University Medical Center Brackenridge Surgery Passport This convenient step-by-step guide will help you prepare for your surgery at University Medical Center Brackenridge. Before your surgery, please read this guide carefully follow all instructions and pre-surgery tips, and provide all requested information.
Welcome to University Medical Center Brackenridge. For more than 125 years, our hospital has been at the forefront of medicine in Central Texas. UMC Brackenridge is the only Level I Trauma Facility serving adults in the Central Texas area, a Neuroscience Center of Excellence and home to the region s only CyberKnife Program. UMC Brackenridge was the first, and remains one of only two, Gold Seal-Approved Designated Stroke Centers in Texas and an accredited Teaching Hospital affiliated with Austin Medical Education Programs and University of Texas Southwestern Medical Education Program. Our professional staff of caregivers is dedicated to providing you with the best medical care and these efforts have been recognized by others. In 2008, UMC Brackenridge was again named as one of four Seton Healthcare Family facilities to receive Magnet designation. This recognition represents the highest nursing designation awarded by the American Nurses Credentialing Center (ANCC), part of the American Nurses Association. As part of the Seton Healthcare Family, UMC Brackenridge also received the Joint Commission s 11th annual Ernest Amory Codman Award, in recognition of initiatives to reduce preventable birth injuries. The program resulted in a 93 percent reduction in birth trauma rates from 2003 to 2006. In addition, when it came time for U.S. News and World Report to rank Austin s best hospitals, it put Seton at the top of the list in its 2010-11 survey, based upon actual patient outcomes, physician referrals and specialties. UMC Brackenridge was recognized in Orthopedics, Neurosurgery, and Ear, Nose and Throat specialties. UMC Brackenridge blends a long tradition of caring for Central Texas with advanced technology. Major renovations over the last several years have brought a new look, leading-edge equipment and expanded services to our facilities. This surgery passport has been prepared with you in mind, and we intend to make you as comfortable as possible during your stay with us. We have attempted to provide you with helpful information and a list of resources that may assist you during your stay. If you find that you need more information than we have provided, please feel free to ask our staff for assistance. Sincerely, Michael Garcia, RN, JD VP, Network Surgical Services Seton Healthcare Family Donna Schulze, RN, BSN, CNOR Director Surgical Services University Medical Center Brackenridge A
Welcome to University Medical Center Brackenridge Surgical Services! For more than 125 years, our hospital has been at the forefront of medicine in Central Texas. University Medical Center Brackenridge had the region s first ambulance, the first intensive care unit, the first Level II Trauma Center, and now the region s first Level I Trauma Center. Our team consistently exceeds benchmark metrics for trauma services. Surgical Services at University Medical Center Brackenridge encompass: Central Sterile Processing Endoscopy Day Surgery Surgery Post Anesthesia Care Unit (PACU) If you have questions after reviewing this guide to surgical services, please call the University Medical Center Brackenridge Surgery Department at (512) 324-7880. If you call Monday through Friday between 8 a.m. and 5:30 p.m. and receive voice mail, leave your name and phone number, and you can expect a call within two hours. If you call after hours, we will call you the next morning. Thank you for choosing University Medical Center Brackenridge. We look forward to your care! University Medical Center Brackenridge Surgical Services Mission Statement To establish University Medical Center Brackenridge as the Surgical Services Center of Excellence while maintaining our uncompromising principles on our journey. The following guiding principles will help us measure the appropriateness of our decisions: Provide a great work environment and treat each other with dignity and respect. Embrace diversity as an essential component in the way we do business. Apply the highest standards in excellence to the way we conduct ourselves professionally and personally. Develop enthusiastically satisfied customers all of the time. Contribute positively to our community and our environment. B
University Medical Center Brackenridge Home of Medical Innovation 1884 First public hospital in Texas 1915 First public nursing school in Austin 1948 First intercranial surgery in Central Texas 1960 First Intensive Care Unit in Central Texas 1961 First open heart surgery in Central Texas First heart/lung machine in Central Texas 1966 First modern concept of Trauma Center 1968 First coronary artery bypass surgery in Central Texas 1972 First kidney transplant in Central Texas 2004 First stroke certification by the Joint Commission in Texas 2005 First Cyberknife in Central Texas 2007 Clinical Education Center, the first of its kind in Central Texas To learn more about these and other innovations go to seton.net/umcb. C
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Table of Contents Pre-operative Instructions Directions & Maps Pre-Surgery Information, Tips and Helpful Hints Inpatient Surgery/Procedure Instructions Pain Control After Surgery Outpatient (Ambulatory) Surgery/Procedure Instructions Isolation Precautions Help Assist in the Safety Process in Your Surgery Five Things You Can Do to Prevent Infection FAQs about Surgical Site Infections FAQs about MRSA Information Concerning Smoking Helping You Prevent Falls Hospital Checklist for Sleep Apnea Patients Seton Financial Policy Patient Rights, Responsibilities and Healthcare Choices Advance Directives and Resuscitation Medical Power of Attorney Universal Medication Form Adult Patient Profile Part A Admissions Pre-Registration Form 2 3 5 6 7 8 9 10 10 11 12 14 15 16 17 18 20 26 35 37 41 1
