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How to prevent problems with your postoperative information

Accreditation Connection, November 19, 2004

Arm your patients with explicit information on what they should do after surgery. "There shouldn't be much of a problem after hours if your physicians and nurses do a good job with postoperative training for patients," says Pat Jepsen, RN, BS, CCM, administrator at the Surgery Center of Des Moines West in Iowa.

Most patients experience pain after surgeries, but you need to make patients aware of this so they know it is normal and not cause for alarm.

Although postoperative information will vary depending on the surgery, Jepsen suggests facilities give all patients the following instructions:

* If given medication for pain, take it so your pain isn't overwhelming
* Rest if you've had anesthesia
* Don't drive if you've had anesthesia
* Avoid signing important documents following anesthesia
* Refrain from making important decisions after you've had anesthesia

If your patient has had anesthesia, talk to a family member or a responsible party about the postoperative information and have the nonanesthetized person sign off on the instructions.

What message are you sending?

Patients may still have questions after reading their postoperative information. The AAAHC and the JCAHO don't define exactly what ASCs should do after hours, so each facility must establish a policy that serves its needs.

For some, it's a recorded message. Regardless of what information you leave on a machine, the first instruction should be that if the patient is having an emergency, he or she should hang up and dial 911. Some surveyors will call an organization after hours to see what information is on its recorder, says Margaret Bridwell, MD, an AAAHC surveyor who spoke during the "Achieving Accreditation" conference in Seattle in June.

Other facilities, such as Healthsouth SurgiCenter at Woodward Park in Fresno, CA, where Dee Patrick, RN, BHA, is the administrator, use answering services with a live operator to direct patients. According to Patrick, the service provider also tells patients to dial 911 for emergencies, call their physician, or the service may contact the administrator or director of nursing (DON). The administrator or the DON assists patients by assessing their complaints and will encourage them to review the postoperative instructions or call the physician's office with symptoms. Remember to list the phone number in the patients' postoperative instructions.

Most often, the patient calling is nervous about the pain he or she is experiencing, and needs reassurance from a healthcare professional. Patrick and Jepsen are both available for their centers' patients after hours.

"Most of the time I'm telling patients what they could find in their postop instructions, but sometimes people get nervous and want to hear a voice," Patrick says.

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