How to Support Safe Surgery
Even “routine” surgery has risks: trust but verify — ask lots of questions!
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When surgery is recommended
Is it the only option? Is it the best option?
If surgery is being discussed for your loved one, try to go to all doctor meetings with them. Help your loved one create a list of questions and concerns such as those shown below.
Take good notes!
Questions to ask:
For every diagnosis that suggests surgery is the treatment, ask:
- What else could it be? Is there another potential diagnosis?
- What are alternatives to surgery?
- What are the benefits and risks for all possible choices?
- Any special risks if your loved one smokes or drinks, or suffers from other health conditions?
- What are the chances for success for each choice? (What do you consider “success”?)
- What are the realistic risks vs. rewards?
- What if I put surgery off for awhile (pros and cons)?
- What if I decide not to have this surgery at all? (Pros and cons)
- Costs of each choice?
- Will my insurance cover the costs?
- What medications would I need? Costs?
(Note: if over 65, look up on The Beers List.)
Two heads are better than one!
- Urge your loved one to get an independent 2nd opinion — maybe even a 3rd opinion. (Not from the doctor’s friends or co-workers who may hesitate to second-guess a colleague.)
- Dig for more information on the Internet at reliable sites, sponsored by the government or leading health care associations.
*Note: Internet information and other research—or advice from friends—does not take the place of seeing doctors!
Even “routine” surgery has risks: trust but verify. Don’t be afraid to ask lots of questions!
Put patients' goals front and center!
What does the patient, your loved one, consider success?
Patient-centered doctors want to know their patients’ goals and expectations, fears and worries.
Every treatment will have a process and an outcome, with risks along the way.
How do they match up with the patients’ personal goals, lifestyle and anything else that would affect their long-term physical well-being and peace of mind?
Have this conversation with every doctor consulted.
When surgery is the only or best option
Aim to choose a qualified surgeon from a safe hospital
Unless it’s an emergency situation, you’re in the driver’s seat more than you know. Surgeons and hospitals have differing levels of expertise and success.
Every patient has the right to “shop around” because every surgery carries risk. Knowing how to minimize risks for best-case results will lend peace of mind that surgery won’t be “a lemon”.
Urge your loved one to talk to surgeons who have done “thousands” of the planned surgery, not “hundreds.” (May mean traveling to a different city if affordable.)
Some people shop around more carefully for a new car than they do for a surgeon!
Questions to Help Find the Right Surgeon for You
- What is the name of the surgery? (Medical name and “regular” or common name)
- How many of these surgeries have you personally done? Don’t settle for any fewer than “hundreds”, but ideally, “thousands.”
- Who would actually perform my operation?
- Who would assist? How many surgeries of this type have they performed?
- Would student/s/residents be present? What would student/resident do in my surgery?
- Will you be performing another surgery at the same time as mine? (Simultaneously, in another operating room.)
- Do you use a surgical checklist in the operating room?
- What is your infection rate for this kind of surgery?
- Do you recommend showering and or shampooing with Hibiclens (similar) prior to surgery? If so, for how long? If not, why not?
- Do you prescribe a prophylactic antibiotic prior to surgery? If not taken in advance of admission, would I get at admission or just prior to surgery?
- Will I get a pre-op MRSA test? (If “No”: will you order?)
- Do you lead a “time out” for everyone on the surgery team to introduce themselves?
- Will you provide me with all Informed Consent papers so I can study them and make sure everything we’ve discussed is covered?
- NOTE: Attach your notes and agreements with your doctor to your Informed Consent paperwork that the hospital will require yuo sign. Make sure the surgeon has a copy, too.
Questions to Help You Know What to Expect
- Who can help me figure out what everything will cost?
- What are my options if I can’t afford any or all parts of treatment?
- Available resources?
- How long will the surgery take?
- What kind of anesthesia will be used?
- Are there other kinds of anesthesia to consider?
- If so, what are the positives and negatives of each type?
- How much pain can I expect?
- When will I have it?
- What will you use to help control my pain?
- Any alternatives pain management resources to consider? (I.e. other meds, biofeedback)
- Will pain management be self-administered via IV that I control — or by prescription and given by nurses?
- Do I have a choice? (Note: studies show that, when patients self manage, they take lower doses of pain meds than are typically prescribed.)
- How long will I be in recovery?
- How will I be monitored after the surgery? For how long?
- May I have a family member sit with me in the recovery area?
- Will I get supplemental oxygen after surgery? Why? Why not? What is the standard of care?
- How long will I be in the hospital?
- What are the signs of recovery?
- How will we know when I’m ready to go home?
- May I have a family member stay with me 24/7?
- What are sleeping provisions for my family member who stays with me?
- Where will I go after leaving the hospital? Home? Rehab? Assisted Living? Other?
- What care will I need after leaving the hospital?
