Chilly_hands

We must be spoiled as our docs, surgeons and anes. All get their own consents. :)

So, anesthesia comes to PAT dept? We are outpatient.

We do have phone numbers, etc., but I am asking, does your facility have all this done prior to day of surgery and what department handles this? Ours has the surgeon consent, done through surgeon office. Then there is anesthesia consent (anes must explain what type of anes is given based on health assmt.) and the few other consents the admitting nurse takes care of. I am trying to come up with a plan to have this all done prior to day of surgery vs having to do this minutes before the scheduled time. Anesthesia is no where near our preadmission area so it has been left to be done on day of surgery. some cases have been cancelled and rescheduled. I am trying to form a plan to avoid these circumstances. I would like this to be a coordinated effort by our PAT department and surgeon office to avoid these pitfalls. I am aware of the issues, I am just looking for anothers process.

I suppose I am not specific enough. At my hospital, preadmission testing calls patients for phone assmt. Then pt comes for labs, etc. surgical consents are signed in provider office or day of surgery. Anes. Consent is signed day of surgery. Hippa release and conditions of admission and consent to bill insurance all done day of surgery. sometimes we have mentally challenged pts come from group homes and have no family, just group home workerswho cannot sign consent. These pts are ward of state and some official, ex: judge, county something or other, is the one to sign consent. how are these cases handled for consents? By phone and fax? The dilemma is 745 first cases and anesthesia and the hippa, insurance billing consent and hippa consent. These court offices are not open atthat time. This is for scheduled cases, not emergent, like lithotripsy, for example.

Question: how does your surgical department obtain consents for surgery, anesthesia, hippa, consent for treatment at facility? The hospital I work at has several forms for signature for a surgical patient. My biggest issue is the patient who is challenged and cannot sign for self and either has a family member to sign or patient is a ward of the state and some judge or unreachable person is the one who signs. The issue is when the patient is with the group home staff, etc. and the responsible party must be reached by phone. Usually the case is the earliest case, no offices are open for phone consents. This has resulted in procedure delays and even cancellations. I have ideas of how to correct this problem but would like some input from others. So, answers to the questions below would be fantastic. 1. Are consents completed prior to surgery day and by whom? 2. Are anesthesia consents obtained prior to surgical day and how is this done? 3. Is preadmission testing involved? thank you!

I'm tired of the Glen Beck thing. You can't make all of the people happy all of the time but you can make some of the people happy some of the time. With that said, I'll stop reading the thread and go on back to trying to deliver care to my patients, who sometimes do get discharged and have to go back to the ER...for some reason or other. Usually with the follow-up phone calls, you find that it's for pain or bleeding. If you inquire further, they didn't take their pain medication on schedule or they weren't icing, resting and elevating something. Go figure.

Here's a silly question. Did Glen Beck actually "write" the article or did someone type what he had spoken? You have to sign in to "hear" the audio and it costs to do that and I'm not that interested. If it were the case that it was him speaking, that would make total sense of the bad grammar. Just wondering.

Oh....he also said he was given some medication that began with an N...perhaps Narcan??

Regardless of his perception of what took place at the hospital, it's hard for me to fathom that none of the staff, except for one or so, would have given him good care at some point. I think Mr. Beck was anxious and frightened of being in pain and what pain he might experience at home after discharge, his next bowel movement, his past alcohol history surely played a part in pain control, his not being properly educated prior to and after surgery. I do have many complaints about the hospital I work at but I do indeed believe that this truly would never happen to a patient at my hospital, he might perceive it, but it wouldn't actually happen.

I'd be a little concerned his wife would take a guy much bigger than her, in the state he was in, into the shower. Most injuries happen in the home, in the shower. Had he fallen and cracked his head open...Yikes!.

I'm a nurse on a short stay unit. Yes, patients having "butt" surgery are discharged the same day and I've never seen one patient in agonizing pain like Mr. Beck. If a patient were in that much pain, he'd be admitted for 23 hour observation. Mr. Beck was also being asked to "breathe" in the recovery room. That's kind of a standard thing, isn't it? The recovery room nurse must be sure the patient is taking good breaths on their own before being discharged from the unit. It is policy for "butt" surgery to have the patient void spontaneously before going home as well as in good pain control. It does appear that Mr. Beck had a good dosing of medication well at the hospital. He must have been writhing in pain. Many of our patients have had Toradol, Percocet, Morphine pumps right on scheduled doses and never experienced the "near death" Mr. Beck is stating happened to him. Fentanyl IV is used frequently in our outpatient setting and we anticipate those patients going home and we don't use it as an "end of life" drug. To me, Mr. Beck has been very ill-informed on his surgical procedure, what to expect before and after surgery and the criteria he has to meet for discharge. Also, in my experience, patients that have history's similar to Mr. Beck, do have a more difficult time with pain control and it is more challenging getting it under control. Mr. Beck's statements are most negative on the healthcare system. Yes, you do run into some facilities with issues, but I'll bet even the worst facility would change behavior's knowing a "well-known" patient is coming for fear of a lawsuit or exactly what Mr. Beck has done. I do believe he's hallucinated from some of the drugs...which can be a side effect. This was a comedy, indeed.

Never once has the patient been drugged before consents has been signed. Usually the Anes. Coordinator speaks to the patients first, then sometime later the surgeon comes in right before taking the patient to OR. The nurse working in the OR and the CRNA or whoever is administering anes. comes to take the patient to the OR. The patient is wide awake as they are taken to the OR or a dose of versed is given just as they unlock the brakes and start wheeling them away. It's worked so far and it really is nice having the family present, even if it means that us preop nurses have to deal with the surgeons and the anes.

My facility puts warming blankets on preoperatively for surgical procedures lasting an hour or longer to maintain core body temperature. Sounds like a good study. Keep us updated.

Last year, our facility flooded on the ground floor. Surgery is on the main floor. Due to the problem, we used the holding area for storage and designated several of the pre-op rooms for holding. Now the anesthesiologist and the surgeons all meet the patient in the pre-op room and have them sign consents and also mark the patient if laterallity is a concern. Family is present. This has worked well due to the fact that most patients are nervous and can't remember what the doctors discuss with them. At least now the family usually remembers. Oh, and nervous patients will sign any form the doctor hands them without reading it, thinking that the doctor would never make a mistake, so it's been good all around. The doctors write the consent and state it to the patient and the patient then signs. The docs aren't really held up with questions from the family either. They've trained themselves to waltz in and ask if they are ready and "let's get the show on the road" and surprisingly, everyone saves all the questions for the nurses.

Recently the hospital that I work for implemented the surgeons to do H&P's on patients within 30 days of scheduled surgery and then to update the H&P the day of surgery. (Sounds reasonable to me, of course). It's been a little rough to get the surgeons to comply, most H&P's are done well over a month before scheduled surgery. That's not acceptable and then the physician is given a blank form to fill out the day of surgery. One excellent surgeon recently updated his H&P from 3 months prior, with just initials and no change. That isn't acceptable according to the policy. The nursing staff have been instructed to not let any patient go to surgery without the proper H&P on the chart. I happen to be the patients admission nurse and followed all the processes implemented. The OR nurse came to do her part and I informed her that the doc didn't complete the H&P. She said she would take care of that and walked to the chart, opened the H&P and filled it in completely from the information in the chart. Never once was a stethoscope placed on that patient other than my assessment. My question: Is any other OR having problems with H&P's and is this ethical that a nurse would do this to a form already signed by a surgeon? When I brought this information to my boss, I was told to "let it go, don't get him mad today".