What does your surgical admission process look like? Is it written down and does every veterinary nurse follow the same steps?
Different hospitals have different procedures they follow when booking in and admitting patients for surgical procedures. This is a little insight into how that might go!
Part 1: Pre-Admission
Part 2: Admission
Part 3: Discharge
Part 4: Follow-Up
Part 1: Pre-Admission
1. Patient Examination
Ideally, your patient will have a consultation with a Vet where a particular procedure is deemed necessary and discussed with and agreed to by the Owner.
2. Surgical Estimate
A detailed estimate must be created for this procedure, including any medications that might be required s well as 10-20% leeway in case of additional drugs, medication and/or surgery time.
A client would rather be estimated more and pay less than the other way around.
3. Confirm Booking
Once the client has had the estimate explained to them, you must ensure that the surgery date and operating Vet are confirmed and an admission time is booked in.
4. Pre-Op Instructions
A list of instructions should be provided to the owner. This should include fasting details, availability to water, any meds that should or shouldn’t be given on the day and any records or paperwork to be brought in on the day of the surgery.
Part 2: Admission
1. Health Check
The admissions nurse is to take the weight of the patient and perform a TPR.
2. Pre-Op Instructions
Confirm fasting instructions have been followed, if the patient has any symptoms of vomiting, diarrhoea or coughing and what, if any, medications the patient has been given on the day prior to admission.
3. Confirm Procedure
Always re-confirm that the owner knows what procedure is taking place and the estimate discussed.
4. Location
Confirm with the owner the site of surgery. If multiple sites/lumps require surgery, the admissions nurse should ensure these locations are clipped (where possible) and/or marked with a surgical marker pen.
5. Consent Form
Ensure the client reads through the surgical consent carefully and signs the term agreement. Ensure the client details are correct and add any additional contact details that are relevant for THAT DAY.
6. Other Considerations
a) Any amendments needing to occur to the surgical procedure and/or estimate that goes beyond the client’s consent must be verbally conveyed to them via phone call BEFORE they are actioned, unless in an emergency. The estimate can then be amended after verbal consent has been given.
b) A phone call with an update should be made to the client once their pet is in recovery where a discharge appointment should also be booked in.
Part 3: Discharge
1. Health Check
Patients should be walked (where appropriate), cleaned and ready to go by the discharge time.
2. Nurse Discharge
Wherever possible, the nurse who assisted in the surgery should be discharging their own patient. This ensures any questions the client may have regarding the surgery or how it went can be answered immediately, accurately and in detail.
3. Notes
Always ensure a printed version of the post-op care notes is given to the client.
4. Post-Op Care
In addition to the printed instructions, the discharge nurse should go through:
- Any relevant results/outcomes from the day’s procedure
- Wound care and e-collar use
- Bandage care and removal
- Food and water instructions
- Exercise/rest recommendations
- Any follow-up checks required
5. Medications
The discharging nurse should always go through the medications the patient had whilst in hospital, as well as explain any take-home medications. Always go over the label and confirm the client understands how to administer the medications, how often they should be given and when to begin giving them.
6. Expectations
Clients should be made aware of things that they can expect as being normal for the particular procedure, and what to look out for as abnormal.
7. Questions
Give the owner an opening to ask any questions they may have for you.
8. Time to go home
Only once all the details of post-operative care and instructions have been relayed to the owner should you bring in their pet. Clients will pay more attention to your instructions without the distraction of their pet in the room.
Show them the surgical site where possible so they are aware of its location.
Part 4: Follow-Up
1. Phone Call
A post-op phone call should be made for every patient the day following a surgery or procedure, or the day following their discharge from the hospital.
This phone call allows you to ensure:
- Your patient is eating, drinking and toileting as normal,
- Your patient is bright alert and their normal self,
- Your patient is comfortable and free of pain,
- The client is complying with post-operative instructions.
- The surgery site is clean and dry and there are no signs of redness, swelling, discharge, etc.
- The client is not having any issues administering their pet’s medications,
- There have been no adverse reactions to any of the medications e.g. vomiting or diarrhoea
- The client is happy with how their pet is recovering as well as the service you have provided throughout the surgical and post-op process.
If you’re in doubt or an owner seems concerned, offer a post-op check-up, even to just ease their mind.
REMEMBER…
Often clients might feel concerned about their pet after a procedure but will hold off calling the vet for fear of ‘bothering’ us with something that ‘is probably nothing’.
Many post-operative complications (however big or small) can be quickly dealt with when discovered early. And this phone call serves to do just that. Instead of the owner stressing over whether they should call us or not, we take the initiative and make the call for them.
Any questions or comments about this or your current Surgical Procedure Admission Process? As Mel in the Comments section below…
