PATIENT PRE-SURGICALINSTRUCTION PACKET

180 SOUTH FRONTAGE ROAD WEST VAIL, CO 81657(970) 476-2451 VAILHEALTH.ORG

TABLE OF CONTENTSWELCOME AND THANK YOU FROM VAIL HEALTH .........................................................................................................................................3

Pre-Surgical CheckList .........................................................................................................................................................................................4

Step 1: Pre-Surgical Interview ..........................................................................................................................................................................5

Step 2: Hibiclens Soap .......................................................................................................................................................................................5

Step3:ConfirmSurgeryTime .........................................................................................................................................................................5

Step4:GettingReadyforSurgery ................................................................................................................................................................5

Step5:PainManagementAfterSurgery...What to Expect .............................................................................................................6

Step6:ManagePossibleProblemsorSideEffectsAfterSurgery ................................................................................................7

EVERYONE HAS A ROLE IN MAKING HEALTH CARE SAFE .........................................................................................................................8

Speak Up ....................................................................................................................................................................................................................8

PayAttention .............................................................................................................................................................................................................9

EducateYourself ....................................................................................................................................................................................................9

Have an Advocate ..................................................................................................................................................................................................9

Know Your Medications .....................................................................................................................................................................................9

Participate in Decisions ......................................................................................................................................................................................9

WHAT IS VAIL HEALTH DOING TO MAKE SURGERY SAFER? ..................................................................................................................10

PatientandFamilyHelpline ...........................................................................................................................................................................10

PATIENT PRE-SURGICAL INSTRUCTION PACKET VAILHEALTH.ORG | 2

Thank you for choosing Vail Health for your surgical needs.Ourknowledgeablestaffisdedicatedtomakingpatientsfeelascomfortableaspossible. Thisstep-by-stepinstructionpackethasbeencreatedasaresourcetoprepareyouandyourfamily membersorcaregiversforsurgery.Inaddition,ourstaffwillguideyouthroughoutthesurgicalprocess.

WELCOME &THANK YOUFROM VAIL HEALTH

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Pre-Surgical ChecklistPlease use this check list as a guide throughout the surgical process.

q Initial consult with surgeon q Surgical Date q Time q Youwillbenotified48-24hourspriorto

surgicaldateoftheexacttimetoarriveat the Vail Health Hospital.

q Does your surgeon require a pre-operative evaluation from your primary care physician?

q The pre-operative evaluation is not alwaysnecessaryanddependsuponyourindividualhealthneeds.

q Dateandtimeofappointment

q Besuretoknowifthesurgeonisrequestingspecifictestingorlabresults.

q Does your surgeon require a pre-operative evaluation from a specialist such as a Cardiologist or Pulmonologist?

q Dateandtimeofappointment

q Besuretoknowifthesurgeonisrequestingspecifictestingorlabresults.

q Pre-Surgical Phone Interview with Vail Health.

q Youwillbecontactedtoreviewyourmedicalhistoryforouranesthesiateam.

q Haveyourcurrentmedicationsincludingdosageandfrequencyavailable.

q Hibiclens Soap (4% Chlorhexidine Gluconate)

q Wash 1 q Wash 2

q Wash 3 q Wash4(morningofsurgery)

q Do you have a ride home from the hospital?

q Will you need any medical equipment such as crutches, walker or ice machine?

q Contactyoursurgeon’sofficetoarrange theseitems.

q The night before surgery. q Don’t Eat Anything After Midnight the

nightbeforeyoursurgery. q Smallsipsofwaterareokaythroughout

the night. Stop all fluids 2 hours before you arrivetocheckinforyoursurgery.

q Day of your surgery. q Ifyouwereinstructedtotakeany

medicationsonthemorningof surgery,itisokaytodosowith asmallsipofwater.

q CheckinattheadmissionsdeskonthefirstfloornexttotheEmergencyDepartmentatVailHealth.

q Bringinsuranceinformationandform ofpayment.

q Going home from Vail Health Hospital. q DropoffanyPrescriptionsat

Pharmacylocatedonthefirstfloor ofVailHealthHospital.

q PhysicalTherapyAppointment - Date -Time

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Step 1: Pre-Surgical InterviewOnceyoursurgeryhasbeenscheduled,youwillbecontactedbyanurseinourPre-SurgicalPlanningDepartment,whowillconductaphoneinterview.Thepurposeofthisinterviewistoreviewyourmedicalandsurgicalhistoryfortheanesthesiateam,instructyouonwhatmedicationstotakeonthemorningofsurgeryandprovidepreoperativeinstructions.Thisintakeprocessisaveryimportantstepinpreparingforyoursurgery.Pleasehavethefollowinginformationreadyforthisinterview:• A list of all medications, vitamins and herbal

supplements you are taking (both prescription and over-the-counter), including dose and frequency.

