Pre-admission Clinic Research Articles

Role of pre-admission clinic and emergency department pharmacists in medication reconciliation

Role of pre-admission clinic and emergency department pharmacists in medication reconciliation

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update.

Nurse-led preadmission clinics or services have been implemented in many health services as a strategy to facilitate the admission and assessment of booked surgical cases. In order to provide the most recent available evidence, this systematic review is an update of our previous review published in 2010. The objective of this review was to integrate recent research with a previously published systematic review on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes. The review considered studies that included adult or pediatric patients who were undergoing any type of elective surgical procedure, either as a day-only case or as an inpatient. The review considered studies that evaluated the effect of attending or receiving the services of a nurse-led elective surgery outpatient preadmission or preoperative assessment clinic. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: length of stay, cancellation of surgery, incidence of non-attendance for scheduled surgery, mortality, morbidity, adverse surgical events, preoperative preparation, recognition and fulfilment of postoperative care needs, patient anxiety and patient or parent satisfaction. TYPES OF STUDIES: The review update considered any randomized controlled trials published after 2009; in the absence of randomized controlled trials other research designs, such as non-randomized controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence regarding the effectiveness of nurse-led preoperative assessment services. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in each component of this review. Methodological validity was assessed by two reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Due to the clinical heterogeneity of the included studies, no statistical pooling was possible and all results are presented narratively. Four new studies were identified from searches and added to the 19 studies from the previous review for a total of 23 studies. There is weak evidence to suggest nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, length of stay, adverse surgical events and morbidity. Similarly weak evidence suggests nurse-led preadmission services may improve patient preparation, recognition of postoperative needs and patient/parent satisfaction. While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low.

Neutrophil Lymphocyte Ratio as a predictor of systemic inflammation - A cross-sectional study in a pre-admission setting.

Background: Neutrophil:lymphocyte ratio (NLR) is an emerging biomarker that is used to predict postoperative mortality and morbidity in cardiac and cancer surgeries. The association of this biomarker with systemic illness and its usefulness in risk assessment of preoperative patients has not been fully elucidated. Objectives: To determine the prevalence of elevated NLR in preoperative patients and to examine the relationship between elevated NLR and the presence of systemic illnesses as well as anaesthesia risk indices such as American Society of Anesthesia (ASA) and the revised cardiac risk index (RCRI) scores. Design: Cross-sectional study Setting: Anaesthesia pre-admission clinic, Toronto Western Hospital, Toronto, Canada Patients: We evaluated 1117 pre-operative patients seen at an anesthesia preadmission clinic. Results: NLR was elevated (>3.3) in 26.6% of target population. In multivariate analysis, congestive cardiac failure, diabetes mellitus and malignancy were independent risk factors predicting raised NLR. After regression analysis, a relationship between NLR and ASA score (Odds Ratio 1.78; 95% CI: 1.42-2.24) and revised cardiac risk index (RCRI, odds ratio 1.33; 95% CI: 1.09-1.64, p-value: 0.0063) was observed. Conclusions: NLR was elevated (> 3.3) in 26.6% of patients. Congestive cardiac failure and malignancy were two constant predictors of elevated NLR at >3.3 and > 4.5. There was a strong association between NLR and anesthesia risk scoring tools of ASA and RCRI.

Neutrophil Lymphocyte Ratio as a predictor of systemic inflammation - A cross-sectional study in a pre-admission setting.

Neutrophil:lymphocyte ratio (NLR) is an emerging biomarker that is used to predict postoperative mortality and morbidity in cardiac and cancer surgeries. The association of this biomarker with systemic illness and its usefulness in risk assessment of preoperative patients has not been fully elucidated. To determine the prevalence of elevated NLR in preoperative patients and to examine the relationship between elevated NLR and the presence of systemic illnesses as well as anaesthesia risk indices such as American Society of Anesthesia (ASA) and the revised cardiac risk index (RCRI) scores. Cross-sectional study Setting: Anaesthesia pre-admission clinic, Toronto Western Hospital, Toronto, Canada Patients: We evaluated 1117 pre-operative patients seen at an anesthesia preadmission clinic. NLR was elevated (>3.3) in 26.6% of target population. In multivariate analysis, congestive cardiac failure, diabetes mellitus and malignancy were independent risk factors predicting raised NLR. After regression analysis, a relationship between NLR and ASA score (Odds Ratio 1.78; 95% CI: 1.42-2.24) and revised cardiac risk index (RCRI, odds ratio 1.33; 95% CI: 1.09-1.64, p-value: 0.0063) was observed. NLR was elevated (> 3.3) in 26.6% of patients. Congestive cardiac failure and malignancy were two constant predictors of elevated NLR at >3.3 and > 4.5. There was a strong association between NLR and anesthesia risk scoring tools of ASA and RCRI.

Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery

BackgroundClinical interventions aimed at reducing the incidence of postoperative pulmonary complications necessitate patient engagement and participation in care. Patients’ ability and willingness to participate in care to reduce postoperative complications is unclear. Further, nurses’ facilitation of patient participation in pulmonary interventions has not been explored. ObjectiveTo explore patients’ ability and willingness to participate in pulmonary interventions and nurses’ facilitation of pulmonary interventions. DesignSingle institution, case study design. Multiple methods of data collection were used including preadmission (n=130) and pre-discharge (n=98) patient interviews, naturalistic observations (n=48) and nursing focus group interviews (n=2). SettingA cardiac surgical ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. ParticipantsOne hundred and thirty patients admitted for cardiac surgery via the preadmission clinic during a 1-year period and 40 registered nurses who were part of the permanent workforce on the cardiac surgical ward. Outcome measuresPatients’ understanding of their role in pulmonary interventions and patients’ preference for and reported involvement in pulmonary management. Nurses’ facilitation of patients to participate in pulmonary interventions. ResultsPatients displayed a greater understanding of their role in pulmonary interventions after their surgical admission than they did at preadmission. While 55% of patients preferred to make decisions about deep breathing and coughing exercises, three-quarters of patients (75%) reported they made decisions about deep breathing and coughing during their surgical admission. Nurses missed opportunities to engage patients in this aspect of pulmonary management. ConclusionsPatients appear willing to take responsibility for pulmonary management in the postoperative period. Nurses could enhance patient participation in pulmonary interventions by ensuring adequate information and education is provided. Facilitation of patients’ participation in their recovery is a fundamental aspect of care delivery in this context.

Use of Negative-Pressure Wound Dressings to Prevent Surgical Site Complications After Primary Hip Arthroplasty: A Pilot RCT.

Negative-pressure wound therapy (NPWT) is increasingly used for primary surgical incisions despite the paucity of evidence. Study objectives were to assess the use of NPWT on surgical sites to prevent infections and other wound complications after elective primary hip arthroplasty and to consider feasibility of a larger trial. A nonmasked, randomized controlled pilot trial. Patients were recruited preoperatively from the preadmission clinic of an Australian hospital during 2013-2014. Computer-generated randomization was performed with allocation concealed until completion of surgery. The intervention group received NPWT (PICO) while the control group received the standard care hydrocolloid, reinforced with 2 absorbent dressings. Patients were followed for 6 weeks for postoperative complications (infection, length of stay, readmission) and skin complications (bruising, seroma, hematoma, dehiscence). Feasibility end points included numbers recruited, randomized, and followed up; fidelity; and costs. Of 77 people approached, 76 were recruited, and 70 were randomized. Of 35 in the negative-pressure group, 2 received the standard dressing. Attrition at 6 weeks exceeded 10% in both groups. Dressing costs were lower in the control group ($3.01/d vs $38.40/d); SSI incidence was 2/35 in the NPWT and 3/35 in the control group (intention to treat: risk ratio [RR] = 0.67; 95% confidence interval [CI] = 0.12-3.7; P = .65). NPWT patients experienced more postoperative wound complications (RR = 1.6; 95% CI = 1.0-2.5; P = .04). A reduction of 3% in SSI incidence suggests that a definitive trial requires approximately 900 patients per group. Yet there is uncertainty around the benefit of NPWT after elective hip arthroplasty.

Long-term quit rates after a perioperative smoking cessation randomized controlled trial.

