About Your Surgery Experience Getting ready for your surgery at University of Washington Medical Center

From Everett Exit I-5 4245 4225 Exit 168B Roosevelt Way N.E. From Downtown Seattle University Way N.E. 15th Avenue N.E. UWMC University of Washington N.E. Pacific Street Montlake Blvd. Exit Montlake Blvd. N.E. 24th Avenue E. Stadium 25th Avenue N.E. Montlake Bridge Evergreen Point Bridge N.E. 45th Street Lake Washington N W E S 520 From Bellevue Patient Education About Your Surgery Experience Getting ready for your surgery at University of Washington Medical Center Directions to University of Washington Medical Center UWMC is located at 1959 NE Pacific St., at the south end of the University of Washington campus. From Interstate 5: Take Exit 168B (Bellevue, State Route 520) heading east. Then take the Montlake Boulevard exit and follow the signs to University of Washington Medical Center. From Interstate 405: Take Exit 14 (Seattle via Evergreen Point Bridge, State Route 520) heading west. Then take the Montlake Boulevard exit and follow the signs to University of Washington Medical Center. 1959 NE Pacific St. Seattle, WA 98195-6127 Box 358119 206-598-6334 University of Washington Medical Center Rev. 11/2003 UH 1761

Helpful Contacts You may find these telephone numbers helpful. If you're in the medical center, dial only the last five digits of numbers with a 598 prefix. Admitting... 206-598-4310 Bills Financial counseling... 206-598-4320 Doctor fees (UW Physicians)... 206-543-8606 UWMC billing... 206-685-1121 Campus Parking Information... 206-685-1553 Emergency Medicine Service (ER)... 206-598-4000 Hospital Administration... 206-598-6300 Interpreter Services 24 hours, Mon-Sun... 206-598-4425 Hospital Administration... 206-598-6300 Lost and Found... 206-598-4909 Medical Director... 206-598-6600 Pavilion Surgery Center 5:30 a.m.-8:00 p.m. Mon-Fri... 206-598-4214 7:30 a.m.-6:00 p.m. Mon-Fri... 206-598-6334 Social Work Department... 206-598-4370 Social Work Housing Services 8:00 a.m.-5:00 p.m. Mon-Fri... 206-598-4170 TTY... 1-800-833-6384 UWMC Parking Information... 206-598-5275 Web site... www.washington.edu/medical/uwmc UW Medical Center Parking The Surgery Pavilion Parking Garage is accessed off N.E. Pacific Street alongside the entrance to the Emergency Department. It is mainly for Surgery Pavilion patients and their visitors, and is staffed from 6 a.m. to 10 p.m. Afterhours parking is only available in the Triangle Garage, and not in the Surgery Pavilion Garage. The Triangle Parking Garage is on N.E. Pacific Place, across the street from UW Medical Center. From Montlake Blvd., turn left onto N.E. Pacific Street and right onto N.E. Pacific Place. There is direct access to the third floor (main entrance) via a pedestrian tunnel. Patients with disability or mobility parking needs may use the valet parking service at the main entrance of the medical center. Wheelchairs and escort services are also available at the main entrance and by asking for assistance from the parking attendant at the Surgery Pavilion or Triangle Garage. You can also request assistance, a wheelchair, or escort service by picking up one of the many phones in the garages. There is limited oversized parking in the Triangle Garage (6' 8" height limit). Additional oversized parking is available in the Husky Stadium Lot. Parking validation is provided for UWMC patients and visitors in the Surgery Pavilion and Triangle Garages. The maximum parking fee is $5 per day for validated tickets for patients and their visitors. For more information on campus parking, call 206-685-1553. For information about medical center parking, call 206-598-5275. Driving directions to locations on the UW campus, including UWMC, are available on this Web site: www.washington.edu/admin/parking/directions/uwmcs.html

Patient Education About Your Surgery Experience Getting ready for your surgery at University of Washington Medical Center This booklet and your visit to the Pre-Anesthesia Clinic will help you get ready for surgery and understand what will happen and why. Your visit provides us with important information about your health, allowing us to safely care for you. We are committed to working with you for a comfortable stay and quick recovery.

