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Physical pre‐operative preparation

Definition

Physical pre‐operative preparation is concerned with reducing harm and complications in the peri‐ and post‐operative period (NHSI [140], Scott et al. [186]).

Related theory

For many patients, waiting for surgery can be a stressful time. Where possible, having someone to sit with patients before surgery (perhaps a relative) may help to reduce anxiety. Patients with learning disabilities or mental health problems can find new environments difficult, so it is preferable if the person with them is familiar.
Upon the patient's admission to the clinical area, a patient identity band (see below) should be placed on their dominant arm with printed information, in line with recommendations from NHS Improvement (NHSI) ([136]). Any assessments not performed at the pre‐assessment clinic should be completed and documented by the admitting practitioner.
The following risk assessments should be included as part of pre‐operative patient checks and recorded in the perioperative care documentation (this is not an exhaustive list, as dependent on institutional protocol):
  • pressure ulcer
  • venous thromboembolism (VTE)
  • falls
  • nutrition screening
  • baseline observations are required and should be recorded:
    • blood pressure
    • pulse
    • respirations
    • temperature
    • oxygen saturations
  • blood glucose (if appropriate).
Box 16.3 outlines additional safety measures that may be necessary.
Box 16.3
Pre‐operative patient safety measures
  • Identity bands
  • Antiembolic stockings and prophylactic anticoagulation
  • Pre‐operative fasting
  • Skin preparation
  • Marking skin for surgery
  • Pre‐operative pregnancy testing
  • Preventing toxic shock syndrome from tampons
  • Assessment for latex allergy
  • Comprehensive pre‐operative checks

Identity bands

Identity bands (or name bands) are fundamental in the identification of patients. Patient misidentification contributes to errors and is a cause of patient safety incidents with potentially grave consequences. NHS Improvement ([136]) highlights the importance of name bands. Since 1 July 2011, it has been mandatory for all hospitals to have electronically printed name bands. Key information should be clearly labelled on a patient's name band (NPSA [155]); see Box 16.4 for details.
Where possible, colour coding for individual risks should be avoided. If a healthcare organization believes colour coding is necessary to alert healthcare professionals to a known risk (e.g. patient allergy), then the National Patient Safety Agency ([155]) recommends the use of only one colour: red.
Box 16.4
Information to be included on an identity band
  • Date of birth in the format dd‐mmm‐yyyy (e.g. 01‐Mar‐2013)
  • Name (surname first in capitals followed by the first name with the first letter in capitals, e.g. MARSDEN, William)
  • Patient's 10‐digit NHS number
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