- Therapies? (I.e. Physical therapy, Occupational therapy)
- Wound care?
- Daily living support?
- In-home nursing care?
- Will I need to make any changes to my…
- Diet? What can I eat? What should I not eat? Why? For how long?
- Lifestyle? Changes to plan for/accommodate? Why? For how long?
- Living arrangements? Changes to plan for/accommodate? Why? For how long?
- What are potential post-op complications? (Red flag if infection is not mentioned. It’s always a potential complication.)
- What are the signs of trouble?
- For trouble signs, what should I do? Who to call? (Get phone numbers, pagers for primary contact and back-ups.)
- What are signs for immediate help – when would we call 911?
- What are the signs of success – the positive guideposts to healing?
- What are the signs of trouble?
- When will I see you for post-op appointment? Can we schedule that as soon as surgery is scheduled? How often will we meet after this?
- Do you have an Emmi video of the procedure you’re recommending so I can learn more?
Scheduling the Surgery
- If surgery is not an emergency, urge your loved one to schedule it on Tuesday, Wednesday or Thursday (safest days for surgeries).
- If possible, avoid July, August, and major holiday weeks when senior hospital staff have earned time off.
- Schedule surgery for when the surgeon will be working and available to your loved one for several days afterward. (It’s OK to ask, “Planning a vacation?”)
- If the surgeon works at different hospitals, help your loved one find out which one has the best safety score.
It matters what month and day you choose for surgery.
How to help your loved one prepare for the day of surgery
A lot of care goes into getting ready for surgery, an anxious time for most patients. From tests, to showering properly, to gathering medications, you can help support these safe steps to a safe surgery.
- Download all of our surgery checklists and take them to doctor visits. Go over them together. (If the surgeon objects to these safety checklists, consider finding another surgeon!)
- Urge your loved one to talk to the surgeon about a screening MRSA test — a quick swab inside the nose. It’s a helpful test so the hospital will know to take some special steps if your loved one carries this germ.
- Ask for the doctor’s advice about diet and exercise to prep for surgery.
- Read the surgeon’s pre-surgery instructions. Help make sure your loved one follows these instructions “to a T!”
- For 2 to 3 days before surgery, remind your loved one to shower with antibacterial shampoo and body soap, with a final shower just before going to the hospital. (Chlorhexidine soap is effective and available at most drugstores.)
- If your loved one is having surgery on a “twin organ” (like kidneys or lungs), or on an arm or leg, help avoid confusion over which side requires surgery. Put a large piece of masking tape over the side that should NOT be cut. Write a big, bold “NO!” on this tape for the side that should not be touched by the surgeon.
- Keep your loved one warm. In cold weather, warm up the car first. Make sure hair is dry. No matter what the season, bring an extra sweater or other soft, warm clothing; hospitals have some very chilly areas.
Prepare to stay with your loved one 24/7 while hospitalized.
It’s okay to ask for help—organize “shifts” with other family members and friends.
Put a large piece of masking tape over the side that should NOT be cut. Write a big, bold “NO!” on this tape for the side that should not be touched by the surgeon.
Download our Medications Record form to fill out with your loved one. Bring the form, along with all of your loved ones current medications to the hospital.
What to Do at the Hospital the Day of Surgery
Details to confirm:
- Your loved one’s name
- Location of procedure (ask for it to be marked)
- Current medications
- Last time your loved one had anything to eat or drink
- Any other information the surgeon feels is important
- How long the surgery will take
- When you can expect updates during the surgery
Confirm the surgical team will:
Take a “Time Out” or “Huddle” just before the surgery to confirm correct patient procedure and …
- Review your loved one’s medications, allergies and any other special conditions
- Introduce team members to each other
- Use a surgical checklist
- Ask that nurse clip (not shave) hair that may need to be removed
- Give an antibiotic on time (Who is responsible? What time?)
- Keep your loved one warm
- Provide additional oxygen
Every conversation with the medical team is important. Know the questions and topics to cover to make the most of their time and expertise.
WHEN TO GET A NURSE
Ask to stay with your loved one in the recovery room so that you can watch for signs of distress, including:
- Chills, shivering
- Extreme pain, moaning
- Nausea, vomiting
- Any signs of distress
- Shortness of breath
- Rapid breathing
How to help as your loved one recovers
During the Hospital Stay
Because nurses typically care for up to 8 patients at a time in their units, it’s important for you to pitch in to help make sure your loved one doesn’t suffer any of the common complications that often add extra days to hospital stays. Our Hospital Stay Checklists make it easy to know what to look for, what to do, and what to ask.
After Leaving the Hospital
About 20% of patients end up back in the hospital within a month. No one is 100% when they leave the hospital so create a good plan for care at home to prevent a hospital round trip!
Whether your loved one is recovering at home or in a nursing home/assisted care facility, they will need to be monitored closely, especially if new medications have been prescribed.