Pre-operative Instructions The Day Before Surgery/Procedure To make your experience as smooth as possible, please complete the enclosed forms prior to your surgery/ procedure date. When we receive your health history forms before your pre-admissions testing appointment, we will likely be able to reduce your wait times. Smokers should not smoke for 24 to 48 hours before surgery to enhance breathing. If you take daily medication, check with your doctor about what to do the morning of your surgery regarding your medication. DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT UNLESS INSTRUCTED OTHERWISE BY ANESTHESIA. We will inform you as soon as possible if for any reason your scheduled surgery time needs adjusting. Please refer to page 16 if you have been diagnosed with sleep apnea. After Your Surgery/Procedure After you leave the operating/procedural room, you may be taken to the recovery room for a brief period. Here you will be cared for by our trained personnel and readied for your return home or admission. For your own safety, a responsible adult MUST drive you home. We highly recommend a responsible adult stay with you for the first 24 hours after surgery. Special Tips Please have no more than two adults accompanying you. One at a time may be allowed to visit the patient prior to and after surgery. If there is a possibility that you are pregnant, please be sure to discuss this with your physician. The Day of Your Surgery/Procedure Bathe or shower to reduce the chance of infection. Wear clothing that is easy to take off and put on. If you have a cold, a fever of 100 degrees or higher, a skin rash or an infection of any kind, notify your physician before coming in for your surgery. Be at the facility at the time given to you. Your surgery could be cancelled if you do not arrive in adequate time. Leave your valuables at home, including jewelry, cell phones, computers, wallets, medications, checkbooks, credit cards, cash, etc., except for a method of payment for your copay. If you choose to pay by check or credit card, make sure the person who accompanies you will take responsibility for those items. Remove all body piercings. If you wear glasses or hearing aids, bring along a case to store them in while you are in surgery. Make sure the person who accompanies you will take responsibility for those items. If you wear dentures, removable bridgework, etc., they may be removed before surgery. We recommend you leave your contacts at home, but if you must wear them to the hospital, be sure to bring along your storage case and solution. Make sure the person who accompanies you will take responsibility for those items. 2
Getting to University Medical Center Brackenridge From IH-35 Exit 235A toward 15th Street. Go west on 15th Street and you will see University Medical Center Brackenridge on your left. Parking is available in the Brackenridge parking garage located at the corner of 15th and Red River. The parking entrance is accessed via 15th Street. From Mopac (Hwy 1 Loop) Exit toward Enfield Road. Head east on Enfield Road for 0.8 miles. Take a slight left onto W. 15th Street and continue 1.2 miles. University Medical Center Brackenridge will be on your right just after you cross Red River Street. You will see the entrance for the hospital parking garage on your right. Where to Park On the day of your scheduled pre-admission testing and on the day of your scheduled surgery/procedure, you are allowed free parking for one car in either the valet parking area or the Parking Garage. Valet parking is located at the South entrance on 15th Street. If you exit either parking area, you will be expected to pay to re-enter. The fee for valet parking is $10. Parking is charged hourly in the Parking Garage, with a maximum daily charge of $9. Daily and weekly passes are available at discounted rates. All parking costs listed are subject to change. Airport Blvd. 290 Enfield/15th St. N Mopac Lamar Ave. Trinity St. Red River St. I-35 3
Map of University Medical Center Brackenridge First Floor Level Map of University Medical Center Brackenridge Second Floor Level 4
Pre-Surgery Information, Tips, and Helpful Hints If your surgeon has given you a specific time to arrive on the day of your surgery please follow his or her instructions. Otherwise, we will give you an arrival time. We will do our best to keep you informed ahead of time if your schedule should need to change. We often ask you to arrive two hours in advance of your surgery/procedure time. If you have not come in for a pre-admission testing visit, we will usually ask you to arrive three hours in advance, but no earlier than 5:30 a.m. Patients having a procedure with a cardiologist or radiologist need to arrive three hours prior to the procedure start time, but no earlier than 5:30 a.m. Please inquire to be sure of your specific arrival time. The average time for pre-admission testing is 60 minutes, but complex cases can take up to two hours or more. Please bring copies of any relevant lab results, EKGs or x-rays you have had within the past three months. Your insurance company may require pre-certification or a second opinion before surgery/procedure. Check with your employer or insurance carrier. Failure to meet your insurance requirements may result in admission delay or surgery cancellation. If your insurance carrier requires that you go to an outside facility for your lab work or other pre-operative tests, we will first pre-register you for the surgery, give you instructions for your surgery, and a representative from the anesthesia department will discuss your health status and the anesthetic options available. You will then be sent to the appropriate outside facility(s) to complete your testing. Also, if your lab work is not done at Seton, the Clinical Pathology Laboratory (CPL) will send you a separate bill. During your pre-admission visit, we will ask you to sign a consent for admission. Please complete the enclosed Universal Medication Form form prior to your arrival. If you have access to a fax machine, please fax to (512) 324-7879. On the day of your surgery, we will ask you to sign a consent form for the surgical procedure. The form requires a yes or no consent to use blood or blood products if medically necessary. If you do not consent we will ask you to sign a blood refusal form. If you wish to sign the refusal form, please discuss your concerns with your surgeon/procedural doctor prior to your surgery day. If you have advance directives (such as Medical Power of Attorney, The Directive to Physicians and Family or Surrogates, or a Donor Card) please bring a copy to the hospital so we will have your wishes on file. If you do not have a Medical Power of Attorney, The Directive to Physicians and