Pre & Post Operative Care

As a junior doctor, you will frequently look after patients prior to and after their operation. You may be asked to clerk patients who are admitted to hospital the night before their operations. Here are some things to consider during your clerking & whilst you’re considering pre & post-operative issues.

Pre-Operative Clerking

  • Before you see the patient
    • What operation will they be having & when? Which consultant will be completing it? Read their last surgical & anaesthetic clinic letters as they often give important instructions about pre-operative care
  • Confirm with the patient which operation they are expecting to have. Take a brief history.
  • Take a brief pre-op assessment
    • Any previous surgery? Any pre or post-operative complications e.g. nausea/vomiting, complications with anaesthetic
    • Drug history – allergies! Holding nephrotoxic agents (e.g. NSAIDs, ACE inhibitors), sliding scale for diabetics, holding of blood thinners. Drugs that must not be stopped: antiepileptics, Parkinson’s medication or increased e.g. steroids
    • Family history – any issues with anaesthetic previously (e.g. pseudocholinesterase deficiency, malignant hyperpyrexia)
    • Social history – baseline mobility & exercise tolerance. What do they do for work & will they need time off?
  • Arrangements to go home (will someone be taking them?) for day case procedures
  • Aim to write a clear pre-operative plan for patients in the notes

Pre-Operative Considerations

  • Ensure patients are reviewed by the anaesthetist & surgeon. The surgeon will often need to mark the site & consent the patient. F1s cannot mark the site of an operation. 
  • Bloods
    • Baseline bloods (renal function, haemoglobin, LFTs & clotting)
    • Unless very low risk, patients will need a valid group & save. Usually, this requires 2 samples  which need to be taken by 2 people on different occasions
    • Blood may need to be cross-matched if you’re expecting blood loss (i.e. for a major operation) so it is ready in an emergency. Do ask your seniors. 
  • MRSA swab
  • Pregnancy test
  • Fasting (usually only if general anaesthetic):  Starved usually 6 hours prior to operation for food with clear fluids up to 2 hours before
  • Drug chart
    • Allergies
    • Prescribe VTE prophylaxis (usually TEDs only)
    • Prescribe medications that need to continue peri-operatively
    • Prescribe maintenance IV fluids, antiemetics & analgesia
    • Consider a sliding scale in diabetic patients
  • Any special requirements e.g. bowel preparation

Post-Operative Considerations

  • Drug chart
    • Review VTE prophylaxis. Never initiate LMW heparin without checking with a senior.
    • Restart routine medications appropriately
    • Optimise fluids & analgesia. Be careful about fluid overload in patients at risk (elderly, heart failure)
    • Laxatives (as necessary) – caution in abdominal surgery
    • Antibiotics (if necessary)
  • Review bowels & when a patient can start eating & drinking
    • Monitor for ileus
    • Consider when to stop sliding scale
    • In GI surgery patients may slowly be escalated on to a normal diet: small sips → clear fluids (if you can read a newspaper through it) → free fluids → soft diet → normal diet
  • Blood: monitor haemoglobin, renal function & inflammatory markers
  • Review any special post-op requirements (surgical & anaesthetic notes)
  • Monitor for complications
  • Consider discharge planning
    • Physiotherapy to mobilise ideally within 24 hours
    • TWOC (trial without catheter)
    • Discharge advice e.g. when to return to work, carry out usual activities
    • Follow up
    • How to care for the wound & dressing
    • Removal of sutures

References

Written by Dr Jaskiran Sodhi & Dr Ella Botzenhardt (FY2)

Edits by Dr Akash Doshi CT2

How useful was this post?

Click on a star to rate it!

Average rating 4.4 / 5. Vote count: 16

No votes so far! Be the first to rate this post.

As you found this post useful...

Follow us on social media!

We are sorry that this post was not useful for you!

Let us improve this post!

Tell us how we can improve this post?

Related Posts

Junior Doctor Pay Calculator
Junior Doctor Pay Calculator
We’ve created a junior doctor pay calculator which will...
Blood Tests
Venepuncture
Equipment Gloves Hand sanitiser Alcohol wipe Tourniquet Cotton...
Paediatrics
Applying to Paediatrics
On the one hand, you wear a Disney lanyard, with a pocket stuffed...

Leave a Comment

Your email address will not be published. Required fields are marked *

Follow us

Our Newsletter

Trending Now

Ranking Foundation Jobs
If you’re worried about not getting your top choice, you shouldn’t worry. It doesn’t...
Junior Doctor Pay Calculator
We’ve created a junior doctor pay calculator which will help you better understand your salary,...
Passing the Prescribing Safety Assessment (PSA)
The PSA is aimed at final year medical students and those graduating overseas to assess their competency...
How to take a psychiatric history
Psychiatry, as a specialty is unique in that diagnostic methods, rely very heavily on symptomatology,...
Fluid Balance
Almost every patient admitted to hospital receives IV fluids at some point in their journey. However,...
Referral Cheat Sheet
Our referral cheat sheet is our most popular resource having been downloaded thousands of times! It has...
Audits & Quality Improvement Projects (QIPs)
Audits & QIPs are a way to identify issues, drive changes and assess the effects they have. It is...

Sign up for our awesome resources

Join over 25,000 users who have signed up for our free weekly webinars, referral cheat sheet & other amazing content!