PRE-OPERATIVE ASSESSMENT POLICY
Version
5
Name of responsible (ratifying) committee
JOINT CHAT CSC GROUP
Date ratified
16/01/2014
Document Manager (job title)
Shirley Lobo- Consultant Anaesthetist (POA LEAD)
Tanya Mapp Senior Sister
Date issued
24/04/2014
Review date
January 2016
Electronic location
Clinical Policies
Related Procedural Documents
POA WEB PAGE, Policies and guidelines web page
(INTRANET)
Key Words (to aid with searching)
Competencies
Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
(unless requirements change)
(Review date: January 2016
Page 1 of 13
Version Tracking
Version
Date Ratified
Brief Summary of Changes
5
16-01-14
Complete re-write
Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
(unless requirements change)
Author
(Review date: January 2016
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CONTENTS
Quick reference guide
Page Number
1. Introduction
5
2. Purpose
5
3. Scope
5
4. Definitions
6
5. Duties and Responsibilities
6
6. Process
8
7. Training requirements
9
8. References and Associated documentation
9
9. Equality impact Statement
11
10. Monitoring Compliance with Procedural Documents
12
Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
(unless requirements change)
(Review date: January 2016
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QUICK REFERENCE GUIDE
This policy must be followed in full when developing or reviewing and amending Trust procedural
documents.
For quick reference the guide below is a summary of actions required. This does not negate the need
for the document author and others involved in the process to be aware of and follow the detail of this
policy. The quick reference can take the form of a list or a flow chart, if the latter would more easily
explain the key issues within the body of the document
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(Review date: January 2016
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1. INTRODUCTION
The purpose of this policy is to provide a framework for safe and effective practice for all staff
working within the Pre-Operative Assessment (POA) service within Portsmouth Hospitals Trust
NHS Trust (PHT). It will define the processes, pathways and responsibilities of all concerned, to
ensure efficient and effective use of the POA resources
2. PURPOSE
From 1 April 2010 the NHS Constitution gave patients new legal rights to access services
within maximum waiting times, the aim is to ensure that patients waiting for an outpatient
appointment, diagnostics, elective or planned admission are managed in line with national
waiting list guidance and patient choice. This will ensure patients are treated in a timely and
effective manner; supporting the delivery of referral to treatment (RTT) targets and the patient’s
rights to access health services under the NHS constitution. The General Practitioner will make
referrals to the appropriate specialty via the Choose and Book or paper referral system.
The purpose of pre-operative assessment is to determine patients’ fitness for an anaesthetic
and surgery and to optimise patients prior to elective surgery. Where relevant, this provides a
platform for risk assessment of patients with physical and psychological preparation for surgery.
POA will be delivered in designated facilities with standardised procedures, timelines and
processes as relevant to individual specialties.
This will ensure that all elective patients are optimised for surgery, thereby reducing
cancellations on the day.
3. SCOPE
This document applies to and affects all staff working within POA and those staff whose roles
interface with and the users of the POA service and includes the following which is not
exhaustive:
POA trained clinical staff
POA healthcare assistants
POA clerical and booking staff
Junior doctors involved in POA
Consultant Anaesthetists
Consultant Surgeons
Secretaries and bookers
Waiting list management staff
Service leads
Divisional managers
Senior matrons and matrons
Outpatient staff
General practitioners
Referral vetting staff
Clinical staff of admitting areas
Theatre staff.
Infection Control Team
In the event of a major incident, the Trust recognizes that it may not be possible to adhere to all
aspects of this document. In such circumstances, staff should take advice from their managers
and all possible action must be taken to maintain ongoing patient and staff safety.
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(Review date: January 2016
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‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises
that it may not be possible to adhere to all aspects of this document. In such circumstances,
staff should take advice from their manager and all possible action must be taken to
maintain ongoing patient and staff safety’
4. DEFINITIONS
Terms stated in full in document.
The Trust, as an employer, will assume ownership of the trust-wide policy with vicarious
liability for the actions of non-medical practitioners authorised to work in the preassessment clinics providing that they:
have undergone the preparation
They are deemed competent to undertake the role, by their line manager
The practice for pre-assessment has been followed as set in this document has been
followed at all times and that, the member of staff has been fully authorised by the
Trust to undertake the role.
5. DUTIES AND RESPONSIBILITIES
A named Consultant anaesthetist will have overall responsibility for the patients’ anaesthetic
fitness, ensuring the following are in place: Selection criteria, guidelines for POA and a clear
mechanism for referral of abnormal test results, or patients’ requiring more detailed
assessment by an anaesthetist. The Surgical Consultant responsible for the patients’ care is
ultimately responsible for patient selection for a procedure, and for supporting all health care
professionals involved with POA.