Family or Surrogates, both are located in the back of this brochure. Please read and complete these forms before the day of your surgery, if you would like to do so. About Anesthesia During your visit to the hospital prior to the day of your planned surgery, you may be seen by a representative from the anesthesia department (unless your procedure will require only local anesthetic or nurse administered moderate sedation). The staff will review your planned procedure, medical history and laboratory studies, and at that time order any additional necessary studies. The anesthetic management of your operation will be discussed and you will have an opportunity to ask questions about choices of anesthetic techniques. Your post-operative pain management also may be discussed. Seton Outpatient Pharmacy For your convenience, the Outpatient Pharmacy offers very competitive prices, and accepts cash, checks, American Express, Discover, VISA and MasterCard. If you wish to have your prescriptions filled at the Outpatient Pharmacy, please make sure your family member or friend has the means to pay for your prescriptions. The Outpatient Pharmacy is a provider in some healthcare plans. You can call the Outpatient Pharmacy at (512) 324-7395 between 9 a.m. and 5:30 p.m. Monday through Friday, to find out if your healthcare plan is included. Hours subject to change. 5
Inpatient Surgery/Procedure Instructions A Step-By-Step Guide to Your Inpatient Surgery at University Medical Center Brackenridge Step 1 Preparing for Surgery For your comfort and safety, there are several factors to keep in mind prior to surgery. Please remember, these can affect the success of your procedure. Unless otherwise instructed, the following instructions are required for anyone having surgery. Follow eating and drinking limitations as instructed by your physician: If you are having general, spinal, epidural, or other regional anesthetic you must strictly observe your time and date requirements of nothing to eat or drink. It is hazardous to have anesthesia and surgery with anything in your stomach. Surgery may be canceled or delayed if you have taken any food or fluid. If you are having a local anesthetic, your surgeon will instruct you regarding eating and drinking limitations. Please do not wear jewelry and do not bring valuables with you. University Medical Center Brackenridge is not responsible for lost valuables. Remove all body piercings and leave them at home. If you choose to bring laptop computers or cell phones with you, your family member or a friend is responsible for all personal belongings. A friend or relative may wait during your surgery. That person should be sure to have a good night s sleep before the day of surgery and a meal before surgery. Please do not bring children as the waiting room area is limited in space. If you develop any skin irritations such as ant bites, nicks, cuts, sun burns, etc., cold, fever, persistent cough, or change in your condition during the week prior to your surgery/procedure, please notify your surgeon for treatment or referral. Please arrive promptly for your scheduled appointment. At this time you will finalize admission procedures, sign consent forms and have your preoperative evaluation. If the patient is a minor, a parent or legal guardian must be present to sign all forms. State hospital or state school patients must be accompanied by an attendant. For your convenience, please bring toilet articles with you to the hospital such as toothbrush/paste, deodorant, comb, brush, shaving supplies and non-skid slippers. Step 2 Pre-Registration Prior to your surgery/procedure, an admissions counselor will call to obtain insurance information and demographics. If an Admissions Counselor has not contacted you, please call three days before your surgery (512) 324-7880 Monday through Friday between 8 a.m. and 5:30 p.m. Step 3 Pre-Admission Testing Please bring this booklet with you. Be sure the Adult Patient Profile - Part A and the Universal Medication Form has been completed. If you have access to a fax machine, please fax to (512) 324-7879. If you have pre-registered, you will sign paperwork and be directed to the appropriate departments for testing. Be prepared to pay any deductibles or co-insurance payments due. If you have not pre-registered, you must bring the same information as requested in Step 2. After registration and testing, you will have completed the pre-admission process. Step 4 Arriving for Your Surgery/Procedure On the day of your surgery, please report to Day Surgery on the first floor (see map on page 4). There is a waiting area for family and friends while you are in the operating room (space is limited). When you arrive, you will be directed to a private room to change into a hospital gown. Intravenous fluids may be started. This helps replace the food and fluids you did not have prior to surgery/ procedure. A nurse will do a final check of your identification band, paperwork and vital signs. Some of the questions will be repetitious, but this is necessary to ensure accuracy. You will be taken to the surgical/procedural room. It may be very cool, but warm blankets will be provided. Your surgeon may give you an estimated length of time for your surgery. A pager will be available to your family to allow us to contact them for various reasons, including when you receive a room assignment, or when the doctor needs 6
to speak with your family. This pager must be returned to the receptionist prior to the patient s discharge from the surgical area. Your family/friends will need to take any of your belongings from you at this time. Step 5 Preparing for Discharge Be sure to confirm your discharge date with your physician so that you can make appropriate advanced discharge preparations. A responsible family member or friend must be available to drive you home when you are clinically ready to be discharged. Also, an adult should be available to assist you during your recovery at home, according to your surgeon s instructions. Bring appropriate clothing for your post-surgery ride home, for example: Slip-on shoes are easiest to wear after surgery. Eye surgery patients should bring a shirt that opens in the front. Hand and arm surgery patients should bring a large, loose sleeved shirt that fits over bulky dressings. Leg and foot surgery patients should bring pants with a large, loose leg, shorts, or a skirt