While surgery and perioperative smoking cessation interventions may motivate patients to quit smoking in the short term, it is unknown how often this translates into permanent cessation. In this study, we sought to determine the rates of long-term smoking cessation after a perioperative smoking cessation intervention and predictors of successful cessation at 1 year. We previously reported short-term results from a perioperative randomized controlled trial comparing usual care with an intervention involving (1) brief counseling by the preadmission nurse, (2) smoking cessation brochures, (3) referral to a telephone quitline, and (4) a free 6-week supply of transdermal nicotine replacement. We now report our 1-year follow-up outcomes. Between October 2010 and April 2012, 168 patients were randomized. At 1 year, 127 patients (76%) were available for follow-up telephone interview. Smoking cessation occurred in 8% of control patients compared with 25% of patients in the intervention group (relative risk, 3.0; 95% confidence interval [CI], 1.2-7.8; P = 0.018). The number needed-to-treat to achieve smoking cessation for 1 patient at 1 year postoperatively was 5.9 (95% CI, 3.4-25.9). Multivariable logistic regression modeling found that the intervention (P = 0.020) and lower nicotine dependency at baseline (P < 0.001) were predictive of success at smoking cessation at 1 year. Poisson regression showed that adjusted for nicotine dependency, those randomized to the intervention group were 2.7 times (95% CI, 1.1-6.7; P = 0.028) more likely to achieve long-term cessation than those in the control group. Adjusted for randomization group, a low level of nicotine dependency resulted in a relative risk of quitting of 5.1 (95% CI, 2.0-12.8; P = 0.001). This study demonstrates that an intervention designed for a busy preadmission clinic results in decreased smoking rates not only around the time of surgery but also continued benefit in smoking cessation at 1 year. Perioperative care providers have a unique opportunity to assist patients in smoking cessation and achieve long-lasting results.

Patient satisfaction from two studies of collaborative doctor-pharmacist prescribing in Australia.

Pharmacist prescribing has been introduced in several countries and is a possible future role for pharmacy in Australia. To assess whether patient satisfaction with the pharmacist as a prescriber, and patient experiences in two settings of collaborative doctor-pharmacist prescribing may be barriers to implementation of pharmacist prescribing. Surveys containing closed questions, and Likert scale responses, were completed in both settings to investigate patient satisfaction after each consultation. A further survey investigating attitudes towards pharmacist prescribing, after multiple consultations, was completed in the sexual health clinic. A surgical pre-admission clinic (PAC) in a tertiary hospital and an outpatient sexual health clinic at a university hospital. Two hundred patients scheduled for elective surgery, and 17 patients diagnosed with HIV infection, respectively, recruited to the pharmacist prescribing arm of two collaborative doctor-pharmacist prescribing studies. Consultation satisfaction response rates in PAC and the sexual health clinic were 182/200 (91%) and 29/34 (85%), respectively. In the sexual health clinic, the attitudes towards pharmacist prescribing survey response rate were 14/17 (82%). Consultation satisfaction was high in both studies, most patients (98% and 97%, respectively) agreed they were satisfied with the consultation. In the sexual health clinic, all patients (14/14) agreed that they trusted the pharmacist's ability to prescribe, care was as good as usual care, and they would recommend seeing a pharmacist prescriber to friends. Most of the patients had a high satisfaction with pharmacist prescriber consultations, and a positive outlook on the collaborative model of care in the sexual health clinic.

Obstructive Sleep Apnea Syndrome-Prevalence and Screening in the Preadmission Clinic

Objective: The aim of this study was to evaluate the suitability of 2 different screening methods for the detection of obstructive sleep apnea syndrome (OSAS) in the preadmission clinic at a university hospital. Methods: Patients were screened for OSAS using 2 different methods. Method 1: If they were deemed conspicuous by answering three specific medical history questions (daytime sleepiness, snoring and BMI (body mass index)), the patients hat to fill in the Epworth Sleepiness Scale (ESS). Method 2: All patients had to fill in the ESS. An ESS-score of 10 or higher was deemed conspicuous and regarded as a high risk for OSAS. The length of hospital stay of these patients was compared to a matched non OSAS group. Results: Of the 4355 (100%) patients evaluated with method 1, 109 (2.5%) had a known OSAS and 631 (14.5%) had to fill in the ESS-Score in consequence of the 3 specific medical history questions. 82 (13% of the 631 patients) of them reached a score ≥ 10, which equals 1.9% of all patients screened with method 1. At least 191 (4.4%) of all patients who were screened with method 1, were declared as conspicuous. Of the 3415 (100%) patients detected with method 2, 115 patients (3.35%) had a known OSAS. 115 patients (3.35%) achieved an ESS score ≥ 10. Thus 230 patients (6.7%) screened with method 2 were classified as conspicuous. The deviation of mean hospital stay was significantly higher in the group of conspicuous patients compared to the inconspicuous patients. Conclusion: At the pre-admission clinic more patients with OSAS or high risk for OSAS were detected using a standardized screening tool (ESS-Questionnaire) compared to specific questions alone. Due to the increased risk for perioperative complications, the preoperative detection is essential for perioperative management and to initiate further diagnostics and therapy.

