Perioperative care: follow the person through the surgical pathway
The term "perioperative" is used to refer to the period around an operation (pre-operative, intra-operative, post-operative). Continuity is central to this approach. Information and decisions made at one phase of this continuum must inform subsequent phases. Therefore, this guide will follow the continuum of care without specifying a preoperative preparation program or post-operative recovery plan.
Assessment looks ahead to the demands of the operation
A pre-surgical assessment combines consideration of the proposed surgical procedures with an individual's prior medical history and current treatment regimen. Findings may necessitate additional investigations or supports prior to proceeding with the surgical procedure. The goal of a pre-surgical assessment is to assess and manage potential risks associated with an individual's upcoming surgery.
For a case study, consider separating information related to the type of surgical procedure the patient is to undergo from information related to the patient. Also, consider what is known regarding daily functioning and support at home. Both factors impact both the preparation for and recovery from surgery even when the diagnosis remains unchanged. Consider recording unanswered questions rather than assuming a partial assessment is sufficient and therefore reassuring.
Decisions should connect benefits with what matters to the person
A perioperative discussion can involve alternatives to surgery, anticipated benefits of surgery, significant risks associated with each option, and potential post-operative needs. Each of these considerations must take into account the patient's priorities. Whether returning to work, managing stairs, or alleviating a particular symptom is most important will vary based upon the individual's perspective. When developing a plan that includes anticipated benefits and potential burden, it provides value when each can be easily understood.
Consider practicing your ability to explain a particular option using everyday terminology prior to incorporating specialized terminology. Additionally, ensure that your explanation leaves room for uncertainty and questions. In addition to discussions, written materials can provide supportive documentation; however, providing a patient with written materials does not equate to them having understood them. Consideration of patients' communication needs, such as language barriers and sensory impairments should be incorporated throughout the continuum of care.
Information must move with the patient
Accurate information regarding the planned procedure, pertinent medical conditions, medications, allergies, and events during care must accompany the patient to both theatre and recovery and back again. Handovers facilitate the transition between stages of care and ideally enable the receiving staff to have a clear understanding of where the patient currently stands and what needs attending to next. Lengthy records do not necessarily constitute effective handovers; locating key points within lengthy records can be extremely challenging.
In a training handover, state the specific procedure being performed, present status of the patient, and outstanding plan. Distinguish clearly between observations and suspicions. Indicate times that are relevant. The activity develops communication skills. Administering anaesthesia and managing postoperative deterioration require supervised clinical training and appropriate professional competence.
Recovery planning begins before the discharge conversation
Postoperative pain management, mobility, nutrition, wound care and practical assistance are examples of elements involved in postoperative recovery. Timing and specifics regarding these components depend on both the nature of the surgery and preoperative assessment. Enhanced recovery refers to a systematic approach to facilitating recovery; enhanced recovery is not universally applicable in terms of a timed process that each patient must adhere to without instructions from their own team.
The discharge plan should specify arrangements for follow-up appointments, prescribed medicines, activity advice and methods to access assistance if there are discrepancies between actual recovery progress and predicted recovery progress. Prior to discharging the patient, inquire whether they believe they are capable of performing that plan in accordance with their circumstances. To review this concept, determine a specific practical need recognized preoperatively which led to establishing support postoperatively. This illustrates a tangible application of continuity of care as opposed to a conceptualized goal.
Check your understanding
A short quiz, with an explanation after each answer.
Which period does perioperative care cover?
Return to the section you found hardest and explain its example without looking at the page. Check the explanation, then repeat the quiz later. Being able to describe the reasoning is more useful than remembering the position of a correct answer.