PREPARING FOR SURGERY SURGICAL SERVICES DEPARTMENT 970-641-7240 WWW.GUNNISONVALLEYHEALTH.ORG/SURGERY HOSPITAL SENIOR CARE CENTER HOME MEDICAL SERVICES ASSISTED LIVING FAMILY MEDICINE CLINIC MOUNTAIN CLINIC HOSPICE AND PALLIATIVE CARE FOUNDATION
WELCOME TO GUNNISON VALLEY HEALTH Dear Patient, Family and Caregivers: Thank you for choosing us for your surgery. We are excited to work with you throughout your surgical experience from preparation for your surgery through recovery. As a partner in this journey, our team is committed to giving you the highest quality of care and support before, during and after your surgery. As you are preparing for your surgery, it is perfectly normal to feel anxious and have questions. Rest assured that our team of surgeons, anesthesia providers, nurses, and other healthcare team members understand and want you to be comfortable and fully prepared for this experience. This book will guide you through the process of having surgery at Gunnison Valley Health. It covers what you need to know about preparing for surgery, your hospital experience and recovery. This guide describes the process most patients go through. But every patient is special. Your experience may be a little different. We encourage you to take an active role in your treatment. If you ever feel that something in this booklet disagrees with what you hear from your surgery team, please ask us about it, along with any other questions you may have. Once again, welcome to Gunnison Valley Health. Thank you for trusting us with your care! GUNNISON VALLEY HEALTH 711 N. TAYLOR STREET GUNNISON, CO 81230 (970)641-1456 Your Surgery Care Team 2
PRE-REGISTRATION AND PRE-ANESTHESIA ASSESSMENT Gunnison Valley Health patients can now pre-register for surgery and do their pre-anesthesia assessment online through secure forms from the comfort of their own home. Please complete the pre-registration/pre-anesthesia assessment process as soon as you are scheduled for surgery. Please visit www.gunnisonvalleyhealth.org/surgery to complete the process What you will need to complete the pre-registration/pre-anesthesia assessment: Personal contact information Emergency contact information Insurance information group name and number, policy number, address and telephone number A list of all medications/supplements you are taking, their dosage and frequency A list of your medical conditions, disease history, and any surgical procedures you have ever had. The name of your Primary Care Physician The name of the surgeon who will be performing your upcoming procedure The goal of the pre-anesthesia assessment is to identify potential risks to you before you are given anesthesia and medications. Testing and/or a visit to your primary care physician may be requested (blood testing, chest X-ray, EKG) depending on past medical history and physical condition to ensure your safety for anesthesia and surgery. After you have completed your pre-anesthesia assessment you will receive a call from a surgical services nurse who has reviewed your medical history with a member of the anesthesia care team and will then give you further instructions to prepare you for surgery. Instructions include when to arrive at the hospital on the day of surgery, eating and drinking instructions, medication information, required pre-anesthesia testing, and any other information that is specific to you or your procedure. This call with a surgical nurse is your chance to ask questions about preparing for surgery and to discuss any special needs you might have. It is important that you are an active partner in your care and wellness. FOR QUESTIONS PLEASE CONTACT THE SURGICAL SERVICES DEPARTMENT AT 970-641-7240 3
PRE-OP PATIENT CHECK LIST Please use the checklist below as you prepare for your surgery. We appreciate your help with the following items and look forward to working with you throughout your surgical experience, from preparation for your surgery through your recovery. A member of the surgical services team will call you between 11 a.m. and 8 p.m. the day prior to your scheduled surgery. This call is to review pre-op instructions and confirm your arrival time as this can sometimes change due to unforeseen circumstances. For any questions or concerns about any of these items, please call the Surgical Services Department at (970) 641-7240. AS SOON AS POSSIBLE: o Complete the online pre-registration and pre-anesthesia assessment process. Please visit www.gunnisonvalleyhealth.org/surgery to complete the process. Ideally, this is completed the day you are put on the surgery schedule. o If your surgeon has instructed