Page 2 Name Date of surgery Time to arrive (You will be called between 2 p.m. and 5 p.m. by the the afternoon before your surgery.) Surgeon Clinic nurse Patient care coordinator Telephone number NOTE University of Washington Medical Center has interpreters to assist you before and after surgery. Please tell the patient care coordinator or nurse if you would like an interpreter, or call Interpreter Services at the number on the last page of this booklet, so that we can assure one is provided for you.

Page 3 Your Visit We need information about your health before your surgery. You will be asked to complete a health survey. At your pre-anesthesia appointment, your health survey and your medical history will be reviewed. If necessary, blood tests, an electro-cardiogram (EKG), and a chest X-ray will be done. Other tests may also be needed because of your particular surgery. Before your visit in the, you will meet with your surgeon in a UWMC specialty clinic. When you meet with your surgeon, he or she will discuss your medical history, complete a physical exam, talk with you about the surgery, and have you sign a consent form. You may also meet your patient care coordinator at the specialty clinic visit. He or she may suggest special procedures before your surgery, such as a blood donation from yourself. When you come to the, be sure to bring two things with you: 1. A list of all the medicines you take and the doses 2. The results of tests you have had at any other hospital or clinic, particularly heart or lung diagnostic testing, such as an EKG, stress test, echocardiogram, pulmonary function tests, etc. This information is important so your doctors know about everything that may affect your care and recovery. Some medicines you are taking may not mix with ones you will be given in the hospital. The visit is a good time for you to ask questions about the day of surgery. When you come to the Pre- Anesthesia Clinic, be sure to bring two things with you: 1. A list of all the medicines you take 2. The results of tests you have had at any other hospital or clinic

Page 4 Your Surgical Experience This flow chart shows some of the steps you will go through before, during and after surgery.

Page 5 Medicines Before Surgery It is very important to talk with the Pre-Anesthesia Clinic staff about the medicines you are taking. You may not be able to take some of them for a day or more before your surgery, such as: Oral diabetic medicines, insulin Coumadin Aspirin Certain diet medicines Non-steroidal anti-inflammatory drugs (NSAIDS), such as Ibuprofen Herbal preparations/supplements A nurse will tell you which of your medicines you can take the morning of surgery. Anesthesia Nurses in the are specially trained to evaluate your anesthetic needs. Please ask questions and talk about any concerns you may have. Your anesthesia team will meet with you the day of your surgery and discuss the best care option for you. The team will be with you in the operating room to manage your comfort, breathing, heart rate, blood pressure, and any medical issues that might arise. The three main types of anesthesia that may be discussed are: General you are unconscious and have no awareness of the surgery. Regional a numbing medicine injected into a cluster of nerves, so you do not have sensation in a large area of your body. You may also be given medicine to relax you or help you sleep. Local a numbing medicine injected into the skin and tissues near the area for surgery. This numbs only the area for surgery, similar to the local anesthetic given for dental work. You may also be given medicine to relax you or help you sleep. If you are diabetic and take insulin or an oral diabetic medication, be sure to receive instructions from the Pre- Anesthesia Clinic about your dose of these medications the day before and morning of your surgery.

Page 6 Remember: No cellular phones in certain patient care areas. Unless told otherwise, do not eat or drink anything after midnight the night before your surgery or in the morning, not even water, candy or gum. All jewelry must be removed. This includes wedding bands and body piercings of all types. More information about anesthesia is available. Please tell your nurse if you would like to discuss special concerns with an anesthesiologist during your visit. Day Before and Morning of Surgery A nurse from the will call you the afternoon before your surgery day to give you your arrival time and review your pre-operative instructions. If your surgery is on Monday, this call will be on the Friday afternoon before. If you are not called by 4 p.m., call the at the number on the last page of this booklet. Please make sure the has the telephone number where you can receive calls the day before surgery. Unless you have specific instructions from your doctor, eat normally and take your usual medicines the day and evening before surgery. Do not eat or drink anything after midnight the night before your surgery or in the morning not even water, candy or gum unless told otherwise. This is very important during surgery, to reduce the chance of vomiting and inhaling stomach contents into your lungs. Swallow the pills you are told to take the morning of surgery with only a sip of water. Brush your teeth without swallowing any water. Shower Instructions Use a special soap called Chlorhexidine gluconate (CHG) to shower or bathe, both the night before and the morning of surgery. CHG can be purchased at most large drug stores. It comes as a two-percent and a fourpercent solution. Either one is okay. A common brand name is "Hibiclens," but any brand is okay. Follow the manufacturer's recommendations. 1. Use the CHG soap FROM THE NECK DOWN. Wash thoroughly, especially around the area of your surgery. 2. DO NOT use CHG on your face or to wash your hair. (You may use your regular shampoo to wash your hair.) 3. Rinse well and repeat.