Measuring height in recumbent critical care patients.

Estimates of the height of patients in the intensive care unit are required to adhere to clinical guidelines for drug dosages, ventilatory support, and nutrition. The gold standard of standing height cannot be used because these patients are often unconscious and recumbent. The ability of physiotherapists or dietitians to measure height in unconscious, recumbent patients has not been evaluated. To compare the accuracy of physicians, physiotherapists, and dietitians in estimating the height of recumbent critical care patients by using existing practice methods. A total of 35 patients were recruited from the cardiothoracic preadmission clinic, where standing height is routinely measured by a physiotherapist. After surgery, in the intensive care unit, 1 physician, 2 physiotherapists, and 2 dietitians measured each recumbent patient's height. Three methods were used: observation, whole-body measurement, and height estimated by using length of the forearm and the British Association for Parenteral and Enteral Nutrition normative chart. Difference from standing height was measured from zero and was compared across professions and methods, with zero indicating no difference. Overall, 17 physicians, 4 dietitians, and 9 physiotherapists consented to measure patients. After adjustments for method, measurements by physiotherapists did not differ significantly from the gold standard (P = .59), whereas those of physicians (P = .02) and dietitians (P < .001) did. Physiotherapists' measurements of supine height of recumbent critical care patients, obtained by using a nonrigid measuring tape, are more accurate than measurements obtained by physicians and dietitians.

Enhancing the pre-admission process for a patient with breast cancer

Objective: The purpose of this paper is to detail the development and implementation of a patient focused pre-admission process, part of which is the check list identified within this paper and comprising the main point of the paper because it is based on patient and publication evidence for women with breast cancer. Women with breast cancer together with health professionals had specific input into the designed pre-admission clinic at a tertiary care hospital. A pre-admission clinic had been established some time ago however, women who attended this clinic deemed it most unsatisfactory for their needs. Results from an evaluation provided information that indicated women with breast cancer required an improved pre-admission process that was aligned to their needs and those of the Breast Cancer Multidisciplinary Team (BCMT). Setting: A large tertiary care hospital in Sydney, New South Wales, Australia. Subjects: Fifty (50) women of mixed cultures. Men can be diagnosed with breast cancer however, throughout this project, women were the only patients presenting for surgery. Primary Argument: Even though remarkable progress has been made in breast cancer survival through medical treatment, women, newly diagnosed with breast cancer are frequently concerned, stressed and anxious as they attempt to come to terms with the news on their cancer diagnosis. Beside the initial medical consultation that informs them on their diagnosis, the women’s first major interaction with the healthcare system commences when they attend the preadmission clinic as a pre-admitted person. Therefore it is appropriate to examine current nursing practices during the pre-admission phase of a Tertiary Hospital so women, newly diagnosed with breast cancer are able to receive appropriate and supportive care. The goal of health professionals is to respect each patient and give voice to them by developing a specifically designed pre-admission process. It is expected any pre-admission process will utilise available evidence and include consultation with the Breast Cancer Multidisciplinary Team (BCMT). Thus the project commenced by identifying the needs of women with breast cancer in consultation with the BCMT, including nurses, physiotherapists, doctors and social workers. This evidence based approach to best practice in the pre-admission process and clinic has not been attempted previously for this cohort of patients. Conclusion: Improving the pre-admission process of patients encourages analysis of the evidence that is appropriate for this cohort and nursing practices. In addition, it offered time to ensure applicability of the pre-admission process and clinic to the lives of the women concerned. During this project opportunities arose for reflection on the journey women follow after their diagnosis and the involvement of the BCMT. Moreover, this process encouraged examination of the most appropriate allocation and use of resources within the context of the pre-admission process and clinic, surgery, and discharge through to home follow up. This paper maps some of the adopted process, the collected data and briefly summarises resources utilised in relation to the pre-admission process.