to fit over bulky dressings. Pain Control After Surgery Treatment Goals People used to think that severe pain after surgery was something they just had to put up with. But with current treatments, that is no longer true. Today, you can work with your nurses and doctors before and after you have surgery to minimize your pain. Pain Control Can Help You. Discuss pain management options with your surgeon and a representative from the anesthesia department. Get well faster. With less pain, you can start walking, do your breathing exercises, and get your strength back more quickly. You may even leave the hospital sooner. Familiarize yourself with the following scale, which will be used to describe your level of comfort. Pain Scale Use of a pain scale to measure your pain provides quick, consistent communication between you and your caregivers. It also gives us measurable information and allows us to set realistic goals. Zero pain after surgery is not always possible, but we do want to provide satisfactory pain relief. Satisfactory pain relief is a level of pain that is tolerable and allows you to sleep, eat, and perform other required or desired physical activities. 0 2 4 6 8 10 0 - No Pain 4 - Tolerable 6 - Moderate 10 - Worst Pain Remember there is no right or wrong answer, this is simply your judgement of pain Pain Relief Take (or ask for) pain relief drugs when the pain first begins. If you know your pain will worsen when you start an activity, take pain medications first. It s harder to ease pain once it has taken hold. Help the doctors and nurses measure your pain. Using the pain scale to report your pain as a number helps the doctors and nurses know how well your treatment is working and whether to make any changes. Tell the doctor or nurse about any pain that won t go away. We aim to make your surgery as comfortable as possible and believe that using the simple principle stated here will help us to accomplish this goal. Acute Pain Management Guideline Panel. Pain Control After Surgery. A Patient s Guide. AHCPR Pub. No. 92-0021. Feb. 1992 7
Outpatient (Ambulatory) Surgery/Procedure Instructions A Step-By-Step Guide to Your Outpatient Surgery at University Medical Center Brackenridge Step 1 Preparing for Surgery/Procedure For your comfort and safety, there are several factors to keep in mind prior to surgery/procedure. Please remember, these can affect the success of your procedure. Unless otherwise instructed, the following instructions are required for anyone having surgery. Surgery/procedure times may need to change, but we will do our best to keep you informed ahead of time if your schedule should need to change. Follow eating and drinking limitations as instructed by your physician: If you are having moderate sedation, you must strictly observe your time and date requirements of nothing to eat or drink. It is hazardous to have anesthesia and surgery with anything in your stomach. Surgery may be canceled or delayed if you have taken any food or fluid. If you are having only a local anesthetic, your surgeon will instruct you regarding eating and drinking limitations. Please do not wear jewelry and do not bring valuables with you. University Medical Center Brackenridge is not responsible for lost valuables. Remove all body piercings and leave them at home. If you choose to bring your laptop computers or cell phones with you, the person who accompanies you will take responsibility for those items. Your family or friend will need to take your belongings and return with them prior to discharge. Wear casual, loose clothing that can be easily folded. Bring appropriate cases for eyeglasses, dentures and removable prosthetics. The person who accompanies you will take responsibility for those items. Leave contact lenses and hairpins at home. Do not wear eye makeup or nail polish. A friend or relative may wait during your surgery/ procedure. That person should be sure to have a good night s sleep before the day of surgery and a meal before surgery. Please do not bring children as the waiting room area is limited in space. If you develop any skin irritations such as ant bites, nicks, cuts, sun burns etc., cold, fever, persistent cough or change in your condition during the week prior to your surgery, please notify your surgeon for treatment or referral. Upon arrival, you will finalize admission procedures, sign consent forms and have your pre-operative evaluation. If the patient is a minor, a parent or legal guardian must be present to sign all forms. State hospital or state school patients must be accompanied by an attendant. Step 2 Pre-Registration Prior to your surgery/procedure, an admissions counselor will call to obtain insurance information and demographics. If an Admissions Counselor has not contacted you, please call three days before your surgery (512) 324-7880 Monday through Friday between 8:00 a.m. and 5:30 p.m. This process will decrease registration time when you come to the hospital. Step 3 Pre-Admission Testing Please bring this booklet with you. Be sure the Adult Patient Profile - Part A and the Universal Medication Form has been completed. If you have access to a fax machine, please fax to (512) 324-7879. If you have pre-registered, you will sign paperwork and be directed to the appropriate departments for testing. Be prepared to pay any deductibles or co-insurance payments due. If you have not pre-registered, you must bring the same information as requested in Step 2. After registration and testing you will have completed the pre-admission process. Step 4 Arriving for Your Surgery/Procedure On the day of your surgery, please report to Day Surgery on the first floor (see map on page 4). There is a waiting area for families and friends while you are in the operating/ procedural room. When you arrive, you will be directed to a private room to change into a hospital gown. Your family/friends will need to take any of your belongings from you at this time. Intravenous fluids may be started. This helps replace the food and fluids you did not have prior to surgery/ procedure. A nurse will do a final check of your identification band, 8
