Deviation in the Standard of Postoperative Care

Evaluate breaches in the standard of care by asking, answering and analyzing the questions below to determine whether or not there was a Deviation in the Standard of Postoperative Care

Answer the following questions to find out if the standard of care was followed for your case.

  • Was the operative note and order sheet complete and on the chart upon arrival to the post-anesthesia care unit?
    Yes
    No
    Answer unknown
    Why is this important?
    In the post-anesthesia care unit, the anesthesiologist needs to report on the patient's condition, the type of surgery performed, the type of anesthesia given; estimated blood loss, and total intake and output during the surgery. The receiving nurse must also be made aware of any complications during the surgery, including any variations in hemodynamic stability.
    (2003) 18 JPANEN 3 196-199

  • Did the clinician ensure that the patient's vital signs were within normal limits? Why is this important?
    Answer this question
    
Establishing and maintaining a patent airway is the primary focus in the management of post-operative and critically ill patients.

    (2012) 30 EANESC 3 527-554 



  • Was the patient monitored at regular intervals to ensure that the patient's temperature was within acceptable limits? Why is this important?
    Answer this question
    
The surgical patient is at risk of both hypothermia and pyrexia in the immediate postoperative phase.

    (2012) 30 EANESC 3 527-554 



  • Was the patient's pain and discomfort adequately controlled? Why is this important?
    Answer this question
    
Pain and discomfort are also important considerations in the patient's post-operative care, as good pain control is required for an optimal physical and psychological recovery.

    (2005) 20 EBPCOG1 23-40 



  • Was the patient’s respiratory status assessed and monitored? Why is this important?
    Answer this question
    
The patient’s respiratory status must be assessed frequently post-operatively.

    (2005) 20 EBPCOG 1 23-40 



  • Was the cardiovascular status of the patient assessed ? Why is this important?
    Answer this question
    
Cardiovascular observation of the post-operative patient is achieved through the accurate measurement and continual monitoring of blood pressure and heart rate.

    (2005) 20 EBPCOG 1 23-40 



  • With which of the following risk factors did the patient present? Why is this important?
    Answer this question
    
The goals of a pre-operative cardiac risk evaluation must focus on determining if the patient is suitable for surgery, assessing the overall cardiovascular risk of the patient, and providing additional therapies to promote long-term cardiovascular health.

    (2012) 8 JNURPR 5 354-364 



  • Was the patient admitted to the Intensive Care Unit post-operatively? Why is this important?
    Answer this question
    
Peri-operative cardiac complications are a source of major morbidity and mortality. A variety of factors in the peri-operative period may produce myocardial ischemia, which if prolonged or intense, may lead to myocardial infarction.

    (2001) 85 EMEDCN 5 1151-1169 



  • With which of the following risk factors did the patient present? Why is this important?
    Answer this question
    
All surgical patients are at increased risk of developing postoperative venous thromboembolic complications (VTE) which include deep vein thrombosis (DVT) and pulmonary embolism (PE).

    (2012) 129 ESTHRR 4 e14-e17 



  • Did the patient receive anti-coagulation therapy prophylactically? Why is this important?
    Answer this question
    
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are potentially life-threatening events which frequently occur postoperatively.

    (2012) 129 ESTHRR 4 e14-e17 



  • Was the patient's intake and urine output monitored and documented? Why is this important?
    Answer this question
    
Fluid intake and urine output must be closely monitored during surgery and every 1 to 2 hours post-operatively. Surgical patients are vulnerable to fluid and electrolyte imbalance.

    (2012) 30 EANESC 3 527-554 



  • Was the patient hydrated with intravenous fluids? Why is this important?
    Answer this question
    
All patients require supplementary IV fluid during and after surgery.

    (2005) 20 EBPCOG 1 23-40 



  • Was the patient’s oxygen saturation maintained above 95%? Why is this important?
    Answer this question
    
Oxygen therapy is administered following surgery to maintain oxygen saturations above 95% to ensure adequate tissue and muscle oxygenation.

    (2006) 7 EAICMD12 445-448 



  • Was the patient's level of consciousness assessed? Why is this important?
    Answer this question
    
Post-operative confusion, cognitive changes and delirium are common after major surgery and in the elderly. The cause can be multi-factorial and early assessment must aim to identify acute or reversible causes.

    (2005) 20 EBPCOG 1 23-40 



  • Did the patient receive respiratory therapy post-operatively? Why is this important?
    Answer this question
    
Respiratory therapy includes close assessment of the patient’s respiratory function in conjunction with regular turning, regular physiotherapy and assisted coughing.

    Click here for additional information at ClinicalKey.com 



  • Was the patient repositioned every two hours? Why is this important?
    Answer this question
    
Effective patient positioning post-operatively has proven to improve surgical outcomes.

    (2001) 73 EAORNJ 3 645,647-648,650-653,656-657,660-663,665-668,670,673-674 



  • Was the patient’s surgical site closely monitored? Why is this important?
    Answer this question
    
The incision must be closely assessed for signs of infection and increased drainage.

    (2009) 89 ESRCNA 2 365-389 



  • Was the patient’s abdomen assessed for the return of bowel sounds? Why is this important?
    Answer this question
    
Post-operatively, patients may experience a temporary disruption of peristalsis.

    Click here for additional information at ClinicalKey.com 



  • Was patient education conducted prior to discharge? Why is this important?
    Answer this question
    
It is of primary importance that the nurse makes sure that the patient has received specific and individualized health education regarding their surgical procedure, signs and symptoms of complications, detailed instructions on the treatment needed after discharge, and detailed information regarding the medication needed after discharge.

    (2005) 20 EBPCOG 1 23-40