• A list of past surgical procedures.

Step 2: Hibiclens Soap (use for three days leading up to surgery)Skinisnotsterile,andgermsonyourskincanincreasetheriskofinfection.Washingwithaspecialsoap that contains 4% Chlorhexidine has been showntodecreasetheriskofinfection.Pleaseaskyoursurgeon’sofficeforabottle.Itisalsoavailableoverthecounteratyourlocalpharmacy.Followthestepsbelowandshowerdaily,beginningthreedaysbeforesurgeryandthedayofsurgerybeforecomingtothehospital.• Step 1: Washyourhair,faceandbodywithyournormalsoap,shampooandconditioner.

• Step 2: Turnoffwater.• Step 3: PourasmallportionofHibiclenssoapontoaclean,wetwashclothandapplytoyourentirebodyfromtheneckdownavoidingyourface,hairandgenitalia.

• Step 4: Letsoapsitonskinforthreeminutes.• Step 5: TurnonwaterandrinseHibiclenssoapoffyourbody.

• Step 6: Useacleantowelaftereachwash.

Step 3: Confirm Surgery Time Youwillbecontactedbyyoursurgeon’sscheduler24-48hoursbeforeyoursurgerywithanexacttimeto arrive at Vail Health.

Step 4: Getting Ready for Surgery Pleasemakesureallitemsinthefollowingchecklistarecompleted.• Reportanycuts,abrasionsorrashestoyoursurgeonpriortothedayofsurgery.

• Reportanycurrentcoldorflu-likesymptomstoyoursurgeonpriortothedayofcheck-intime.

• Drinkplentyoffluidsthedaybeforeyoursurgery.Aftermidnight,drinkonlysmallsipsofclearfluids(water,applejuice,cranberryjuice).Stopdrinkingallfluidstwohoursbeforeyoursurgery.

• Refrainfromdrinkingalcoholorsmokingfor 24hourspriortosurgery.

• DO NOT EAT ANYTHING AFTER MIDNIGHT (thisincludescandyandchewinggum)

• Takemedicationsthathavebeeninstructedbyyoursurgeonorpre-surgicalplanningnurse.Youmaytakemedicationswithasmallsipofwater.

• Don’tapplylotions,powderordeodoranttoyourbody.• Wearcomfortableclothingtothehospital.• Donotshavehairatornearyoursurgicalsiteforthreedayspriortoyoursurgery.

• Donotwearmake-uporjewelryonthedayofsurgery.• Bringsomethingtoread,watchorlistentointheeventofanunexpecteddelay.

• Donotbringyourmedicationstothehospital.• Dropoffprescriptionsatthepharmacytogetfilled.• Bringallinsuranceinformationandaformofpayment.• Check in to Admissions upon arrival.

Instructions & Helpful Tips for Family Members• Thenursesmayneedafewminutestopreparethepatientforsurgery,atwhichtimeyoumaybeaskedtostayinthewaitingarea.

• Oncethepatientisreadyforsurgery,youmaybeinvitedtositwithhim/herinthepre-operativeareauntilhe/shegoestosurgery.

• Generally,ittakesabout1½hoursfromthepointofadmissionscheck-inuntilthepatientheadstotheoperatingroom.

• Oncethepatientistakentotheoperatingroom,familymemberswillbeprovidedwithinformationonhowtoseetheprogressionofthepatientthroughout the surgical process.

• Thereisawaitingroomlocatedonthe 3rdflooracrossfromthepre-operativearea.

• Thehospitalcafeteriaislocatedinthebasement—Level B.

• Whenthepatientisawakeandreadyforvisitors,youwillreceiveacallfromthenurseinvitingyouintotherecoveryarea.

PATIENT PRE-SURGICAL INSTRUCTION PACKET VAILHEALTH.ORG | 5

Step 5: Pain Management After Surgery... What to Expect Here at Vail Health, we strive to keep all patients as comfortableaspossibleregardlessofthetypeofsurgeryorprocedure.Satisfactorypaincontrolisoneofourtoppriorities,whichiswhyweoffera24-hourAcutePainService,includinganacutepainteamcomprisedofananesthesiologistandnurseavailabletoworkwithyoursurgicalteamandmanageyourpainaroundtheclock.Byusingmultipletechniques,ourgoalistokeepyourpainatatolerablelevel.Wedonotexpectthatyouwillbepain-freeimmediatelyafterorwithinthefirst24-72hoursofsurgery.Ourgoalistocontrolyourpain.