Isolation Precautions paperwork and vital signs. Some of the questions will be repetitious, but need to be asked again to ensure accuracy. You will be taken to the surgical room. It may be very cool, but warm blankets will be provided. Your surgeon may give you an estimated length of time for your surgery. A pager will be available to your family to allow us to contact them for various reasons, including when you receive a room assignment or when the surgeon needs to speak with your family. This pager must be returned to the receptionist prior to the patient s discharge from the surgical area. We request that family and friends remain in the waiting room. Step 5 After Surgery/Procedure After surgery, bandages or dressings are usually placed over the incision. If you had a general, epidural, and/or spinal anesthesia, you will remain in the Post Anesthesia Care Unit (Recovery Room) until you are stable, then you will be transferred to Day Surgery. If you had a local you may go to Day Surgery directly. You will spend a brief time in Day Surgery. You will be observed and offered juice and crackers and assistance in walking until you are able to do so on your own. You will receive instructions, change clothes and return home. Step 6 Preparing for Discharge A responsible family member or friend must be available to drive you home when you are clinically ready to be discharged. It is highly recommended that an adult be available to assist you during your recovery at home, according to your surgeon s instructions. Bring appropriate clothing for your post-surgery/procedure ride home, for example: Slip-on shoes are easiest to wear after surgery/ procedure. Eye surgery patients should bring a shirt that opens in the front. Hand and arm surgery patients should bring a large, loose sleeved shirt that fits over bulky dressings. Leg and foot surgery patients should bring pants with a large, loose leg, shorts or a skirt to fit over bulky dressings. Isolation Precautions are extra steps that are used to protect patients and others from infections, diseases or certain germs. If you are in isolation, it is important to understand what your isolation means and what you should expect from the hospital staff or visitors. When you, or your family member, have been placed on the following isolation precautions: Contact Isolation Precautions used for infections, diseases or germs that are spread by touching the patient or items in the room. Healthcare workers and visitors will: Wear a gown and gloves. Remove the gown and gloves before leaving room. Do hand hygiene (hand washing or use waterless hand sanitizer) upon leaving the room. Patients will: Stay in the room except for medically necessary procedures or therapy. Wear a clean patient gown and do hand hygiene before leaving the room. Droplet Isolation Precautions used for diseases or germs that are spread by coughing, sneezing, or talking during certain medical procedures. Healthcare workers and visitors will: Wear a surgical mask in the room. Do hand hygiene (hand washing or use waterless hand sanitizer) upon leaving the room. Patients will: Stay in the room except for medically necessary procedures or therapy. Wear a surgical mask when leaving the room. Airborne Isolation Precautions used for diseases or germs that are spread by breathing germs in the air. Very few diseases need Airborne Isolation. Healthcare workers and visitors will: Wear an N95 respirator mask while in the room. Do hand hygiene (hand washing or use waterless hand sanitizer) upon leaving the room. Patients will: Be placed in a room with special air flow and with the door closed. Stay in the room except for medically necessary procedures. Wear a surgical mask when leaving the room. 9
Help Assist in the Safety Process in Your Surgery As a patient, you can make your care safer by being an informed member of your health care team. Preparing for your surgery Ask your doctor Are there any prescription or over-the-counter medicines that you should not take before your surgery? Can you eat or drink before your surgery? Should you trim your nails and remove any nail polish? If you have other questions, write them down. Take your list of questions with you when you see your doctor. Ask someone you trust to Take you to and from the surgery facility. Be with you at the hospital or surgery facility. This person can make sure you get the care you need to feel comfortable and safe. Before you leave home Shower and wash your hair. Do not wear make-up. Your caregivers need to see your skin to check your blood circulation. Leave your jewelry, money and other valuables at home. At the surgery facility The staff will ask you to sign an Informed Consent form. Read it carefully. It lists: Your name The kind of surgery you will have The risks of your surgery That you talked to your doctor about the surgery and asked questions Your agreement to have the surgery Make sure everything on the form is correct. Make sure all of your questions have been answered. For your safety, the staff may ask you the same question many times. They will ask: Who you are What kind of surgery you are having The part of your body to be operated on. They will also double-check the records from your doctor s office. A health care professional will mark the spot on your body to be operated on. Make sure they mark only the correct part and nowhere else. This helps avoid mistakes. Your neck, upper back or lower back will be marked if you are having spine surgery. The surgeon will check the exact place on your spine in the operating room after you are asleep. A time out is performed to make sure they are doing the right surgery on the right body part on the right person. The Joint Commission, www.jointcommission.org Five Things You Can Do to Prevent Infection Avoiding contagious diseases like the common cold, strep throat and the flu is important to everyone. Here are five easy things you can do to fight the spread of infection. 1. Clean your hands. Use soap and warm water. Rub your hands really well for at least 15 seconds. Rub your palms, fingernails, in between your fingers and the backs of your hands. Or, if your hands do not look dirty, clean them with alcohol-based hand sanitizers. Rub the sanitizer all over your hands, especially under your nails and between your fingers, until your hands are dry. Clean your hands before touching or eating food. Clean them after you use the bathroom, take out the trash, change a diaper, visit someone who is ill or play with a pet. 2. Make sure health care providers clean their hands or wear gloves. Doctors, nurses, dentists and other health care providers come into contact with lots of bacteria and viruses. So before they treat you, ask them if they ve cleaned their hands. Health care providers should wear clean gloves when 10