POA staff are responsible for providing patients with procedure specific patient information
leaflets and instruction sheets, however it is the responsibility of individual specialties to
ensure this has been made available and regularly updated.
Trained pre-operative assessors are responsible for working within guidelines and
competencies agreed locally by anaesthetists and surgeons.
Pre-operative Assessment Responsibilities:
5.1 POA Administrative Assistant /Waiting List Office / Medical Records Staff
 Advise the patient by phone or letter of any cancellations or changes to the POA appointment
made by the department.
 Request patient medical notes in a timely manner to be available at the time of assessment.
 Ensure a sufficient amount of patient labels are printed and present in the medical notes.
 Place appropriate POA documentation package in each set of medical notes.
 Work in conjunction with other POA staff to prepare documentation.
 Store prepared notes according to clinic date and time of assessment.
 Receive patients into department on their arrival, complete appropriate entry on PAS.
 Track and forward medical notes to relevant departments on completion of POA process.
 Recalling notes that have been required for other patient appointments, to enable completion
of the POA process.
5.2 Registered Nursing Staff
 Complete the appropriate POA form or electronic preoperative assessment record and
nursing documentation.
 Provide patients with Trust generic and individualised written and verbal
information/instruction.
Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
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(Review date: January 2016
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Identify/perform/order investigations/referrals relevant to the POA process. Exceptions to this
would be investigations required on admission that cannot be completed within the POA
process or are not required by the POA process.
Store medical notes in appropriate areas to await further action.
Access/interpret/action and document investigation results.
Refer/liaise to other clinicians/agencies as appropriate/required.
Determine suitability and site for surgery (in conjunction with Consultant Anaesthetist if
necessary).
Communicate POA outcomes as soon as available with relevant persons.
Endeavour to release the medical case notes in a timely manner for those patients who have
a TCI date.
Direct patients to specialist practitioners for specific pre and post-operative advice/treatment.
Liaise with the patient’s general practitioner/surgery/primary care/patient on issues relating to
the patients admission.
5.3 Generic Workers
Perform investigations as requested by Registered Nursing Staff and document in the POA
form.
Complete the appropriate POA form and nursing documentation.
Liaise with trained staff.
Facilitate effective patient flow through the Department/Hospital.
Assist Administrative Assistant(s) with medical note preparation as required.
Support Registered Nurses in accessing investigation results.
Support Registered Nurses in delivery of patient information.
Perform tasks that support day to day operation of the Department as instructed by
Departmental Manager/Nurse in Charge.
MRSA swabs.
5.4 Volunteers
Support the POA Unit as directed by POA staff to include: meeting and greeting of patients,
assisting with administrative tasks, assisting patients and relatives/carers. Liaise with other
departments and personnel to facilitate patient flow through the department.
Admission for Surgery
POA staff will endeavour to ensure that all investigations/results ordered by the POA team are
accessed and actioned prior to admission; however there will be circumstances when this is not
possible, usually when the time frame between POA and TCI does not conform to these
standard operating procedures. If this occurs, POA staff will attempt to identify this clearly in the
POA documentation.
Documentation completed at POA will be enclosed in a clear fronted pink folder secured in the
first inner spine of the patient case notes and will consist of the following core documentation:
 Telephone/short procedure or face to face assessment
 Nursing Assessment / electronic POA
 Evaluation
Documentation will be filed in the following order:
 POA assessment document
 ECG ( according to POA guidelines)
 Printed abnormal results (Results within normal range should be transcribed into the appropriate
section of the Pre-Operative Assessment Document).
 E mails (full final print out)
Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
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(Review date: January 2016
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Risk assessment ( if identified risk at POA and completed at POA)
Nursing Assessment
Evaluation
Additional specialty specific documentation/information
Every effort will be made by POA to ensure the case notes are available to the admitting area
prior to admission.
Exceptions:
 When case notes are requested for release before POA investigations/results are available
 or if repeat /further tests need to be performed
 or any other specific instructions relevant to admission are required
If notes are requested for a patient admission prior to the completion of the POA process it will
be the responsibility of the admitting team to ensure that all investigations/results are
Checked / available prior to the patient going to surgery.
6. PROCESS
6.1 The Pre-operative Assessment Appointment
As soon as the patient is added to the waiting list a POA appointment will be made within the
following time frames:
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Pre-Operative Assessment will occur a maximum of 16 weeks prior to anticipated surgical
date.
Exceptions: Cancer pathway patients who require an appointment at short notice will be
booked into slots, or by direct negotiation with waiting list manager and POA.
