8.DESCRIPTION:

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In most Latin American countries, the issue of safety in patient care is one of the benchmarks for quality in health care, in the same way, working on patient safety, in addition to being an ethical imperative of health institutions is a legal obligation.

In Colombia, the Ministry of Health and Social Protection has established the procedures and conditions of authorization of health services and has defined the priority processes within the conditions of authorization of surgical services. Two of these processes are the preparation of the patient for the surgical act and the transfer of the patient to the operating room¨[1].

According to the WHO, major surgery is “any procedure performed in the operating room that allows the incision, excision, manipulation or suture of a tissue; generally requires regional or general anesthesia or deep sedation to control pain” (WHO). In other words, a surgical procedure is not only carried out in an operating room, it is also carried out in procedure rooms (of low or medium complexity) in emergency services (ICU), specialized dental offices, gastroenterology units, emergency departments, interventional radiology, among others.

According to the structure of the process, surgical care has 3 phases according to its relationship with the surgical act: pre-surgical, surgical and post-surgical phase. The pre-surgical phase is the phase that precedes surgery and where a series of moments occur, necessary for its correct execution and in which there is interaction between several people. In the pre-surgical phase, the patient goes through a process, in which they have contact with professionals and technicians who, according to their responsibilities, offer information, clarify clinical and administrative doubts, carry out a detailed review of the required documentation and previous clinical history; all this to guarantee that the procedure is carried out successfully. Within the surgical act and after it, there is also a series of actions that, carried out correctly, reduce the risk of subsequent complications.[2].

9. PROCEDURE:

PREPARATION OF MATERIALS AND EQUIPMENT.

• Prepare the necessary equipment: Material for the patient's hygiene (towel, soap, cup).

• Body antiseptic solution.

• Hair removal material (scissors) if necessary.

• Clothes for patient and bed.

• Container for dental prosthesis, if applicable.

• Polish remover or remover, if applicable.

• Latex gloves

• Complete history of the patient.

• Pre-surgical exams, as well as all those   necessary and specific for the intervention:

• Crossmatches (recent date)

• Complete blood count (recent date).

• rx. chest (recent date) and specific

• EKG if ordered.

• Blood chemistry tests if required (recent date)

• Coagulation tests (recent date)

• Anesthesia evaluation, (recent date)

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THE AFTERNOON BEFORE THE INTERVENTION.

• Ask the patient what medicines he takes at home, if he has any type of allergies and if he has any major disease (diabetes, hypertension, etc.) inform and mark the medical history.

• Verification of the user's personal data with the entry order

• Information to the user and the family of the time of the intervention, where they can wait for their relatives, when they will receive medical information and the necessary techniques for the preparation. If the user and the family express doubts about the intervention and/or medical diagnosis, the treating specialist will be contacted to provide the necessary information.

• Review the patient's history, review the preoperative and if necessary perform E.K.G and laboratory tests that are required as presurgical tests.

• Give evacuating enema, if necessary
   

• Check if the user: has jewelry, nail polish, etc., delivering valuables to the family member.

• At the time of scheduling the surgery, it is explained to the outpatients not to shave (shave) or remove any hair in or near the surgical site, since in recovery they proceed to motilar if necessary

• Administer medication if prescribed and take additional tests that are pending.

• Inform the user of the dietary standards up to the time of the intervention. Explain the need for restriction of food and oral fluids, at least 8 hours before surgery, if applicable.

• Make sure that there is no contraindication or allergy to the prescribed drug, be it oral premedication and/or intestinal preparation or others.

• Explain the individual treatments to the user and/or family, according to the protocol: intravenous therapy, insertion of a urinary catheter or nasogastric tube, use of a spirometer, anti-embolic stockings or drains, etc.

• Administer medication and/or pre-surgical preparation according to guidelines.

THE NIGHT BEFORE THE INTERVENTION.

• Administer the preoperative medication that is prescribed.

• Inform the user that they will remain fasting, including water, 8 hours before surgery, intervention or surgical procedure. If you need to take oral medication, do it with the least amount of water possible

• For the purpose of preventing infection, hospitalized or outpatient users should bathe thoroughly on the day of surgery with soap including their hair.