Parental Satisfaction in Pediatric Daycare Surgery

Parental Satisfaction in Pediatric Daycare Surgery

Same-day discharge after angioplasty for peripheral vascular disease: Is it a safe and feasible option?

Peripheral vascular disease affects 20% of the population >55 years of age. Patients who become symptomatic are managed by a number of technique's including medical management, percutaneous angioplasty, bypass surgery, and in nonreconstructable situations, limb amputation. Clinicians treating patients by means of angioplasty have traditionally carried out these procedures on an inpatient basis. Limited resources and pressure on the availability of inpatient beds has necessitated clinicians to reevaluate how many of these patients are managed. Treating suitable patients as day cases is an attractive option that frees up resources and is financially advantageous. This paper examines the feasibility of same-day discharge after angioplasty, with a particular emphasis on achieving safe patient outcomes. It explores how advances in endovascular technologies and techniques have contributed to making same-day discharge an ever more feasible option. Nurse led pre-admission clinics run by specialist nurses facilitate safe and appropriate patient selection, where patients at risk for postprocedural problems can be identified effectively based on predefined clinical criteria.

Use of Xpert® MRSA PCR point-of-care testing beyond the laboratory

A meticillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction assay (Xpert(®) MRSA, Cepheid) was assessed for point-of-care testing (POCT) used by healthcare assistants in an orthopaedic pre-admission clinic and on a vascular ward to reduce turnaround time. POCT results were compared with the routine swabs taken for culture. The POCT assay was easy to use, the turnaround time for negative results was greatly reduced, and sensitivity was 75.0% in the pre-admission clinic and 80.0% in the vascular ward. There were 27 POCT-positive/culture-negative results, but there was no evidence of MRSA infection or colonization in these patients for at least a year post procedure. POCT for MRSA colonization performed beyond the laboratory has important advantages over laboratory-based methods and should be explored further.

G421(P) Single centre experience of the use of Entonox for urethral and rectal catheter insertion for video-urodynamic investigation

Aim:Catheter placement to allow video-urodynamics (VUD) to be performed can be uncomfortable and embarrassing for young people. Traditionally at our unit children requiring urethral and rectal catheter insertion for VUD...

Ultrasound-guided Multilevel Paravertebral Blocks and Total Intravenous Anesthesia Improve the Quality of Recovery after Ambulatory Breast Tumor Resection

Regional anesthesia improves postoperative analgesia and enhances quality of recovery (QoR) after ambulatory surgery. This randomized, double-blinded, parallel-group, placebo-controlled trial examines the effects of multilevel ultrasound-guided paravertebral blocks (PVBs) and total intravenous anesthesia on QoR after ambulatory breast tumor resection. Sixty-six women were randomized to standardized general anesthesia (control group) or PVBs and propofol-based total intravenous anesthesia (PVB group). The PVB group received T1-T5 PVBs with 5 ml of 0.5% ropivacaine per level, whereas the control group received sham subcutaneous injections. Postoperative QoR was designated as the primary outcome. The 29-item ambulatory QoR tool was administered in the preadmission clinic, before discharge, and on postoperative days 2, 4, and 7. Secondary outcomes included block success, pain scores, intra- and postoperative morphine consumption, time to rescue analgesia, incidence of nausea and vomiting, and hospital discharge time. Data from sixty-four patients were analyzed. The PVB group had higher QoR scores than control group upon discharge (146 vs. 131; P < 0.0001) and on postoperative day 2 (145 vs. 135; P = 0.013); improvements beyond postoperative day 2 lacked statistical significance. None of the PVB group patients required conversion to inhalation gas-based general anesthesia or experienced block-related complications. PVB group patients had improved pain scores on postanesthesia care unit admission and discharge, hospital discharge, and postoperative day 2; their intraoperative morphine consumption, incidence of nausea and vomiting, and discharge time were also reduced. Combining multilevel PVBs with total intravenous anesthesia provides reliable anesthesia, improves postoperative analgesia, enhances QoR, and expedites discharge compared with inhalational gas- and opioid-based general anesthesia for ambulatory breast tumor resection.

