PRE AND POST-OPERATIVE CARE

DOCUMENT TYPE: PROCEDURE

PURPOSE
Describes pre-operative care for patients going to the Operating Room from an inpatient area and post-
operative care for patients returning to an inpatient area after surgery.
POLICY STATEMENTS
Patients going to the operating room must wear appropriate Identification Band that includes at least 2 unique
patient identifiers – patient’s name and date of birth, Medical Record Unit Number (MRUN), or Provincial
Health Number (PHN).
Patients with known allergies must wear the appropriate allergy ID band.
ID band must not be on the operative limb.
Decision to have Parental Presence at Induction of Anesthesia rests with the anesthesiologist.
SITE APPLICABILITY
Applicable to all inpatient areas at BC Children’s Hospital and Sunny Hill Health Centre.
PRACTICE LEVEL/COMPETENCIES
Providing pre- and post-operative care are foundational level competencies for RNs at BCCH.
DEFINITIONS
Fasting Guidelines:
Ingested material Minimum fasting period
Clear fluids* 1 hour
Breast milk 4 hours
Infant formula 6 hours
Non-human milk** 6 hours
Light meal‡ 6 hours
*examples of clear fluids include water, clear fruit juices or drinks (apple juice, koolaid), carbonated beverages,
clear tea. Jello (gelatin) and clear broth are not considered clear liquids for pre-sedation/pre-operative
fasting as these may be protein based and thus may potentially delay gastric emptying.
**since non-human milk is similar to solids in gastric emptying time, the amount ingested must be considered
when determining an appropriate fasting period
‡a light meal typically consists of toast and clear liquids. Meals that include fried or fatty foods or meat may
prolong gastric emptying time. Both the amount and type of food ingested must be considered when
determining an appropriate fasting period.

NOTE: No solids after midnight is recommended for patients in Surgical Daycare Unit (SDCU) or
Radiology to allow for potential schedule changes.

PRE-OPERATIVE CARE
1. COMPLETE pre-op checklist. Ensure most recent weight in kilograms, vital signs, EoPC score and Braden
Q score are recorded.
2. CONFIRM surgical consent and consent for blood products when applicable are completed
3. ENSURE that the surgical site is marked if applicable.
4. ENSURE chart contains all pertinent patient records (i.e. consents, lab reports, history, patient care
flowsheets).

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5. PROVIDE pre-op teaching, including the child in a developmentally appropriate way. DOCUMENT on
appropriate teaching flowsheet or in Nurses’ Notes.
6. BATHE patient using 2%-4% Chlorhexidine scrub, SHAMPOO hair, and REMOVE nail polish.
7. REMOVE jewellery (e.g. body piericings).
8. NOTIFY other services as appropriate.
9. REFER to fasting guidelines for fasting requirements for elective surgery/sedation.
10. CONFIRM actual time of last solids, liquids, clear fluids ingested with caregiver and record these on Pre-
Operative Checklist.
11. ADMINISTER pre-op medication as ordered. DOCUMENT on anaesthetic record and in M.A.R.
NOTE: DO NOT GIVE INJECTIONS IN OPERATIVE LIMB.
NOTE: Some routine medications must be given pre operatively, e.g. anticonvulsants,
antihypertensives, steroids, immunosuppressants. Confirm with anesthesiologist if uncertain.
12. ATTACH Addressograph card to chart.
13. TRANSPORT patient to OR as per transport policy. Parents may accompany patient just inside the OR
doors. If accompanying patient into the OR, the OR nurse will prepare them for entry.
14. PROVIDE report to OR nurse. The OR nurse will confirm patient identification, surgical procedure, surgical
site if applicable and patient allergy status in the presence of the transferring nurse.
15. ACCOMPANY parents out of OR area if necessary.
DOCUMENTATION
1. COMPLETE and SIGN preop checklist.
2. DOCUMENT in nurse’s notes:
o time of transfer to OR
o method of transport
o person accompanying patient