• Check the non-existence of jewelry, dental prostheses, nail polish, no makeup or lipstick

• The dental prosthesis for the safety of the user must be delivered only to the family and record it in the medical history to whom it was delivered.

• Take vital signs and record them in the clinical history.

•  Make sure that the user is duly informed.

• Write down in the HC the time the user leaves the service, as well as any incident that may have been observed.

• If the user requires a hearing aid, they must keep it on and it will be removed at the appropriate time upon entering the surgery area.

THE MORNING OF THE INTERVENTION.

• Confirm that ambulatory surgery users have carried out the preparation at home according to the recommendations given in the pre-anesthesia consultation

• Vein canalized with jelco 18 or 16 according to surgery, in the left arm

• If the surgery is of the head and neck, anesthesia extension must be placed, but it will be placed in the operating room

• Nursing informed consent, completed and signed Anesthesia informed consent, completed and signed

• Informed consent of the surgical specialist, completed and signed

•  Complete pre-anesthetic evaluation

•  Old medical history, and all pre-surgical exams

• Compliance with medical orders and pre-anesthesia

•  Verification of results of complete examinations ordered by the surgical specialist or the anesthesiologist according to pathology

• A complete fast.

• Clean and dry surgical gown.

• Suspended anticoagulants if the pathology requires it

• Exams or diagnostic aids necessary according to the surgical procedure.

• Correctly completed surgical preparation checklist in the electronic medical record

• Every user when entering the surgery recovery area proceeds to place the identification bracelet if it is outpatient, if it is hospitalization or emergency, it is verified that they come with it. At the same time, it will be identified if it is allergic and the identification handle is placed.

• Risks identified and risk handles placed.

• Verification of the bathroom if possible, and perform a correct preapsepsy

• Put on surgical gown, indicating to the user how to put it on

• Before entering the operating room in the recovery area with the user awake, the surgical site is marked with a marker and an asterisk, with the user awake and checking with the site of the surgical incision, in addition the patient must be present. surgeon (according to surgical demarcation guide)

• Check the non-existence of jewelry, dental prostheses, nail polish, etc.

• If the user takes pre-medication, tell him to stay in bed avoiding displacements due to the risk of falls. You will be told to urinate first.

• Take vital signs, blood pressure, pulse and oximetry and record them in the clinical history and also informing if any alteration occurs, notify the anesthesiologist

• Ensure that the user is duly informed about the surgical procedure and its care, but notify the treating physician to clarify doubts

• Indicate in relation to devices for personal use such as dental prostheses, hearing aids, glasses, etc., that they can keep them if they wish, however, they must be removed in the pre-surgical area, giving them to a family member.

• Write down in the HC the time the user leaves the service, with their respective observations, as well as any incident that may have been observed.

• The user must be ready 20 minutes before the scheduled time for departure to the operating room.

• Make sure that the user's history is complete, with pre-anesthetic evaluation and medical orders fulfilled, pre-surgical exams,

• Arrange time for family members to talk with the client before transfer to the surgical area.

• Inform the user and family about the accompaniment to the pre-surgical area, once there a family member can stay with him until he goes to the operating room.

• Also indicate to the family the place to wait during the intervention.

• The head nurse of recovery or operating rooms will check the correct preparation of the patient before transferring him to the operating room

10. GENERAL CONSIDERATIONS

• Treat all infections away from the surgical area. Do not perform scheduled Interventions until the infection has been resolved.

• Control of diabetes; reduce glycosylated hemoglobin levels to <7% if possible.

• Preoperative hospital admission as short as possible.

• Encourage quitting smoking 30 days prior to surgery.

• In general, avoid immunosuppressive medication in the perioperative period, if possible.

[1] Colombian Journal of Anesthesiology, volume 43 year 2015

[2] IMPROVING SAFETY IN SURGICAL PROCEDURES INSTRUCTIONAL PACKAGES TECHNICAL GUIDE “GOOD PRACTICES FOR PATIENT SAFETY IN HEALTH CARE”