• Pain MedicationsMedicationsarerecommendedforpatientswithsevere and intolerable pain. —Yoursurgeonwillmanageyourhomepain

medicationregimen. —VailHealthoffersanon-sitepharmacyforyour

convenience. —Takeyourmedicationexactlyasitis

prescribed. —It’simportanttodecreaseandeliminatethe

useofpainmedicationsassoonaspossible.• Safety Guidelines for Pain Management —Reportanyreactionsand/orallergiesto

medicationstoyourphysicianornurse. —Ifthepainmedicineisnotprovidingrelief,talk

toyourphysician,nurseorpharmacist. —DONOTdrinkalcoholortakeanyother

medicationsthatmaycausedrowsinesswithoutinformingyourphysicianornurse.

—DONOTdrivewhiletakingpainmedications. —Reportandtreatsideeffectsimmediately.Call

aphysicianifyouexperiencesleepapnea,slowingortroublewithbreathingfromopioids.

Communicating Your Pain Level It’simportantforyoutobeabletodescribeyourlevelofpaintoyourdoctorsandnurses.The10pointpainscaleisastandardizedmethodthatanyhealthcareporganizationsusetohelppatientscommunicatetheirpainlevelbyturningthepainyouarefeelingintoanumericalrating.

At7orhigher,itisimportanttoinformstaffmembers.Itisbeyondtolerableandwilllikelyinterrupteating,sleeping,movementandwillcausecryingormoaning.

Formostpatients,aratingof0-2meanstheyhavenopainorverylittlepain.

Ascoreof3-6indicatesthepainistolerable—youare able to sleep, eat and completephysicaltherapy.

0 Veryhappy,

no pain

1—2Hurts just a little bit

3—4Hurts a

littlemore

5—6Hurts even more

7—8Hurts a

whole lot

9—10Hurtsasmuch

as possible

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Step 6: Manage Possible Problems or Side Effects After Surgery• Constipation—Topreventconstipationwhiletakingpainmedication:

—Increasefiberinyourdietbyeatingfruits,vegetables,wholegrainsandbeans.Ifyoucannotgetenoughfiberfromfood,addafibersupplementtoyourdiet.

—Drinkenoughwater(8-10glassesdaily)andothernon-alcoholic,non-caffeinatedfluidstokeepyoururineclearorpaleyellowincolor.

—Gotothebathroomwhenyouhavetheurgetogo. Do not hold it.

—Takeoneofthefollowingover-the-countermedicationsforaslongasyouaretakingnarcoticpainmedication.Stoptakingitifyoudevelopdiarrhea.(Thefollowingareadultdosages.)

o Docusate 100mg by mouth two times a day o Senna 17.2mg by mouth once a day o Miralax 17g by mouth once a dayIfyoubecomeconstipatedandhavenothadabowelmovementwithintwodays,takeoneofthefollowingover-the-countermedicationsuntilyouresumeanormalbowelregimen.Generally,suppositoriesandenemasworkmorequicklycomparedtopills.Stoptakingifyoudevelopdiarrhea.(Thefollowingareadultdosages.)

—MilkofMagnesia30mLbymouthtwiceaday —MineralOil30mLbymouthonceaday —Magnesiumcitrate150mLbymouthonceaday —Bisacodyl10mgrectallyonceaday —FleetEnema133mLrectallyonceaday• Nausea or Vomiting—Usuallygoesawaywithinafewdaysandcanbepreventedortreatedwithanti-nauseamedicines.Youshouldalsoeatfoodbeforetakinganypainmedication.

• Drowsiness—Usuallygoesawaywithinafewdays.Report severe drowsiness.

• Itching—Usuallygoesawayinafewdaysbutcanrequireswitchingtoanothermedication.

• Deep Vein Thrombosis (DVT) —Deepveinthrombosis(DVT)occurswhenan

abnormalbloodclotformsinalargevein.Theseclotsusuallydevelopinthelowerleg,thigh,orpelvis, but can also occur in other large veins in thebody.

—IfyoudevelopDVTanditisdiagnosedcorrectlyandquickly,itcanbetreated.

—SincethesymptomsofDVTcanbesimilartootherconditions,likeapulledmuscle,thisoftenleadstoadelayindiagnosis.SomepeoplewithDVTmayhavenosymptomsatall.