6.2 Type of Pre-Operative Assessment
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Pre-operative assessments will be performed by either:
Telephone assessments
Face to face
6.2.1 Local anaesthetic questionnaires:
 Identified on TCI card and PAS as Local Anaesthetic and telephone assessed. This
can be done by an appropriately trained health care assistant/generic worker.
6.2.2 Telephone interviews are allocated to day-case/in patients following fixed criteria:
 patients will be assessed by trained nursing staff.
 assessment staff will default patients to face to face assessment if significant issues are
highlighted.
6.2.3 Face to Face interviews are allocated to in-patients and day case patients following fixed
criteria:
 patients will be assessed by trained nursing staff.
 Assessment staff will default patients to anaesthetic note review and/or face to face
anaesthetic assessment if needed.
6.2.4 Consultant Anaesthetist referral/note review/face to face interview will be made by:
 assessment nurse
 surgeons
 Junior doctors involved in POA.
6.3 POA Appointment Booking
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On receipt of the TCI card, Admin Lead for each specialty will include additions to the waiting
list. This will be done on a time scale specific to individual specialty.
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(Review date: January 2016
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The waiting list / access team will allocate appointments and book these onto PAS under the
appropriate clinic code. Patients do not need to have a TCI allocated to be offered a POA
appointment.
The waiting list / access team POA dates/times to the Admin Team to send appointment
letters. This will also be done on a time scale specific to individual specialty.
The turnaround for allocation of appointments from receiving the additions to waiting list will
be done on a time scale specific to individual specialty.
Patients wishing to change their appointment should contact information rooms/waiting list
managers from contact details sent out in appointment letter.
Patients wishing to decline their planned surgery should contact the waiting list
manager/respective team who remove the patient from the waiting list.
6.3.1 Patients who do not attend appointments - DNA
 POA Nursing staff will attempt to contact any patient who DNAs using the contact telephone
number held in the patient records. To respect patient confidentiality messages will not be left
on answer phones or with anyone other than the patient.
 Nursing staff will advise the consultant and waiting list team electronically of patients who
DNA their appointment.
 It is the responsibility of the waiting list team to arrange another appointment.
 As per the local Policy only 2 appointments can be DNA’d. Following this the patient will be
referred back to the care of the GP, although this is variable around the Trust.
6.3.2 Changes to appointments
 It is the responsibility of the waiting list team to advise the patient by telephone of any
cancellations or changes to the appointment made by the POA clinic; this could be because
of staff sickness, adverse weather conditions, accommodating short notice requests for
appointments. In adverse weather, the POA team may alter the appointment i.e. face to face
to telephones.
7. TRAINING REQUIREMENTS
Health care professionals, who undertake POA, will be able to demonstrate competencies for
POA.
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Course in physical assessment and history taking.
http://pht/Departments/LearningDevelopment/infection/comp_intra_only/reg%202013/H
T_physicalexamination_2012.pdf
Level one is used as competency.
Competencies in ECG/phlebotomy.
http://pht/Departments/LearningDevelopment/infection/comp_intra_only/reg%202013/R
ecording%20a%2012%20lead%20ECG.pdf
LA/telephone guidelines for band three generic workers.
Annual appraisal during the course of employment will ensure the appropriate levels of
competencies are maintained. Employees who fail to meet the required standard of
performance due to lack of knowledge, experience, skill, aptitude, ill health or some other
reason should be offered support to help them improve to required level within a given time
scale. Where an employee has been unable to improve to the required standard, despite
training and support their manager should instigate the Capability procedure at the appropriate
level.
http://www.porthosp.nhs.uk/Human-Resources-Policies/Capability%20Policy.doc
Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
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(Review date: January 2016
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8. REFERENCES AND ASSOCIATED DOCUMENTATION
9. AAGBI SAFETY GUIDELINE – Pre-Operative Assessment
10. NCCAC. Preoperative Tests, The Use of Routine Preoperative Tests for Elective Surgery Evidence, Methods and Guidance. London: NICE, 2003
11. Carlisle J, Langham J, Thoms G. Guidelines for routine preoperative testing. Editorial, British
Journal of Anaesthesia 2004; 93: 495-97.
12. Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence.
Health Technology Assessment 1997; 11: number 12.
13. Garcia-Miguel F J, Serrano-Aguilar P G, Lopez-Bastida J, Preoperative Assessment. The
Lancet 2003; 362: 1749-57.
14. American Society of Anaesthesiologists Task force on Preanaesthetic Evaluation. Practice
advisory for preanaesthesia evaluation: a report by the American Society of Anaesthesiologists
Task Force on Preanaesthesia Evaluation. Anaesthesiology 2002; 96: 485-96.
