PASS the Candy
These two antihypertensive drug classes are held prior to surgery due to risk for intra-op hypotension.
Angiotensin Converting Enzyme (ACE) Inhibitors & Angiotensin Receptor Blockers (ARB)
*ACE(PRIL)- Lisinopril, Enalapril, Benazepril, etc.
*ARB (ARTAN)- Losartan, Valsartan, Telmisartan, etc.
Patient prep and recovery instructions can be found where?
Media section of the chart
*Ask patients if they received prep and recovery information in the office
*Navigate in epic to locate it (chart review--> Media)
*Extra hand outs can be found in vascular books in chart desks
1. Nephrology Associates of Tidewater (NAT)
2. Tidewater Kidney Specialists (TKS)
*Ask the patient who their nephrologist is before you page.
*Have Istat done before you page you do not need to page twice (Ex. Scheduled dialysis day but also might have hyperkalemia and need dialysis before vs. after procedure).
*If patient is unsure look in media section of the chart. Patient likely has been seen before by a Nephrologist and you can look at top of the note for name and Nephrology group logo.
Carb loading drinks should be completed at least ___ hours prior to surgery.
2 hours
*If patient failed to drink morning of surgery notify surgeon. Do not give them it to drink in pre-op unless surgeon directed.
Colorectal bundle patients are required to complete antibiotics when before surgery?
1. Oral antibiotics night before
2. IV antibiotics in SPAR 60 minutes before incision
*Verify with pre-op that oral antibiotics completed. This is given to patient by the office.
*page provider ASAP for antibiotic orders
Consents previously signed/dated can be used within ___________ days.
60
*Consents signed/dated >60 days will need to be updated on day of surgery
Dialysis patients require these 3 things before going to the operating room.
Istat, documentation of dialysis information, and consent
*Documentation of dialysis information before anesthesia is for patient safety and so it's captured in the event of an emergency.
*Make it bests practice for All dialysis patients not just "vascular procedures"
*Istat to make sure patient went for treatment and K is normal before anesthesia and to make sure treatment is not required before discharge.
*if it's not their HD day and istat is normal HD consent is not required. Ok to still get if you want to be "extra" :)
Expected Nursing assessments post AVF (AV fistula) or AVG (AV Graft) procedure include...
Thrill & Bruit assessment with vital signs and Incision Assessment
*AVF/AVG should be added as LDA's
*Bruit & Thril documentation is on LDA flowsheet with incision documentation/assessment.
Name all 6 ERAS programs/service lines
2. GYN
3. Bariatrics
4. Urology
5. Living Kidney Donor
6. Colorectal/Hepatobiliary
Glucose goal for hysterectomy and colorectal cases is less than _______ mg/dl.
180
*Glucose should be checked on ALL patients in pre-op having a hysterectomy or colorectal case.
*Page anesthesia is glucose is not at goal (<180)
Patients receiving cataract surgery are required to have this document completed before procedure occurs.
CAT-9 Asssment
*The office completes this document with the patient in the office and faxes to the SNGH Chart room. Chart room team will then pull it into Media for documentation and regulatory requirements.
*Blank CAT-9 Assessments are placed on the paper chart only if not received by the office.
For CLABSI prevention, patients with Tunneled Dialysis Catheters are required to have what completed before going to the OR?
CHG dressing changes are required per Sentara policy within 24 hours of admission and as needed when soiled.
*Even it patient had it changed at dialysis yesterday this sterile procedure and documentation is required per Sentara policy.
*Dressing change and site assessment should be charted in LDA flowsheet.
*Document and report any concerns for infection when viewing insertion site ASAP and send blood cultures if ordered by provider.
*CHG dressings should be changed every 7 days and PRN.
Vein Ablation and Phlebectomy patients are required to wear this for at least 1 week post procedure.
Compression
*Post procedure handouts are given prior to procedure. If patient does not have it then give a hand out or use smart notes to document in AVS .SPARPOSTOPPHLEBECTOMY & .SPARPOSTOPVEINABLATION
What should be done after the patient has cleansed with CHG and put a gown on?
Connect patient to bair hugger
*Bair hugger needs to be put on patient to maintain patients core temperature and should be completed and documented before going to the OR.
What status board icon indicates a colorectal or hysterectomy bundle case?
Lighting Icon!
*A lighting icon on status board indicates the patient (based on procedure code) meets criteria for SSI bundle (Hysterectomy or Colorectal).
These Medications used for treatment of diabetes and chronic weight gain should be held prior to surgery due to increased risk for aspiration due to delayed gastric emptying.
GLP-1 agonists
*Trulicity, Victoza, Ozempic, Wegovy, Byetta, etc.
*Once Weekly GLP-1 Agonists should be help at least a week prior to procedure.
*Daily GLP-1 Agonists should be help day of procedure
Which cranial nerves are REQUIRED to be documented for carotid procedures?
V-Trigeminal
VII-Facial
IX- Glossopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal
*Documentation is required pre op before going to the OR and post procedure
*NEURO COGNATIVE ADULT FLOWSHEET
Patients who need dialysis after their outpatient procedures can safety be transferred when....
Procedure Care Complete has occurred
*Phase 2 recovery should be complete along with event time documentation and patient discharge instructions
*Effective hand off to dialysis should occur so patient can be discharged following their treatment and do not require a transfer back to SPAR for any education!
Name at least 4 acceptable ERAS drinks patients can consume before surgery.
1. Ensure Pre Surgery Clear
2. G2 Gatorade (if diabetic)
3. Gatorade Zero
4. Gatorade (non diabetics)
5. Powerade
These 8 items are required and on the Pre-op Colorectal Bundle
1. Bowel Prep
2. Oral Abx night before surgery
3. Nasal Antiseptic (ERAS)
4. CHG wipe
5. Carb load drink 2 hours before (ERAS)
6. Glucose <180
7. Temp-attached to air warmer
8. Antibiotics initiated in SPAR and completed within 60 minutes of incision.