DVT SIGNS AND SYMPTOMS Thefollowingarethemostcommonandusuallyoccurintheaffectedlimb:

—Recentswellingofthelimb —Skinthatmaybewarmtothetouch —Unexplainedpainortenderness —Rednessoftheskin• Pulmonary Embolism (PE) —DVTcancausealife-threateningcomplication

calledaPulmonaryEmbolism(PE). —Partorallofthebloodclotmaybreakoffand

travelthroughthebloodstreamintothelungs. —Abloodclotinthelungscanbelifethreatening

and can cause death. SIGN & SYMPTOMS OF A PULMONARY EMBOLISM If you have any of these symptoms it is a

MEDICAL EMERGENCY and you should SEEK MEDICAL HELP IMEDIATLEY:

—Recentorsuddenshortnessofbreath —Chestpainordiscomfortthatworsenswitha

deep breath or coughing —Coughingupblood —Suddencollapse BEFORE AND DURING HOSPITALIZATION —Beforesurgerytalktoyourhealthcareprovider

aboutpreventionofbloodclots. —Tellyourhealthcareproviderisyouhaveany

riskfactorsforDVT. —Ifyouhavebeenconfinedtobed,movearound

as soon as possible. —Compressionstockingshelptopreventbloodclots. —SCDsarecompressiondevicesthatwraparound

yourcalf.SDCsinflateanddeflateto“pump”yourcalftokeepyourbloodflowing.

—Anticoagulantmedicationsmayalsobegiventohelp prevent blood clots.

PATIENT PRE-SURGICAL INSTRUCTION PACKET VAILHEALTH.ORG | 7

Bybeinganactive,involvedandinformedmemberofyourhealthcareteam,youplayanimportantroleinmakingyourcaresafe.Researchshowsthatpatientswhotakepartindecisionsabouttheirhealthcarearemorelikelytohavebetteroutcomes.

The following are practical ways you can be an active participant in the safety of your care.

EVERYONE HAS A ROLE IN MAKING

HEALTH CARE SAFEYour health care involves doctors,

nurses, technicians and you.

Speak Up• Ifyouhavequestionsorconcerns,speakup.Ifyoudon’tunderstand,askagain.

• Ask the doctor to initial the area that is to be operatedupon,sothatthere’snoconfusionin theoperatingroom.

• Ifyouthinkyouareabouttoreceivethe wrongmedication,tellthedoctorornurse aboutyourconcern.

• Ifyouthinkthehealthcareprofessionalhasconfusedyouwithanotherpatient,tellhim/herwhoyouareandaskhim/hertoconfirmyouridentity.

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Pay Attention• Tellyournurseordoctorifsomethingdoesn’tseemright.

• Expecthealthcareworkerstointroducethemselveswhentheyenteryourroom.Iftheydon’t,askthemto.Lookfortheiridentificationbadges.

• Noticewhetheryourcaregivershavewashedtheirhands.Handwashingisthemostimportantwaytopreventthespreadofinfections.Don’tbeafraidtoremindadoctorornursetodothis.

• Knowwhattimeofdayyounormallyreceiveamedication.Ifitdoesn’thappen,bringthistotheattentionofyournurseordoctor.

• Makesureyournurseordoctorconfirmsyouridentitybycheckingyourwristbandoraskingyournamebeforehe/sheadministersanymedicationortreatment.

Educate Yourself• Askalldoctorstreatingyouaboutthespecializedtrainingandexperiencethatqualifieshim/hertotreatyou.

• Gatherinformationaboutyourcondition.Goodsourcesincludeyourdoctor,yourlibrary,respected websites and support groups.

• Writedownimportantfactsyourdoctortellsyousothatyoucanlookforadditionalinformationlater.Askyourdoctorifhe/shehasanywritteninformationyoucankeep.

• Thoroughlyreadallmedicalformsandmakesureyouunderstandthembeforeyousignanything.Ifyoudon’tunderstand,askyourdoctorornursetoexplainthem.

• Makesureyouarefamiliarwiththeoperationofanyequipmentthatisbeingusedinyourcare.Ifyouwillbeusingoxygenathome,donotsmokeorallowanyonetosmokenearyouwhileoxygenisinuse.

Have an Advocate• Youradvocatecanaskquestionsthatyoumaynotthinkofwhileyouareunderstress.

• Youradvocatecanalsohelprememberanswerstoquestionsyouhaveasked,andspeakupforyouifyoucannot.

• Makesurethispersonunderstandsyourpreferencesforcareandyourwishesconcerningresuscitationandlifesupport.

