Pre-Operative Patient Preparation

Pre-Operative Patient Preparation

• Hygiene: Assist patient with personal care, remove nail polish and makeup, and hair removal (depilatory creams or clippers, not shaving unless required by surgeon, done close to procedure). Document skin condition and preparation method.
• Attire: Assist patient into a clean hospital gown.
• Vital Signs and Assessment: Assess and record patient's physical and emotional status, vital signs. Report untoward signs, symptoms, and extreme apprehension to the surgeon.
• Menses: Inform circulating nurse of menstruating patients to avoid confusion with vaginal bleeding. Use sanitary pads.
• Personal Belongings: Allow family to take valuables. Secure wedding rings (tape or tie). Store ambulatory patient clothing in a locker; bag and mark all items with patient name and date. Document disposition of belongings.
• Prostheses: Remove all removable prosthetics (eyes, limbs, contact lenses, eyeglasses, dentures, bridges) for safekeeping. Dentures may be permitted during local anesthesia. Hearing aids may be allowed, and contact lenses should be removed prior to general anesthesia.
• Hair: Long hair may be braided; wigs removed or covered with a cap; remove hairpins.
• Anti-embolic Stockings: Apply for patients with varicose veins, thrombophlebitis, or history of emboli, and for some geriatric patients, and for longer procedures.
• Voiding: Encourage patients to void prior to surgery, especially for abdominal or pelvic procedures. Record time of voiding; double check that a urine specimen is not needed before discarding urine. Foley catheter insertion may be performed in OR post-anesthesia.
• Spiritual Needs: Allow for religious symbols; permit family/significant others to stay with patient until OR. Some hospitals allow parents to accompany infants/children.
• Allergies and Special Orders: Note any allergies according to institutional policy and any special orders like NG tubes, IV fluids, or antiembolic stockings; correctly identify patient, bed, and chart.
• Consent: Ensure preoperative consent form is signed, witnessed, and dated. Document any advance directives.
• Transport: Place patient on a stretcher with elevated side rails and safety restraints.

Admitting Patient to the OR

• Transport: Individual transporting patient must have patient details; stretcher must have side rails, safety belt/straps, and an infusion pole.
• Reception: Nurse greets patient in the OR receiving area; verify patient identity (address by name if conscious).
• Patient Verification: Verify patient's identity with identification bracelet or chart; verify surgical procedure, site, and surgeon with patient/family (as appropriate).
• Chart Review: Verify chart completeness, lab results, last meal/drink time, premedication given and effects.
• Informed Consent: Ensure informed consent has been obtained, consent form is signed, witnessed, and dated.
• Holding Area: Patient admitted to the holding area for observations and assessment. Nurse performs tasks (cap, warm blanket, patient verification, team notification, chart review, pre-procedure vital signs, allergy/medication history, skin tone/integrity, and physical/mental state assessments).
• Procedural Information: Inform patient about procedures. Provide privacy. Remove body hair (if ordered). Reassure and answer questions (address anxiety).
• Comfort/Environment: Adjust blanket if too warm/moisturize lips if dry. Explain any delays or unusual circumstances. Create a quiet, restful atmosphere with appropriate music/earphones. Minimize extraneous noises.
• IV Line: Ensure intravenous line is in place and functioning.
• Patient Transfer: Transfer patient to OR once prepared.

Surgical Site Verification

• Consent: Recheck consent information.
• Site Clarification: Ask patient to describe/clarify procedure and point to the site.
• Marking: Marking of the procedure site (laterality, surface, levels, digits, lesions, bilateral procedures not needing markings) in the pre-procedure area must occur before entering OR.
• Indelible Marking: Use indelible markers; do not use stickers. Eye procedures have an indelible dot; ear procedures have a mark behind the ear.
• Alternatives: For anatomically impossible marking, use coloured arm bands.