The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [607]
13 Monitor whether the patient has adequate hydration. To ensure the patient is adequately hydrated (NICE 2010, C; SIGN 2002, C).
14 Record temperature daily. To detect infection early and signs of inflammation associated with venous thrombosis. C
15 Launder according to the manufacturer’s instructions. To reduce the risk of cross-infection and promote patient comfort. C
16 On discharge from hospital, check the patient understands the following:
(a) signs and symptoms of DVT
(b) correct use of prophylaxis at home, for example how to wear antiembolic stocking correctly
(c) implications of not using prophylaxis correctly
(d) to continue to undertake leg exercises if immobile
(e) to avoid long periods of travel for 4 weeks after an operation.
To reduce the risks of developing a DVT or PE after an operation and to ensure that the patient reports any symptoms promptly to enable the early detection and management of DVT and/or PE (NICE, 2010, C).
Procedure guideline 14.2 Preoperative care: theatre checklist
Essential equipment
Identification bracelets
Allergy bands if necessary
Theatre gown
Cotton-based underwear or disposable pants can be worn if wearing them does not interfere with surgery
Antiembolic stockings
Labelled containers for dentures, glasses and/or hearing aid if necessary
Hypoallergenic tape
Patient records/documentation including medical records, consent form, drug chart, X-ray films, blood test results, anaesthetic assessment, record and preoperative checklist
Procedure
Action Rationale
1 Assess the preoperative education received by the patient and ensure that it is complete and understood. To ensure that the patient understands the nature and outcome of the surgery to reduce anxiety and possible postoperative complications (Walker 2002, E).
2 Check that the patient has undergone relevant investigative procedures, for example X-ray, electrocardiogram (ECG), blood test and that these are included with the patient’s notes. To ensure all relevant information is available to the nurses, anaesthetists and surgeons (AORN 2000, C).
3 For female patients:
(a) check and confirm pregnancy status on all women of childbearing age. If a pregnancy test is required, ensure the result is known to all healthcare professionals involved in the operation
(b) if appropriate, ask the patient if she is menstruating and ensure that she has a sanitary towel in place and not a tampon.
To eliminate the possibility of unknown pregnancy prior to the planned surgical procedure. E
This is to prevent infection if the tampon is left in place for longer than 2 hours (www.tamponalert.org.uk, C).
4 Check the consent form is correctly completed, signed and dated. To comply with legal requirements and hospital policy and to ensure that the patient has understood the surgical procedure (NMC 2008, C).
5 Check the operation site is marked correctly. To ensure the patient undergoes the correct surgery for which they have consented (AORN 2000, C).
6 Check that the patient has undergone preanaesthetic assessment by the anaesthetist. To ensure that the patient can be given the most suitable anaesthetic and any special requirements for anaesthetic have been highlighted (AORN 2000, C).
7 Record the patient’s pulse, blood pressure, respirations, temperature and weight. To provide baseline data for comparison intra- and postoperatively. The weight is recorded so that the anaesthetist can calculate the correct dose of drugs to be administered (AORN 2000, C).
8 Instruct the patient to shower or bath as close to the planned time of the operation as possible and before a premedication is administered, if appropriate. To minimize risk of postoperative wound infection and prevent patient accidents (Pratt et al. 2007, C).
9 Assist the patient to change into a theatre gown after having a shower/bath. To reduce the risk of cross-infection, increase ease of access to operation site and avoid soiling of patient’s own clothes (Pratt et al. 2007, C).