The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [608]
10 Long hair should be held back with a non-metallic tie. For safety, to prevent hair getting caught in equipment and to reduce the risk of infection. E
11 All jewellery, cosmetics, nail varnish and clothing, other than the theatre gown, are to be removed. Wedding rings may be left in situ, but must be covered and secured with hypoallergenic tape. Metal jewellery may be accidentally lost or may cause harm to the patient, for example diathermy burns. Facial cosmetics make the patient’s colour difficult to assess. Nail varnish makes the use of the pulse oximeter, used to monitor the patient’s pulse and oxygen saturation levels, impossible and masks peripheral cyanosis (Vedovato et al. 2004, C).
12 Valuables should be placed in the hospital’s custody and recorded according to the hospital policy. To prevent loss of valuables. E
13 Disposable or cotton underwear could be worn unless the patient is undergoing major urology or gynaecology procedure. To maintain patient’s dignity (NMC 2008, C).
14 Check whether patient passed urine before premedication. To prevent urinary incontinence when sedated and/or unconscious and possible contamination of sterile area. E
15 Apply antiembolic stockings correctly. To reduce the risk of postoperative deep vein thrombosis or pulmonary emboli (NICE 2010, C).
16 Ensure the patient is wearing an identification bracelet with the correct information. To ensure correct identification and prevent possible patient misidentification (AORN 2000, C).
17 Ensure the patient is wearing an allergy alert band if appropriate. To reduce allergic reactions to known causative agents and to alert all involved in the care of the patient in the operating theatre (AORN 2004, C).
18 Check when patient last had food or drink and ensure that it was at least 6 hours before planned operation time. To reduce the risk of regurgitation and inhalation of stomach contents on induction of anaesthesia (Asai 2004; Dean and Fawcett 2002, C).
19 Note whether the patient has dental crowns, bridge work or loose teeth. The anaesthetist needs to be informed to prevent accidental damage. Loose teeth or a dental prosthesis could be inhaled by the patient when an endotracheal tube is inserted. E
20 Ensure prosthesis, dentures and contact lenses are removed. Make a note of irremovable prosthesis (for example pacemaker, knee replacement) on the preoperative checklist. To promote patient safety during surgery, for example dentures may obstruct airway, contact lenses can cause cornea abrasions. Internal non-removable prosthesis may be affected by the electric current used in diathermy. E
21 Spectacles may be retained until the patient is in the anaesthetic room. Hearing aids may be retained until the patient has been anaesthetized (these may be left in position if a local anaesthetic is being used). Any prosthesis should then be labelled clearly and retained in the recovery room. To allow the patient to communicate fully, thus reducing anxiety and enabling the patient to understand any procedures carried out. P
22 Complete the preoperative checklist by asking the patient and checking records and notes before giving any premedication. Questioning premedicated patients is not a reliable source of checking information as the patient may be drowsy and/or disorientated (AORN 2000, C).
23 Give the premedication, if prescribed, in accordance with the anaesthetist’s instructions. Different drugs may be prescribed to complement the anaesthetic to be given, for example temazepam to reduce patient anxiety by inducing sleep and relaxation. E
24 Advise the patient to remain in bed once the premedication has been given and to use the nurse call system if assistance is needed. To reduce the risk of accidental patient injury as the premedication may make the patient drowsy and disorientated. E
25 Ensure the patient is supported fully on the canvas, especially the head, when transferred from the ward bed to the trolley. To reduce the risk of injury to the neck, and so on, during transfer from the ward to the operating theatre (AORN 2001, C).