you to see your Primary Care Physician, or has ordered pre-operative testing, please make this appointment within the 30 days prior to your surgery to meet the pre-operative requirement. ONE WEEK BEFORE YOUR SURGERY: o Arrange for a responsible adult to accompany you and drive you home the day of your surgery as well as a 24 hour caregiver. It is required that a responsible adult accompany you and drive you home upon your discharge. The telephone number of your designated driver must be given to the Ambulatory Surgery Department nurse. Surgery will not be performed unless these arrangements have been made. o Follow any instructions you have been given by your physician regarding discontinuation of aspirin, anti-inflammatory medications, herbal medications, or blood thinning medications, such as Coumadin and Plavix. o Prior to surgery it is important to cleanse your skin. We recommend using an antibacterial solution called Chlorhexidine Gluconate (CHG) [Brand name is Hibiclens]. This may be picked up at the Surgical Services Department after you are scheduled for surgery or you may purchase at City Market, near the first aid section. If you are allergic to CHG please do NOT use it and let your surgical team know. You may also use an antibacterial soap such as Dial. Please see the How to Clean Your Skin Before Surgery section of this booklet for detailed instructions. o Do not shave the area where you will have surgery for one week prior to surgery. o If you develop a cold, fever, or rash, notify your surgeon. Your surgery may be postponed. 4
PRE-OP PATIENT CHECK LIST ONE DAY BEFORE YOUR SURGERY: o Perform CHG skin cleanse by following the detailed instructions provided in the Preparing for Surgery Guide. o DO NOT eat or drink anything after 12 midnight the night before your surgery/procedure, unless otherwise instructed by surgery department. This includes water, coffee, gum, mints or candy. This helps prevent food or stomach acid from getting into your lungs. Failure to follow the instructions may result in a delay or cancellation of surgery. You may brush your teeth without swallowing water. o Remove any nail polish from fingernails as well as toenails. THE DAY OF YOUR SURGERY: At home: o If you have been instructed by the surgery care team to take medications by mouth the morning of surgery, please swallow it with the smallest amount of water possible. If you use inhalers, bring them with you on the day of surgery o Please do not bring any valuables with you to the hospital o Some items you should bring with you include: Any assistive devices you require (glasses, hearing aids, crutches, walker, cane, etc.) C-Pap/Bi-Pap if you use at home and will be staying overnight at the hospital Inhalers Appropriate storage containers/solutions for dentures, contact lenses or other prosthetics as you may be asked to remove them. o Please remove all piercings and jewelry and leave at home. These can pose the possibility of injury if worn during surgery. o Shower the morning of your surgery using Hibiclens (use antibacterial soap instead ONLY if you are allergic to Chlorhexidine Gluconate). On the morning of your surgery please do not use any lotion, hair products, makeup, perfume, cologne, after-shave or scented lotions. o Dress in loose, comfortable clothing (sweatpants, etc. that can accommodate any bandages that may need to be applied after your surgery) and flat supportive shoes. o Please provide enough travel time in order to arrive at the hospital at your designated arrival time. If your arrival time is before 7:30 a.m., please use the Emergency Room Entrance. If you arrival time is after 7:30, use the main entrance on the North East side of the building. Report to the surgery waiting room on the second floor. 5
HOW TO CLEAN YOUR SKIN BEFORE SURGERY Cleaning your skin before your surgery can reduce your risk of an infection after surgery. You will receive special soap to clean your skin. This soap is called chlorhexidine. The brand name is Hibiclens. Your Washing Schedule 1 week before your surgery (date) Stop shaving surgery area. Do not shave or use any hair removers (like Nair or waxing) on the area. 3 nights before your surgery (date) Stop shaving any area of the body, including the legs and underarms. Men can still shave their face. Put clean sheets on your bed. Use these sheets for all 3 nights. Evening shower. Wear clean pajamas to bed. Wear these pajamas for all 3 nights. 