Does Preoperative Oral Carbohydrate Reduce Hospital Stay? A Randomized Trial

Oral carbohydrate-rich fluids are used preoperatively to improve postoperative recovery, but their effectiveness for reducing length of hospital stay is uncertain. We assessed the effectiveness of preoperative loading with carbohydrates on the postoperative outcomes of 44 patients scheduled for elective colorectal surgery who were randomly allocated to a carbohydrate-rich fluid group or a usual care group during their preadmission clinic visit. Our primary outcome was the time patients required to be ready for discharge. Patients in the control group spent an average of 4.3 days (95% confidence interval [CI], 3.2-5.7) in the hospital and patients in the carbohydrate-rich fluid group spent 4.1 days (95% CI, 3.2-5.4) in the hospital until they met discharge criteria (P = .824). We found that the safety of administering preoperative oral carbohydrate-rich fluids is supported, but we were unable to confirm or refute the benefit of this treatment regimen for contributing to shorter hospital stays after elective colorectal surgery.

A wellness program for cardiac surgery improves clinical outcomes

ObjectiveTo evaluate the efficacy of an Integrative Cardiac Wellness Program (ICWP) for cardiothoracic surgery patients on postoperative recovery, bleeding risk, satisfaction and participation in rehabilitation programs. DesignAn open label study whereby ICWP participants were compared to a historical control group that received usual care at the same hospital. MethodsPatients enrolled at pre-admission clinics took metabolic supplements (CoQ10, magnesium orotate, alpha lipoic acid, omega 3 fatty acids) three times daily from enrolment until surgery and for 4 weeks afterwards. Between postoperative days 3–7, patients received individualised health education from a naturopath followed by a phone call post-discharge. The control group consisted of elective cardiothoracic patients receiving usual care prior to the ICWP commencing. Data was collected from medical records, a survey and interviews. ResultsData from 922 patients were analysed. ICWP participants (n=337) were well matched with controls (n=585) for age, gender and history of hypertension, hypercholesterolaemia, diabetes and smoking.Multivariate analysis found that CABG ICWP patients had a relative reduction of 42% for postoperative inotrope (cardiac stimulants) support compared to controls (p<0.001). Similarly, the ICWP valve surgery patients had 40% relative reduction in the incidence of postoperative inotrope support compared to controls (p=0.02).There was no significant difference between the treatment and control groups in the incidence of serious bleeding events, defined as return to theatre due to haemorrhage or blood transfusion requirements.ICWP patients gave positive feedback of their experience and there was a 46% increase in attendance at rehabilitation programs compared to controls (p=0.033). ConclusionsThe ICWP is safe, improves postoperative heart function, is well accepted by patients and has long-term patient benefits by improving attendance at rehabilitation.

Using Prospective Analysis to Improve Quality Care in the Surgical Patient with Diabetes

An insulin-using patient with diabetes who required surgery was identified by those caring for the individual to be at high risk of receiving fragmented care due to the focus of the admission being surgical. A formal review of our current process was undertaken using the Failure Modes and Effects Analysis (FMEA) methodology. Through this systematic review, potential failure modes and their potential effects were identified. These were ranked according to severity, frequency and detectability. Four major potential failures were identified: 1) pre-operative instructions were being given to the patient verbally, with no copy available for reference on the day of surgery; 2) the transfer of information from the OR to the internist providing post-operative care was lacking; 3) transfer of information from the pre-operative assessment to the post-operative internist providing care was lacking; 4) staffing of pharmacists at pre-admission clinics was inconsistent. The impact of these potential failures was that this group of patients arrived at the post-operative unit with poor management of their diabetes care resulting in patients requiring treatment for preventable problems, such as hypoglycemia. The outcomes of the FMEA process were: 1) implementation of a double copied medication instruction sheet completed during the pre-admission clinic visit with a copy provided to the patient and a copy placed on the chart; 2) a pre-printed order set, to be completed at the pre-admission visit, with orders for post-operative diabetes care to be implemented at the authorization of the anaesthetist and 3) review of pharmacy staffing in the pre-admission clinic.

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update protocol

Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update protocol