9. The Art of the Pre-Op
Preparing a patient for the OR should be a thorough, detail-oriented process. While we discuss a checklist approach, too often we glaze-over important details. Even for routine surgeries, consider a Pre-Op like a brand new “consult”. This means you should obtain relevant info about the Dx, history, and procedure.
Pre-op assessments should include:
- A Pre-op “note”– an EPIC template note is available and should be used for all preops
- Enter “Pre Procedure Note” into “Type” box at top of a blank note and it will auto-populate with fields
- Discussion with the primary team, informing them the patient is going to OR
- Instructions to primary team about what orders we need placed (we cannot place orders on patients on other services, but it is our responsibility to make these orders happen).
- Accurate consent form – use interpreter for non-English speaking parents/patients and document the interpreter number on the form
- Consents should not contain abbreviations
- All consents should have a nurse witness signature at bottom
- Telephone consents are acceptable, but need a witness
- Central line consents should specify type of line and number of lumens (but not a side)
- A review of current meds and discussion with fellows about adjustments:
- Seizure and blood pressure medications
- Stress-dose steroid plans
- Insulin / glucose management in diabetics
- Anti-platelet or anti-coagulation medications
- A review of recent laboratory studies – do not wait to order these the morning of surgery – they should be obtained at least 24 hrs in advance so that abnormalities can be corrected in time for OR
- Hgb / Hct = greater than 10 / 30 -- discuss with fellow if less
- Platelet Count = greater than 75 -- discuss with fellow if less (threshold is 50 for line insertions, 40 for line removals)
- Potassium Level = normal range -- iSTAT measurement is OK
- Bowel prep as discussed with Pediatric Surgery or Colorectal fellows
- NPO/IVF -- Varies according to type of diet, default after MN, but can adjust according to the following
- Regular diet - NPO for 8 hours
- Carbohydrate diet – NPO for 6 hours
- Breast Milk / liquid diet– NPO for 4 hours
- When in doubt, check with fellow
- Pregnancy test for menstruating females or those over age 12
- On-call antibiotic and blood product orders
- Intra-op orders for local anesthetic (and wound Cx’s if relevant)