This article is one in a series of patient safety topics that provide simple, easy-to-follow checklists for patients to follow as they prepare for orthopaedic surgery.
When we go for surgery we turn over our care to highly trained doctors, nurses, and hospital staff. However, we also know that patients who understand their treatment are going to get the most out of their hospital visit.
Talk to your caregivers, understand what is happening to you, and never be afraid to ask questions. Bring a friend or family member as your healthcare advocate. Ask new and unfamiliar caregivers to identify themselves and explain their role in your treatment. Be involved, and help to make your care go well.
When you visit your surgeon, prepare the following checklist to provide your surgeon and surgical team with necessary information about you and your orthopaedic problem.
- Orthopaedic Problem. Describe when it began, how it bothers you, and what treatments you have tried for it.
- Medical History. List all of your past and current medical problems and how they have been treated.
- Family History. List diseases or health conditions that affect your family, including any problems that arose during surgery or with anesthesia.
- Current Medications. List the medications you are taking and their dosages. Be sure to include any over-the-counter medications or diet supplements you take on a regular basis.
- Allergies and Sensitivities. List all medication, food and environmental allergies, such as pollen or bee stings, that you have. Tell your surgeon if you have ever had an allergic reaction such as a rash, swelling, or difficulty breathing. In addition, there are some medications and foods that you may be sensitive to, even though you are not truly allergic to them. Include these medications and foods on your list and describe the side effects you have experienced.
- X-Rays, Images, Operative Notes and Lab Tests. Bring copies of medical records, operative notes, x-rays, CT scans, MRI studies, and lab test results — especially those that relate to your orthopaedic problem.
- Questions or Concerns. List the questions that you have about your health and your planned surgery. Discuss these with your surgeon and surgical team. It is important that you understand the goals of your surgery, how the surgery will be done, any possible risks or complications, and the plan for your recovery.
- Bring to the hospital:
- A list of all your medications, over-the-counter drugs, and herbs and vitamins
- A list of your drug and food allergies and sensitivities
- Your insurance card
- Copies of any legal documents, including medical proxy, power of attorney or a living will
- The name and phone number of your primary contact while you are in surgery or, if you are having same-day surgery, the name and phone number of the person who will be picking you up
- A small amount of cash, but no valuables or jewelry
- Little else. Most hospitals provide everything you need, even tooth brushes, bed clothes, and slippers. Men may prefer their own razor, women some cosmetics, but not perfume.
- An I.D. band will be given to you. Hospitals may have two patients with the same name, but your number is unique to you. If the band comes off, be sure to have it replaced.
- Before surgery your doctor and healthcare team will ask you many questions. Some questions — such as your drug allergies and identification of the surgical site — may be asked several times. This repetition is planned, and you should expect these questions from your team. Some questions that may be asked include:
- Do you have diabetes and take diabetic medications?
- Do you take any blood thinners?
- Do you or any member of your family have a history of problems with surgery — such as adverse reactions to anesthesia — or problems with medications?
- Your doctor will review, discuss and then ask you to sign a consent form that clearly outlines the planned surgical procedure.
- Your doctor will confirm the surgical site with you and then mark the correct area on your skin.
- Give your cell phone, reading glasses, hearing aides and other personal items to a friend or family member before you go into the operating room. These items can be returned to you when you are awake and recovering.
Pay attention to the health care you receive. If something does not seem right — such as the type of medication you are receiving -- tell your doctor, nurse, or another healthcare professional.
- Expect healthcare workers to introduce themselves to you. Look for their identification badges.
- Notice whether your caregivers have washed their hands. Hand washing is the most important way to prevent the spread of infection.
- Help to avoid medication errors:
- Make sure health care professionals confirm your identity by checking your wristband or asking your name before giving you any medications or treatments.
- Know what time of day you usually get a medication. Tell your nurse or doctor if a regular medication is missed.
- Be able to identify the pills before swallowing. Your regular medications may have a different color or shape in the hospital.
- Do not take pills from home. They may duplicate the medications you are getting, or conflict with them. Tell your physician if you are not getting your regular pills.
- Prevent falls.
- Surgery and postoperative medicines can make the best athlete weak and unsteady.
- Some medicines and extra intravenous fluids may cause a need to empty your bladder frequently. Do not be embarrassed to ask for help. Do it early, before it is urgent. Allow time for busy staff to get there.
- Serious falls occur when patients try to be independent against instructions.
- At night many people need help more than during the day. Turn on lights, wear glasses, and use non-skid shoes if getting up.
- Wheel chairs should be securely locked before getting in and out.
- Hot water in a shower can lower your blood pressure and cause fainting.
- Know your treatment plans.
- Ask questions to make sure you understand the next steps in your treatment.
- Encourage visitors to wash their hands before and after visits.
- Discourage visits from friends and family members who are not feeling well. Children are frequent cold carriers.
- If staff moves your bedside table or rolling stand, ask them to put it back before leaving. Otherwise your water, personal articles, phone, or even call button may be out of reach.
- Food servers should not just leave the tray, but help set it up to be reachable.
- If equipment in your room starts to ding or buzz this should not alarm you. It is usually something simple like your IV indicating to the nurse that it is time for a refill.
You usually receive a lot of instructions just prior to leaving. The nurse will give you the highlights in writing, such as a list of the medications you will need to take. It is hard to remember everything. As always, ask questions if you do not understand the instructions.
- Have a family member present to help recall what was said.
- Take notes, and specifically find out:
- When to see the doctor again
- Dates and times if home nurses or therapists are coming to you
- What to do about bandages
- When is bathing permitted
- When it is okay to be alone in the house
- When you can drive
- Advice about elevation of an operated extremity, and weight bearing on a leg after surgery
- Understand about all medicines you need. Someone will have to get prescriptions filled to you.
- Make sure you understand any signs of complications, such as infections or blood clots. Know how to quickly contact your doctor or healthcare team should you notice signs of complications.
- As in the hospital, night time bathroom trips can be dangerous. Sleeping pills and pain medications cause unexpected balance problems. Blood loss from surgery can make you woozy when first standing up.
- Stand still at the bedside for a moment before walking
- Use eye glasses and turn on a light
- Be sure slippery scatter rugs have been removed
- Be aware that emptying your bladder can drop blood pressure and cause fainting. Men are much safer sitting down.
Research shows that patients who take part in decisions about their health care are more likely to have better outcomes. Ask questions, understand treatment, and follow instructions, and you will be on the road to recovery.
The American Academy of Orthopaedic Surgeons
6300 N. River Road
Rosemont, IL 60018