Page 7 4. Pat dry with a clean towel and put on clean clothes. 5. After your morning shower or bath, DO NOT apply hair products, deodorants, lotions, cosmetics, or fragrances. Shaving Instructions 1. DO NOT shave (with a blade razor) areas of your body that will be near your surgical site within 12 hours of the morning of your surgery. 2. You may use an electric shaver as desired. Driving Arrangements If you are going home on the same day you have surgery, you must arrange for someone to take you home. Your surgery may be cancelled if you arrive without a responsible adult to drive you home, get you settled, and make sure you are safe and comfortable. This must be a responsible adult who will get you into your home and make sure you are comfortable. Your ride must be ready, within 30 minutes of your discharge, to drive you home. It cannot be a taxi driver. You also need to arrange for a responsible adult to stay with you for at least 24 hours after surgery. Pavilion Surgery Center Your family and friends can accompany you to the Pavlion Surgery Center. Due to the limited space in the check-in area, they may be asked to wait in the general waiting area. Arriving at the Hospital Parking UW Medical Center has a valet parking service for medical center patients and their visitors, located in front of the medical center, near the main entrance. Additional parking is available in the Surgery Pavilion Parking Garage, accessed off N.E. Pacific Street alongside the entrance to the Emergency Department. This is primarily for Surgery Pavilion patients and their visitors, and is staffed from 6 a.m. to 10 p.m. After-hours parking is only available in the Triangle Garage and not in the Surgery Pavilion Garage. The Triangle Garage is on N.E. Pacific Place, across the street from the main UW Medical Center entrance.

Page 8 Please do not bring jewelry (including rings), money, credit cards or other valuables with you. Bring a list of your medicines, but do not bring the medicines unless you have been told to by the Pre-Anesthesia Clinic nurse. Bring your cases to store glasses and contact lenses while you're having surgery. Parking is validated by the hospital at a fixed daily cost of about $5.00, and is subject to change. Please see page 12 for a map to the hospital entrances and the back cover for a map to parking, and special reasons to park in lot S1. Admission On the day of your surgery, report to Pavilion Surgery Center Reception, on the second floor. The Surgery Pavilion is on the east side of the hospital and linked to it by a footbridge. Generally, we ask you to come in 2 hours before your surgery. This allows time for us to prepare you for your surgery. During this time you will: Sign admission forms Meet your anesthesiology team Be assessed for health status changes Have your IV started Bring a book or a project to help this time pass more quickly. We will do our best to let you and your family know of any changes about your surgery start time. Getting Ready for Surgery When you come to UWMC, wear clothes that are easy to take off and are loose and comfortable to wear home. Please do not bring jewelry (including rings) or other valuables with you. Bring a list of your medicines, but do not bring the medicines unless you have been told to by the nurse. Please remember to bring your hospital card (U-Card), your L&I claim number if you have one, as well as insurance, pharmacy insurance coverage information card and applicable copayment for discharge medication. We will ask you to remove all your clothing, including undergarments, and to put on a hospital gown. You will need to remove glasses, contact lenses, hearing aids, hairpins, and all jewelry. In some cases, you will also be asked to remove dentures. Please bring cases to store these items, if you have them.