they perform tasks such as taking throat cultures, pulling teeth, taking blood, touching wounds or body fluids, and examining your mouth or private parts. Don t be afraid to ask them if they should wear gloves. 3. Cover your mouth and nose. Many diseases are spread through sneezes and coughs. When you sneeze or cough, the germs can travel three feet or more! Cover your mouth and nose to prevent the spread of infection to others. Use a tissue! Keep tissues handy at home, at work and in your pocket. Be sure to throw away used tissues and clean your hands after coughing or sneezing. If you don t have a tissue, cover your mouth and nose with the bend of your elbow or hands. If you use your hands, clean them right away. 4. If you are sick, avoid close contact with others. If you are sick, stay away from other people or stay home. Don t shake hands or touch others. When you go for medical treatment, call ahead and ask if there s anything you can do to avoid infecting people in the waiting room. 5. Get shots to avoid disease and fight the spread of infection. Make sure that your vaccinations are current even for adults. Check with your doctor about shots you may need. Vaccinations are available to prevent these diseases: Chicken pox Mumps Measles Diphtheria Tetanus Hepatitis Shingles Meningitis Flu (also known as influenza) Whooping cough (also known as Pertussis) German measles (also known as Rubella) Pneumonia (Streptococcus pneumoniae) Human papillomavirus (HPV) The Joint Commission, www.jointcommission.org FAQs about Surgical Site Infections What is a Surgical Site Infection (SSI)? A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in about 1 to 3 out of every 100 patients who have surgery. Some of the common symptoms of a surgical site infection are: Redness and pain around the area where you had surgery Drainage of cloudy fluid from your surgical wound Fever Can SSIs be treated? Yes. Most surgical site infections can be treated with antibiotics. The antibiotic given to you depends on the bacteria (germs) causing the infection. Sometimes patients with SSIs also need another surgery to treat the infection. What are some of the things that hospitals are doing to prevent SSIs? To prevent SSIs, doctors, nurses and other healthcare providers: Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery. Clean their hands with soap and water or an alcoholbased hand rub before and after caring for each patient. May remove some of your hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur. They should not shave you with a razor. Wear special hair covers, masks, gowns and gloves during surgery to keep the surgery area clean. Give you antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery. Clean the skin at the site of your surgery with a special soap that kills germs. 11
What can I do to help prevent SSIs? Before your surgery: Tell your doctor about other medical problems you may have. Health problems such as allergies, diabetes and obesity could affect your surgery and your treatment. Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit before your surgery. Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection. At the time of your surgery: Speak up if someone tries to shave you with a razor before surgery. Ask why you need to be shaved and talk with your surgeon if you have any concerns. Ask if you will get antibiotics before surgery. After your surgery: Make sure that your healthcare providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub. If you do not see your providers clean their hands, please ask them to do so. Family and friends who visit you should not touch the surgical wound or dressings. Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands. What do I need to do when I go home from the hospital? Before you go home, your doctor or nurse should explain everything you need to know about taking care of your wound. Make sure you understand how to care for your wound before you leave the hospital. Always clean your hands before and after caring for your wound. Before you go home, make sure you know who to contact if you have questions or problems after you get home. If you have any symptoms of an infection, such as redness and pain at the surgery site, drainage, or fever, call your doctor immediately. If you have additional questions, please ask your doctor or nurse. FAQs about MRSA (Methicillin-Resistant Staphylococcus aureus) What is MRSA? Staphylococcus aureus (pronounced staff-ill-oh-kok-us AW-ree-us), or Staph is a very common germ that about 1 out of every 3 people have on their skin or in their nose. This germ does not cause any problems for most people who have it on their skin. But sometimes it can cause serious infections such as skin or wound infections, pneumonia, or infections of the blood. Antibiotics are given to kill Staph germs when they cause infections. Some Staph are resistant, meaning they cannot be killed by some antibiotics. Methicillin-resistant Staphylococcus aureus or MRSA is a type of Staph that is resistant to some of the antibiotics that are often used to treat Staph infections. Who is most likely to get an MRSA infection? In the hospital, people who are more likely to get an MRSA infection are people who: have other health conditions making them sick have been in the hospital or a nursing home have been treated with antibiotics. People who are healthy and who have not been in the hospital or a nursing home can also get MRSA infections. These infections usually involve the skin. More information about this type of MRSA infection, known as community-associated MRSA infection, is available from the Centers for Disease Control and Prevention (CDC). www.cdc.gov/mrsa How do I get an MRSA infection? People who have MRSA germs on their skin or who are infected with MRSA may be able to spread the germ to other people. MRSA can be passed on to bed linens, bed rails, bathroom fixtures and medical equipment. It can spread to other people on contaminated equipment and on the hands of doctors, nurses, other healthcare providers and visitors. Can MRSA infections be treated? Yes, there are antibiotics that can kill MRSA germs. Some patients with MRSA abscesses may need surgery to drain the infection. Your healthcare provider will determine which treatments are best for you. 12
