
  • conducting a physical examination
  • ordering appropriate laboratory and non‐laboratory investigations.
Additionally, a POA practitioner should have knowledge of the Enhanced Recovery Programme (see Box 16.1) if it is required to support the patient along their perioperative care pathway.
Box 16.2
Role of the assessor in the pre‐operative assessment (POA) clinic
  • Work to guidelines and competencies agreed by anaesthetists, surgeons and other allied health professionals to ensure a consistent approach.
  • Take a targeted history and conduct a relevant physical examination of the patient, including airway assessment.
  • Refer patients who fall outside the agreed criteria to the anaesthetist, who may then make further referrals.
  • Arrange and perform investigations in accordance with local and national guidance (NICE [144]).
  • Ensure that the results of tests are evaluated and address any abnormal investigation results with the available anaesthetist, surgeon and/or primary care professional, according to local guidelines.
  • Refer patients back to primary care or another healthcare professional to optimize their medical condition, according to local guidelines.
  • Take responsibility for following up referrals to ensure the patient remains in the pre‐operative system.
  • Liaise actively with the anaesthetic department.
  • Arrange and co‐ordinate any assessment and/or investigations needed nearer the time of surgery. Take responsibility for all communication with the patient throughout their pre‐operative journey.
  • Commence necessary planning for the perioperative stay and ensure a timely discharge.
  • Identify factors that may influence the dates of surgery offered, for example school holidays.
  • Collate all information prior to surgery and ensure that the multidisciplinary documentation is available for anaesthetists to see at least 48 hours prior to admission.
  • Communicate the approximate length of an operation, any special requirements and essential resources to the waiting list office, bed management office, operating theatre department and/or theatre scheduler.
  • Contact all patients who fail to attend POA to identify the reason. Act on the reason, following local protocols for the management of DNAs (did not attend) in POA.
The AAGBI ([6]) states that trained POA staff ‘play an essential role when, by working to agreed protocols, they screen and assess patients for fitness for anaesthesia and surgery’ (p.6). Although they are not qualified to make the final decision about a patient's fitness for surgery, they play an important role in ‘identifying potential problems’ (p.6).
Non‐complicated patients often do not require further assessment by an anaesthetist until the day of admission. Patients considered complicated by the trained assessor are further reviewed by an anaesthetist. This is supported by Kenny ([87]), who found that approximately 20% of patients assessed by pre‐assessment nurses were referred to the anaesthetic clinic. Of these referrals, half were due to the discovery of poorly controlled, undiagnosed or complex health problems and half were due to the nature of the surgery required.
While the POA can be performed by non‐anaesthetic personnel such as nurses, it is vital that the anaesthetist in charge of the patient's case is aware of the patient's co‐morbidities.

Competencies

Competency assessment is also carried out in pre‐assessment in the form of a competency portfolio, as advocated by Walsgrove ([218]). The competency portfolio was designed in correlation with the NHS Modernization Agency's ([138]) guidance on POA. The portfolio covers administrative function, physical assessment (medical and nursing history), psychological and social assessment, decision making, and interventions (referral, pre‐operative counselling, and ordering and performing tests and investigations). To ensure quality, regular audits of the pre‐assessment documentation should be carried out.
Previous section | Next section