Same Day Surgery, Cardiac Pre-Op Patients

The following information pertains to the CV Surgery Improvement Task Force. Their goal is to drastically reduce the incidence of Surgical Site Infection, most notably Deep Sternal SSI’s, and CABG SSI’s. FYI: Deep Sternal SSI rates for Jan/Feb 2008 was 2.09% (the benchmark is 0.76%) Surgeries are followed up to one year, post-procedure.

FOLLOW UP TO LAST WEEK’S IN SERVICE IN THE NEW CARDIAC SURGERY PRE-OP PROTOCOL

1. The PSP’s are to find out from the RN’s exactly which area to clip. Only patients who are have CABG (Bypass surgery) are required to have their legs and forearms clipped. (They still require that their chest and groins are clipped.) In the new orders, the surgeon will mark specifically which areas he wants clipped.
2. All other CV surgery patients only need their chest and groins clipped.
3. Chests are to be clipped from nipple to nipple, and neck to navel.
4. Position the clipper at a flat to 15 - 30 degree angle on the patient’s skin
5. Stretch the skin taut
6. Clip hair using short strokes against the direction of hair growth
Final skin prep
7. Use medical tape (paper tape) to remove hair clippings from surface of skin
8. Thoroughly cleanse clipped area using appropriate available products
9. Instruct patient to wash the chest area with one or two cloths to get all the hair off, and the groins areas with separate cloths, the legs with separate cloths, and the forearms with separate cloths (if legs and forearms have been clipped.) o
10. These disposable cloths have antiseptic solution on them. Patient is to allow solution to air dry.

PREOPERATIVE HAIR REMOVAL (CLIPPING) CHECKLIST
(From the 3M Learning Package)

REQUIRED SUPPLIES

¨ Charged clipper body
¨ Packaged clipper blade(s)
¨ Gloves
¨ Waste bag
¨ Under pads
¨ Medical tape


PRE-PROCEDURE CHECK

¨ Verify clipping area(s) with nurse
¨ Identify patient
¨ Ensure adequate light and privacy
¨ Uncover only the area to be clipped
¨ Protect bedding with under pads
¨ Put on gloves

CLIPPING PROCEDURE

Prior to clipping
¨ Make sure ON/OFF switch is in OFF position
¨ Attach disposable blade

Clipping process
¨ Switch to ON position
¨ Position the clipper at a flat to 15 - 30 degree angle on the patient’s skin
¨ Stretch the skin taut
¨ Clip hair using short strokes against the direction of hair growth

End of procedure
¨ Turn clipper to OFF position
¨ Remove clipper blade according to manufacturer’s instructions
¨ Clean clipper body and return to charger

Final skin prep
¨ Use medical tape to remove hair clippings from surface of skin
¨ Thoroughly cleanse clipped area using appropriate available products

ADMISSION ORDERS FOR CARDIAC SURGERY PATIENTS

1. These orders are going through their final look at the document committee and it is hoped that they will be passed, and in print by next month. Most of the orders refer to Inpatients from CCU and D6 who are going to surgery, but there are orders that will affect SDS.

2. If patients go through PAC, they will get their usual pre-op blood work and ECG and whatever other tests have been ordered by anesthesia.

3. The new orders for SDS indicated that patients are to rinse and spit with Chlorhexidine gluconate mouthwash 0.12% 10 ml pre-op. It was decided that SDS patients will not be asked to rinse and spit with this mouthwash at home, as they might get it mixed up with their chlorhexidine body wash. Patients are to swish the mouthwash for 20 seconds.

4. It was brought to the attention of the CV Task group that many patients are so strict with their NPO status that they do not even brush their teeth! The group was very surprised, and I think that this is something that we should include with our redesign PAC Patient Education.

5. Please remember that RN’s are responsible for ensuring that pre-op clipping sites are double checked. Two incident reports have been filed from patients having been clipped in the OR. NOTE: The incident report did not indicate where the patient came from pre-operatively.