What are some of the things that hospitals are doing to prevent MRSA infections? To prevent MRSA infections, doctors, nurses and other healthcare providers: Clean their hands with soap and water or an alcoholbased hand rub before and after caring for every patient. Carefully clean hospital rooms and medical equipment. Use Contact Precautions when caring for patients with MRSA. Contact Precautions mean: Whenever possible, patients with MRSA will have a single room or will share a room only with someone else who also has MRSA. Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with MRSA. Visitors may also be asked to wear a gown and gloves. When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands. Patients on Contact Precautions are asked to stay in their hospital rooms as much as possible. They should not go to common areas, such as the gift shop or cafeteria. They may go to other areas of the hospital for treatments and tests. Some patients may be tested to see if they have MRSA on their skin. This test involves rubbing a cotton-tipped swab in the patient s nostrils or on the skin. What can I do to help prevent MRSA infections? In the hospital: Make sure that all doctors, nurses and other healthcare providers clean their hands with soap and water or an alcohol-based hand rub before and after caring for you. Can my friends and family get MRSA when they visit me? The chance of getting MRSA while visiting a person who has MRSA is very low. To decrease the chance of getting MRSA your family and friends should: Clean their hands before they enter your room and when they leave. Ask a healthcare provider if they need to wear protective gowns and gloves when they visit you. What do I need to do when I go home from the hospital? To prevent another MRSA infection and to prevent spreading MRSA to others: Keep taking any antibiotics prescribed by your doctor. Don t take half-doses or stop before you complete your prescribed course. Clean your hands often, especially before and after changing your wound dressing or bandage. People who live with you should clean their hands often as well. Keep any wounds clean and change bandages as instructed until healed. Avoid sharing personal items such as towels or razors. Wash and dry your clothes and bed linens in the warmest temperatures recommended on the labels. Tell your healthcare providers that you have MRSA. This includes home health nurses and aides, therapists and personnel in doctors offices. Your doctor may have more instructions for you. If you have questions, please ask your doctor or nurse. If you do not see your providers clean their hands, please ask them to do so. When you go home: If you have wounds or an intravascular device (such as a catheter or dialysis port) make sure that you know how to take care of them. 13
Information Concerning Smoking The Seton Healthcare Family is committed to ensuring the health, safety and welfare of all individuals utilizing our facilities and services. Consistent with our mission as a health care institution, smoking is prohibited by all staff, patients and visitors at Seton facilities. The policy which went into effect November 15, 2007 means that smoking is not permitted anywhere inside or outside Seton s nine acute care facilities in Central Texas Seton Medical Center Austin, Seton Southwest, Seton Northwest, University Medical Center Brackenridge, Seton Edgar B. Davis Hospital, Seton Highland Lakes Hospital, Seton Shoal Creek, Seton Medical Center Williamson, Seton Medical Center Hays and Dell Children s Medical Center of Central Texas. This policy is also in effect at Seton s leased facilities where patient care is provided. Areas where smoking is not permitted include the outdoor grounds, entranceways and all parking areas. Medical evidence has confirmed that tobacco smoking and second-hand exposure to tobacco smoke causes disease and contributes to poor health. It is every patient s responsibility to participate in maintaining their own health. This includes stopping smoking if you currently smoke and remaining smoke free if you have recently quit. If you would like assistance with either of these endeavors, we would like to help. Please ask your healthcare provider for assistance or refer to the following resources: Freedom From Smoking Online Free Online Cessation Program offered by the American Lung Association. For more information, go to www.lungusa.org. 1-800-QUIT-NOW, is a 24/7, 365 days a year phone-line designed to provide support and coaching to those who are embarking on the journey to quit smoking. Trained cessation experts staff the quitline phone centers. 1-877-44U-QUIT is the National Cancer Institute s Smoking Quitline. Counselors are available to answer smoking-related questions in English or Spanish, Monday through Friday 9 a.m. to 4:30 p.m. For additional information, visit the site at www.cancer.gov/ cancertopics/smoking. The Texas Medical Association offers material geared toward physicians who are assisting and treating patients who smoke. Visit www.texmed.org and type smoking cessation in the search box. If you want help to quit smoking, resources are located at our information desks and gift shops. In addition, smoking cessation aids are available for purchase in our gift shops. Here are just a few benefits of quitting smoking, according to the American Cancer Society: Over time: 20 minutes after quitting: Your heart rate and blood pressure drop. 12 hours after quitting: The carbon monoxide level in your blood drops to normal. 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. 1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs and reduce the risk of infection. 1 year after quitting: The risk of coronary heart disease is half that of a smoker. 5-15 years after quitting: Your stroke risk is reduced to that of a nonsmoker. 10 years after quitting: The lung cancer death rate is about half that of a continuing smoker s. The risk of cancer of the mouth, throat, esophagus, bladder, cervix and pancreas decrease. 15 years after quitting: The risk of coronary heart disease is that of a nonsmoker s. Other rewards that can improve your day-to-day life: Food tastes better Your sense of smell returns to normal Ordinary activities no longer leave you out of breath (for example, climbing stairs) Damaging effects on your appearance are reduced, including: Premature wrinkling of the skin Bad breath 14