15. Pre-operative Assessment – the role of the anaesthetist. AAGBI,London 2001
(www.aagbi.org/publications/guidelines/docs/pre-operativeass01.pdf).
16. The Anaesthesia Team. AAGBI, London 2005
(www.aagbi.org/publications/guidelines/docs/anaesthesiateam05.pdf).
17. National good practice guidance on pre-operative assessment for inpatient surgery. NHS
Modernisation Agency, 2003 (www.wise.nhs.uk). Laqua MJ, Evans JT.
18. Cancelled elective surgery: an evaluation. American Surgeon 1994;60:809–811.
19. Thromboembolic risk factors (THRIFT) Consensus group. Risk of and prophylaxis for venous
thromboembolism in hospital patients. BMJ 1992;305:567–574.
20. Tryba M. European practice guidelines: Thromboembolism prophylaxis and regional
anaesthesia. Reg Anaes & Pain Med 1998;23:178–182.
21. Blood transfusion and the anaesthetist – Red Cell Transfusion. AAGBI, London 2008
(www.aagbi.org/publications/guidelines/docs/red_cell_08.pdf).
22. Surgical safety checklist and implementation manual. World Health Organization, 2008
(www.who.int/patientsafety/safesurgery/ss_checklist/en/index.html).
23. Consent for anaesthesia 2. AAGBI, London 2006
(www.aagbi.org/publications/guidelines/docs/consent06.pdf).
24. You and your anaesthetic. RCoA/AAGBI, May 2008 (www.youranaesthetic.info).
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25. Lack JA et al. Raising the standard: information for patients. RCoA/AAGBI February 2003
(www.rcoa.ac.uk/index).
26. Haynes AB et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global
Population (for the Safe Surgery Saves Lives Study Group) NEJM 2009;360:491–499.
27. Pre-operative Tests: The use of routine pre-operative tests for elective surgery. NICE Clinical
Guideline CG3 June 2003 (www.nice.org.uk/nicemedia/pdf/Preop_Fullguideline.pdf).
28. Guidance on the provision of Paediatric Anaesthesia Services. RCoA,2010
(www.rcoa.ac.uk/docs/GPAS-Paeds.pdf).
29. Anaesthesia and peri-operative care of the elderly. AAGBI,December 2001
(www.aagbi.org/publications/guidelines/docs/careelderly01.pdf).
30. Extremes of Age. National Confidential Enquiry into Perioperative Deaths (NCEPOD), 1999
(www.ncepod.org.uk).
31. Setting a Standard through Learning – Pre-operative Assessment (CDROM and book). NHS
Modernisation Agency/Southampton University, November 2002
www.preop.soton.ac.uk/docs/Sept04%20PreOpCDG.pdf).
32. 23 Seeking Patients’ Consent: the Ethical Considerations. GMC, London 1999 (www.gmcuk.org). Re: C (Refusal of Medical Treatment) [1994] 1 FLR 31.
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably
practicable, the way we provide services to the public and the way we treat our staff reflects
their individual needs and does not discriminate against individuals or groups on any grounds.
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(Review date: January 2016
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Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
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(Review date: January 2016
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10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
Minimum requirement to
be monitored
Patient satisfaction Survey
Lead
Shirley Lobo
Tool
Questionnaire
Frequency of Report
of Compliance
Yearly
Reporting arrangements
Policy audit report to:
Lead(s) for acting on
Recommendations
All staff
 CD CHAT
NPSA audits / hand
hygiene
Tanya Mapp
POA education forum /
knowledge and skill
updates
Shirley Lobo
Tanya Mapp
Spread sheet
monthly
Policy audit report to:
All Staff
 Matron CHAT
Attendance
KSF
Monthly
Yearly
Policy audit report to:
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All staff
Tanya Mapp
This document will be monitored to ensure it is effective and to assurance compliance.
The effectiveness in practice of all procedural documents should be routinely monitored (audited) to ensure the document objectives are being
achieved. The process for how the monitoring will be performed should be included in the procedural document, using the template above.
The details of the monitoring to be considered include:
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The aspects of the procedural document to be monitored: identify standards or key performance indicators (KPIs);
The lead for ensuring the audit is undertaken
The tool to be used for monitoring e.g. spot checks, observation audit, data collection;
Frequency of the monitoring e.g. quarterly, annually;
The reporting arrangements i.e. the committee or group who will be responsible for receiving the results and taking action as required.
In most circumstances this will be the committee which ratified the document. The template for the policy audit report can be found on
the Trust Intranet Trust Intranet -> Policies -> Policy Documentation
The lead(s) for acting on any recommendations necessary.
Preoperative Assessment Policy : Issue Number 5 Issue Date 24/01/2014
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