Page 9 In the Pre-Operating Area and Operating Room The pre-operating area has many patients who are being prepared for surgery. We regret that your family and friends cannot go with you to the pre-operating area or the operating room. The nurses and anesthesiology team who will care for you during surgery will introduce themselves to you. You will have a chance to ask questions about your care and what is happening. After a numbing solution is applied, an IV a small intravenous needle and tube will be put into the back of your hand or arm. Medicine and IV fluid can be given to you quickly and easily through the IV, and it will be in place for some time after surgery. Usually you will be given medicine through this IV to make you relax, or even sleep, before going to the operating room. It is important that you are comfortable be sure to ask the nurse for pain relief before the pain gets too severe. In the Recovery Room If you are having your surgery in the hospital operating room, you will be in the recovery room one to two hours after surgery. This recovery room does not accommodate visitors because of space and patient privacy needs. If you are having surgery in the Pavilion Surgery Center, one visitor will be able to join you in the Pavilion Recovery Room. This will keep a safe and quiet environment for all patients. If you are staying overnight, your family will be able to join you once you get to your hospital room. While you slowly wake up from the anesthetic, you may feel cold and nauseated. Your mouth may be dry, and your throat may be sore if a breathing tube was used during surgery. If you have had a regional anesthetic, that part of your body may be numb until the anesthetic wears off. A nurse will check your breathing, heart rate and blood pressure often. He or she will help you with any nausea and/or pain you may feel. It is important that you are comfortable be sure to ask the nurse for pain relief

Page 10 before the pain gets too severe. The nurse will ask you to rate your pain on a one-to-10 scale, where one is minor and 10 is the worst pain. Pain relief may be given by: A pill, if you can eat and drink after surgery Medicine put into the IV tube in your hand Medicine injected into your arm or buttock Medicine given through a small tube in your back Patient-controlled analgesia (PCA) by a special machine that puts a dose of pain medicine into your IV tube when you push a button. The button should be pushed only by you. Your doctors decide the correct amount for your needs. You do not have to wait for a nurse you are in control of your pain relief. You will not become drug addicted if you are in pain and use the machine as prescribed. Going Home Your surgeon will decide whether you go home the same day as your surgery or stay in the hospital. Please discuss this with him or her during your Specialty Clinic visit. If your ride does not stay with you at the hospital, please assure they can be here within 30 minutes. You will need someone to take you home after surgery who can get you into your home and make sure you are comfortable. For your safety, you will also need a responsible adult to stay with you for at least 24 hours after surgery. For patients going home the same day you can expect to have some pain and possibly some nausea. You may also be sleepy for the rest of the day. Please do not do any of the following for 24 hours after anesthesia or relaxing medicine: Drive Drink alcoholic beverages Travel alone Operate machinery Sign any legal papers Be responsible for another person, such as a child

Page 11 Ask your surgeon how you might be limited due to the surgery and how long these limitations will last. Think carefully about what you will need to help you at home and make these arrangements before your surgery. Work out things like how you will get to the bathroom, up and down stairs, have your meals, and care for yourself. If you need temporary local housing, ask at the Pre- Anesthesia Clinic or call the Social Work Housing Services number on the last page of this booklet. Before you leave the hospital, you will be given information about your care at home. A return appointment for follow-up care will be made for you, if you do not have one scheduled already. Do you understand everything? Medical history, blood tests, X-rays, EKG done in...page 3 Consent form...page 3 Medicines that should not be taken before surgery... page 5 Anesthesia choices...page 5 Telephone number where we can reach you the afternoon/night before surgery...page 6 No food or liquids after midnight the night before surgery...page 6 Night and morning bathing before surgery...pages 6 & 7 Where to come the day of surgery... pages 7 & 8 What to bring, what to leave at home...page 8 Pre-operating area, starting your IV...page 9 Recovery room: how you will feel, pain relief... pages 9 & 10 Going home, have someone with you for 24 hours... page 10 Help you will need at home...page 10 Safety after anesthesia...page 10 Ask your surgeon how you might be limited after surgery. Think carefully about what you will need to help you at home and make arrangements before surgery.

Page 12 TO I-5 15th Ave. N.E. N.E. Pacific St. University of Washington Campus Gate 6 Magnuson Health Sciences Center TRIANGLE PARKING GARAGE N.E. Pacific Place S1 PARKING GARAGE Columbia Rd. PORTAGE BAY UW Medical Center SURGERY PAVILION PARKING GARAGE Montlake Blvd. N.E. TO SR 520 Helpful Contacts Pre-Anesthesia Clinic: 206-598-6334 Pavilion Surgery Center: 206-598-4214 Interpreter Services: 206-598-4425 Social Work Housing Services: 206-598-4170 Operating Room: 206-598-4270 Other: