The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [600]
Namebands
Namebands (otherwise known as identity bands or wristbands) are fundamental in the identification of patients. In the most recent guidance, the information to be included on the namebands is: date of birth, in the format dd.mm.yyyy, name (surname first in capitals followed by the first name with the first letter in capitals) and the patient’s 10-digit NHS number (NPSA 2007). The NPSA Alert (2007) ‘Standardising wristbands improves patient safety’ states that within 2 years all NHS organizations in England and Wales where wristbands are used should generate and print all patient wristbands from the hospital electronic demographic system.
Specific patient preparations
Fasting
General anaesthesia carries the risk of the patient inhaling gastric contents during induction, which could lead to serious complications and can even be fatal although this is relatively rare (Dean and Fawcett 2002). This is due to the potential for airway reflexes (such as coughing or laryngospasm) or gastrointestinal motor responses (such as gagging or recurrent swallowing) occurring during surgery (Asai 2004). Surgery itself can be a factor as manipulation of organs in the chest or abdominal cavities may force gastric contents up the oesophagus (Asai 2004).
Ensuring that the patient understands the rationale for fasting is important in order to reduce anxiety. For elective surgery patients are kept ‘nil by mouth’ long enough to allow the stomach to empty. This means that patients can have water or clear fluids up to 2 hours before surgery and solid foods up to 6 hours before, provided this is light food (AAGBI 2010, RCN 2005). However, gastric emptying can be delayed by anxiety or the action of some opiates, for example morphine (O’Callaghan 2002), so it is important to be aware of this when deciding when to commence patients ‘nil by mouth’. Most patients prefer not to eat but would like to have a drink to keep their mouth moist before surgery and so are happy to comply with only fasting from water and clear fluids for 2 hours prior to surgery. Patients being fed via a nasogastric or gastrostomy tube should have their feed stopped 6 hours prior to surgery but they are able to have water up to 2 hours before surgery. Depriving elderly or unwell patients of fluids for a length of time can be detrimental to their health so in these cases other methods of hydration such as intravenous fluids should be considered (AAGBI 2010).
Skin preparation
Traditionally perioperative preparation has included the removal of body hair from the planned surgical wound site. Hair can interfere with the exposure of the incision, suturing and application of tape or dressings as well as increasing the risk of acquiring a surgical site infection (SSI) due to its associated bacteria (JBI 2008). There is around a 10% incidence of SSIs in UK patients every year, which can increase hospital stay and morbidity by delaying wound healing and causing unnecessary pain (JBI 2008).
Three methods of hair removal are currently used.
Shaving: using a sharp blade held within a razor which is drawn over the patient’s skin to cut hair close to the skin’s surface.
Clipping: using clippers with fine teeth to cut hair to about 1 mm from patient’s skin. Heads of clippers are either disposable or disinfected (JBI 2008).
Chemical depilation: using chemicals to dissolve hair. Cream needs to remain in contact with skin for 5–20 minutes. There is a risk of causing irritation or allergic reaction so a patch test needs to be carried out 24 hours before cream applied.
There have been two systematic reviews examining perioperative shaving (Kjonniksen et al. 2002, Tanner et al. 2006). Both conclude that shaving is not advisable.