1 night before your surgery (date) Evening shower with chlorhexidine. On the day of your surgery (date) Morning shower with chlorhexidine. Put on clean clothes and go to the hospital for your surgery. Be Careful Not to do These Things DO NOT use this special soap on your face, head or hair. DO NOT let it get into your eyes, ears, nose, mouth or crotch area. DO NOT use on broken skin or open wounds. If the soap touches these areas, rinse it with water for at least 1 minute. STOP using the soap if you have a rash, redness, itching or any other problem with the chlorhexidine. You may be allergic to it. Rinse with water for at least 1 minute. And call your healthcare provider. Do not use these packets if you know that you are allergic to chlorhexidine. Please tell your healthcare provider. Use another kind of antibacterial soap, such as Dial. Use the other soap as you normally would. Rinse it off your skin each time. 6
PRE-OP PATIENT CHECK LIST ON THE DAY OF YOUR SURGERY Getting to Gunnison Valley Health Hospital From the North (Crested Butte, Almont) Head South on Highway 135. Turn left on East Denver Avenue, heading East. Go 6 blocks and turn left on N. Colorado St. The main entrance and parking area for the hospital will be on your left. From the South (Town of Gunnison, East and West on Highway 50) Head into Gunnison on Highway 50. Turn North at North Main Street (Highway 135) Turn right on East Denver Avenue, heading East. Go 6 blocks and turn left, heading north, on N. Colorado St. The main entrance and parking area for the hospital will be on your left. WHAT TO DO WHEN YOU ARRIVE FOR SURGERY You will be escorted to the pre-op holding area to be prepared for surgery. One family member may go with you at this time. You will be given a gown to put on. A nurse will take your vital signs and review your prior medical/surgical history with you. During your stay, you may be asked the same questions multiple times from different members of your care team. This is for your safety, and part of our practice to ensure the best care possible. This is also an opportunity for you to ask any remaining questions you may have about anesthesia or your procedure. The members of your care team you will meet in the pre-op area will include your pre-op nurse, operating room nurse, and anesthesia provider. Then your surgeon will come see you and can answer any last-minute questions you have to prepare you for surgery. 7
ABOUT YOUR ANESTHESIA On the day of your surgery, your anesthesia provider will meet with you to discuss your medical history and go over any testing or lab results you may have done recently. The anesthesia provider will discuss the details of the procedure, including the risks and benefits. After discussing your options and answering your questions, an anesthetic plan will be determined. You will be continuously monitored and cared for throughout your surgical procedure. Our goal is to provide a safe and comfortable anesthetic experience and recovery. Types of anesthesia available: - General anesthesia provides loss of consciousness, where you will be entirely asleep - Monitored Anesthesia Care consists of local anesthetic injections as well as IV sedation with constant monitoring by an anesthesia provider. - Regional anesthesia (for certain procedures) involves the injection of a local anesthetic to provide numbness, loss of pain/sensation to a large region of the body. Regional anesthetic techniques include spinal blocks, arm/leg nerve blocks. Medications and sedation can be given to make you drowsy and blur your memory with these types of blocks. Spinal Anesthesia: This consists of a single dose of local anesthetic being delivered to numb you from your abdomen to your feet. The extent of your numbness depends on your surgical procedure. The pain control from a spinal usually lasts 4-6 hours. Nerve block: This consists of an injection of local anesthetic near a nerve to provide pain control during and after your surgery. Typically, the block lasts 4-24 hours. SURGERY DELAYS The time of your surgery is sometimes approximate and unavoidable delays or time changes can occur. This can happen for a number of reasons, but not limited to: Incomplete or abnormal lab results Failure to comply with pre-operative instructions Emergency situations that take precedence over scheduled procedures Surgery prior to yours has taken longer than planned Surgical case prior to yours has cancelled In the event that the time of your surgery is changed on the day of surgery, we will make every effort to notify you as soon as possible. Please ensure that we have the best contact number to reach you and be close to your phone on the day prior and day of surgery so that we may notify you of any time changes with your procedure. We thank you for your patience and understanding. 8