POST-OPERATIVE CARE ON RETURN TO UNIT

1. PREPARE bedside for patient arrival. Ensure equipment required for patient care is available.
2. Upon patient arrival, VERIFY patient identification with transferring nurse by ensuring patient is wearing an
ID band and that information matches addressograph plate and patient chart.
3. ASSIST with transfer of patient from stretcher to bed.
4. RECEIVE verbal report at the bedside from transferring RN using “ARED” sections of SHARED transfer of
care form as a guide. Review anesthetic record, OR record, PACU record, physician’s orders and plan of
care with transferring RN.
5. PERFORM focused physical assessment including assessment of operative site, catheters, drains, tubes,
special equipment/appliances, etc in presence of transferring RN and verify findings. Ask questions as
needed to clarify information. INVOLVE family in handover process if present.
6. PERFORM bedside safety check and site to source check of infusion systems in collaboration with
transferring RN.
7. ASSESS skin colour, level of consciousness and vital signs (Temperature, Heart Rate, Respiratory Rate
and Blood Pressure –TPR and BP) with transferring RN. Confirm patient status is unchanged or improved
from PACU.

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8. If patient is stable, then MONITOR vital signs:
 hourly x 4, THEN
 every 2 hours x 2, THEN
 as per physicians order thereafter or as per unit routine
9. COMPLETE patient assessment once transfer is complete and transferring RN has left.
10. APPLY restraints if necessary to protect patient from pulling at tubes/catheters or dressing. ENSURE side
rails are up.
DOCUMENTATION
1. COMPLETE handover checklist on SHARED form and sign in appropriate section with transferring RN.
2. DOCUMENT on SHARED Transfer of Care form:
o bedside handover checks completed
o vital signs taken
o physical assessment completed
o physician's orders reviewed
o patient condition and ongoing concerns noted
o plan of care and education needs discussed
o method of transfer noted
o date and time of transfer noted
o signatures of both RNs that handover process was done per transfer form
3. ASSESS and DOCUMENT in appropriate record(s) (patient care flowsheet, nurses’ notes):
o changes in level of consciousness or skin colour
o vital signs as in #8 unless otherwise indicated
o other vital signs as ordered (e.g. Neuro vital sign checks, neurovascular checks)
o operative site and articles insitu Q4H
o need for medication: eg. analgesic, antiemetics
o fluid balance (ie. parenteral, oral intake, urinary, gastric output)
o any other pertinent actions or observations

REFERENCES
Bomba, D.T. and Prakash, R. (2005). A description of handover processes in an Australian public hospital.
Australian Health Review. 29(1):68-79.
Cook-Sather, S.D. and Litman, R.S. (2006). Modern fasting guidelines in children. Best Practice and Research.
Clinical Anaesthesiology. 20(3):471-481.
Groah, L. (2006). Hand offs - A link to improving patient safety. AORN Journal. 83(1):227-230.
Royal College of Nursing (2007). Standards for Assessing, Measuring and Monitoring Vital Signs in Infants,
Children and Young People. London: Author. Retrieved from
http://www.rcn.org.uk/__data/assets/pdf_file/0004/114484/003196.pdf.
Sexton, A., Chan, C., Elliot, M., Stuart, J., Jayasuriya, R., Crookes, P. (2004). Nursing handovers: do we really
need them? Journal of Nursing Management. 12: 37–42.
Warner, M.A. (1999). Practice Guidelines for Perioperative Fasting and the Use of Pharmacological Agents to
Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective
Procedures. A report by the American Society of Anesthesiologists. Canadian Anesthesiologists'
Society (2005). Revised Guidelines to the Practice of Anesthesia.
Wilson, D. and Hockenberry, M.J. (Eds), (2008). Wong’s Clinical Manual of Pediatric Nursing 7th Ed. St.
Louis, Missouri: Mosby Elsevier.

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