• Reviewconsentsfortreatmentwithyouradvocatebeforeyousignthemandmakesureyoubothunderstandexactlywhatyouareagreeingto.

• Makesureyouradvocateunderstandsthetypeofcareyouwillneedwhenyougethomeandknowswhattolookforifyourconditionisgettingworseandwhomtocallforhelp.

Know Your Medications• Askaboutthepurposeofthemedicationandaskforwritteninformationaboutit,includingitsbrandandgenericnames.Alsoinquireaboutthesideeffectsofthemedication.

• Ifyoudonotrecognizeamedication,verifythatitisforyou.Askaboutoralmedicationsbeforeswallowing,andreadthecontentsofbagsofIntravenous(IV)fluids.Ifyou’renotwellenoughtodothis,askyouradvocatetodoit.

• IfyouaregivenanIV,askthenursehowlongitshouldtakefortheliquidto“runout.”Tellthenurseifitdoesn’tseemtobedrippingproperly(toofastor too slow).

• Wheneveryouaregoingtoreceiveanewmedication,tellyourdoctorsandnursesaboutallergiesyouhaveornegativereactionsyouhavehadtomedicationsinthepast.

• Ifyouaretakingmultiplemedications,askyourdoctororpharmacistifitissafetotakethosemedicationstogether.Thisholdstrueforvitamins,herbalsupplementsandover-the-counterdrugstoo.

• Makesureyoucanreadthehandwritingonanyprescriptionswrittenbyyourdoctor.Ifyoucan’treadit,thepharmacistmaynotbeabletoeither.

Participate in Decisions• Youandyourdoctorshouldagreeonexactlywhatwillbedoneduringeachstepofyourcare.

• Knowwhowillbetakingcareofyou,howlongthetreatmentwilllastandhowyoushouldfeel.

• Moretestsormedicationsmaynotalwaysbebetter.Askyourdoctorwhatanewtestormedicationislikelytoachieve.

• Keepcopiesofyourmedicalrecordsfromprevioushospitalizationsandsharethemwithyourhealthcareteam.

• Don’tbeafraidtoseekasecondopinion.Ifyouareunsureaboutthenatureofyourillness/injuryandthebesttreatment,consultwithoneortwoadditional specialists.

• Ask to speak with others who have undergone the procedureyouareconsidering.Theseindividualscanhelpyouprepareforthedaysandweeksahead.

PATIENT PRE-SURGICAL INSTRUCTION PACKET VAILHEALTH.ORG | 9

Ourhealthcareprofessionalsdemonstratetheircommitmenttoqualityandsafetybyprovidingexcellentcareandservicesthatmeetthehigheststandards.VailHealthhasanimpressivelylowinfectionrate.Weincorporatethefollowingstepsandprogramstoensureourpatients’safety.

• PROPER HAND HYGIENE: We wash our hands accordingtotheCentersforDiseaseControlguidelines, using soap and water or waterless alcohol hand sanitizer.

• VERIFICATION: Weverifythecorrectprocedureateverystepinthesurgicalprocess—fromschedulingtotheoperatingroom.

• MARKING:Wemarkthesurgicalsiteinthepreoperative area.

• INFECTION PREVENTION:Weusemeasurestopreventinfectionsuchasclippersinplaceofrazors,preventativeantibiotictreatmentpriortosurgeryandkeepingpatientswarmpriortosurgerytopreventinfection.

• PATIENT INVOLVEMENT: We involve patients in planningandtreatmentfromadmissiontodischarge.

• RAPID RESPONSE TEAM: We have a RapidResponseTeamtobringcriticalcareexpertisetothepatientbedsideifneeded. Familiescanactivatetheteambydialing4444 onanyhospitalbedsidetelephone.

• FALL REDUCTION:OurFallReductionProgramhelpsidentify,preventandeducatepatientsandfamiliesatriskforfalling.

Patient and Family HelplineIfyouhavequestionsorconcernsrelatedtoyourcareorneedhelp,pleasecallourPatient&FamilyHelpLineat(970)477-5222.Pleasecontactyoursurgeonifyouhavemedicalquestionsrelatedtoyoursurgery.

WHAT IS VAIL HEALTH DOING TO

MAKE SURGERY SAFER?Vail Health appreciates that you’ve chosen our care team for your medical needs.

PATIENT PRE-SURGICAL INSTRUCTION PACKET VAILHEALTH.ORG | 10

180 SOUTH FRONTAGE ROAD WEST VAIL, CO 81657(970) 476-2451 VAILHEALTH.ORG