Stained teeth Gum disease Bad smelling clothes and hair Yellow fingernails While we are not asking people to quit smoking, it is our hope that a smoke-free environment will provide the opportunity to do so. Please talk with your physician or a Seton associate about smoking cessation support information and resources available to assist you during your visit to a Seton facility. Wearing glasses or contact lenses but still not able to see well, or if you wear them and left them at home Feeling dizzy or weak or have a history of dizzy spells Have been experiencing diarrhea, urinary frequency, or urinary incontinence If you take four or more medications daily or are taking pain medication If you ve had surgery in the last 48 hours Your Unique Fall Risk Factors: We have an obligation to provide the healthiest environment possible for our associates, physicians, patients, their families and visitors, says Charles J. Barnett, President and Chief Executive Officer, Seton Healthcare Family. Helping You Prevent Falls We want to help you avoid falling while you re in the hospital and after you return home. Falls are the most common cause of injury and injuryrelated deaths for older adults - one in three adults 65 years and older fall each year. According to the Centers for Disease Control (CDC), 14,900 people died from a fall and 1.8 million more were treated for fall-related injuries in 2004. Who is at risk for falling? You may be at risk for falling if you have any of the risk factors listed below. (Be sure and tell your nurse if any apply to you.) A previous fall in the last 6 months A condition that may lead to altered level consciousness such as Alzheimer s, Seizures, Narcolepsy, etc. Difficulty walking or getting out of a chair or bed Conditions that may limit your mobility such as amputation, muscle weakness, Parkinson s or arthritis. Foot problems that are painful or cause unsafe use of shoes Sensory problems that cause your feet to be numb. Who is at risk for serious injury from falling? While some patients are at risk for falling, others are even at a greater risk of having a serious injury from falling. Tell your nurse if you or your loved one has any of the following risk factors: Brittle bones or have been told by your doctor that you have Osteoporosis Take any type of medication that may thin your blood (Aspirin, Coumadin, Vitamin E, Plavix, Aggrenox) What to expect while you re a patient at University Medical Center Brackenridge In order to minimize the likelihood of you or your loved one falling while a patient we are committed to: Screening all patients for risk of falling Implementing measures to reduce the chance of falling (bed in low position, call light within your reach or bed alarm on.) Notifying other members of the healthcare team if you are identified as at risk Checking on you frequently during your stay Routinely scanning your environment to identify and correct safety hazards Regularly checking that your pain is controlled, positioning is comfortable, possessions are within reach and elimination needs are addressed. 15
What you can do to partner with the staff to reduce your chance of falling: Tell your nurse if you use an assistive device (such as a walker, cane or wheelchair) and didn t bring it to the hospital with you so we can arrange for you to use one while you are here. Use your call light to ask for help in getting out of bed... our goal is that you call, don t fall. Let the nurse know if you see anything that might be a fall hazard such as a spill, unsecured cord, etc. What can I do to prevent falling at home? When you go home, there are measures you can take to ensure a fall-safe environment: Begin a regular exercise program. Exercise makes you stronger and will help you feel better. Lack of exercise leads to weakness and increases your chances of falling. Have your doctor or pharmacist review all the medicines you take even over-the-counter medicines. As you get older, the way medicines work in your body can change. Some medicines, or combinations of medicines, can make you sleepy or dizzy and can cause you to fall. Have your eyes checked by an eye doctor at least once a year. Poor vision can increase your chances of falling Make your home safer. About half of all falls happen at home. To make your home safer: Keep pathways clear by removing things you can trip over such as cords, oxygen tubing, etc. Remove small rugs or use double-sided tape to keep them from slipping Keep items you use often within reach so you don t have to climb to get them Have grab bars put next to your toilet and in the tub or shower Use non-slip mats in the bathtub and on shower floors Improve lighting in your home. As you get older, brighter light will help you to see more clearly. Have handrails and lights put in on all staircases; use non-slip socks if your steps are not carpeted Use a walker, cane, etc. if needed Wear shoes inside and outside Watch out for house pets Hospital Checklist For Sleep Apnea Patients For effective treatment, OSA (Obstructive Sleep Apnea) patients must use CPAPs/BIPAPs anytime while sleeping. The use of narcotic pain medications and the lingering after-effects of anesthesia can make OSA worse. Please bring in your own CPAP/BIPAP equipment (i.e. tubing, mask, etc.). Using your own equipment ensures that it has been properly set to treat your OSA. Label all parts of your CPAP equipment prior to admission. The hospital staff will need to inspect your equipment before use to ensure it is functioning properly. Your physician and care staff may determine that hospital issued equipment is more appropriate to provide treatment. They will discuss any changes with you. Have your equipment serviced and cleaned prior to your scheduled admission or procedure. The majority of home care companies can provide this service if you take the equipment to them. While in the hospital, supplemental oxygen may be required. Your mask may have oxygen ports for attaching an oxygen line. If it does not, the hospital will provide a port adapter. If you are having surgery, tell your surgeon that you have sleep apnea and request a consultation with the anesthesiologist to discuss your OSA and how it will be managed. Tell the anesthesiologist your prescribed pressure settings and ask if they will need a letter from, or a consultation with, your sleep doctor. 16