DURING AND AFTER YOUR SURGERY THE OPERATING ROOM In the Operating Room your heart rate, blood pressure and oxygen level will be monitored. The anesthesia team member assigned to you will then administer medication previously discussed with you and your surgeon. AFTER YOUR SURGERY After surgery you will be taken to the Post Anesthesia Care Unit (PACU), or Recovery Area, a special unit designed to monitor your health after surgery. During your stay in PACU, the nursing staff will monitor your vital signs and overall condition, and that you are responding appropriately. Once you achieve set criteria, you will be evaluated for discharge to home, or inpatient services. The type of anesthesia you have received will determine your length of stay, area of care and overall post-operative course. The length of time spent in PACU is typically one to two hours but may be up to six hours depending on your condition. YOUR COMFORT Surgical procedures may result in minimal discomfort to severe pain. Managing your discomfort is of primary importance to us. Our goal is to partner with you to set safe comfort goals. To do so, we will gather some information from you in the pre-admission process and in pre-operative holding area. Some questions you may be asked include: Do you have pain now? - Related to your scheduled procedure? - Unrelated to your scheduled procedure? Using the 0-10 pain scale: - Where do you place your pain? - What level do you consider tolerable/goal? - What do you do for this pain currently? Medications, ice/heat, positioning/elevation, other NO PAIN MILD PAIN MODERATE PAIN SIGNIFICANT PAIN SEVERE 9
YOUR DISCHARGE Your discharge time may vary depending on whether you are a same day surgery patient (going home on the day of surgery), or an inpatient (a patient who is admitted to the hospital). In all cases, patients must meet the criteria for safe discharge as defined by Gunnison Valley Hospital. If you are a surgery patient going home the same day, you must have a responsible driver and a 24 hour caregiver to help you at home upon discharge. When you are discharged, you will be given written instructions that are specific for your procedure. You will be provided information about what to do if you experience any unforeseen complications as a result of your surgery, such as bleeding and symptoms to look for that may indicate an infection. If you experience ANY surgery-related problems after your discharge, contact your physician immediately for advice. After same day surgery, a member of the nursing staff will telephone you the next business day after your surgery to follow your progress and to assist you and your family with whatever questions may arise. All patients should also receive a call two weeks after surgery to ensure that you are recovering as expected. If you have questions, please call us at 970-641-7240 (Monday through Friday 7 a.m. to 5 p.m.). If you need to talk to your surgeon, please call their office during business hours or for afterhours please call the hospital at 970-641-1456. If there is an emergency please call 911. ADMISSION TO OUR FACILITY When overnight observation or extended stay is needed, you will be taken to your hospital room directly from PACU. Family and Friends can join you in your room after you are transferred to the patient unit located on the first floor of the hospital. Any personal belonging stored by PACU will be brought to your room. When you arrive in the room you will meet your new nursing care team and be shown how to use the nurse s call light for help. As always, you remain a partner in your care and recovery; ask questions when you have them and give feedback that will aid in your recovery and discharge home. FAMILY AND VISITORS Our goal is to keep your family/caregiver as informed as possible. You may have one family member with you in the pre-operative holding room and during surgery your family/ caregiver may wait in the surgery waiting area. Your family/caregiver will need to let the pre-op nurse know where they can be reached while you are in surgery. Once your surgery is complete the operating room nurse will call a designated family member/caregiver and the surgeon will speak to your family. Your PACU nurse will do his/her best to keep your family updated on progress in the recovery room. There is a phone available in the waiting room for your family/caregivers to contact the Surgical Services Department for updates or they may call 970-641-7240 at any time. 10
GUNNISON VALLEY HEALTH 711 N. TAYLOR STREET GUNNISON, CO 81230 (970)641-1456