: y r e g r Su During, and After , Before 44140 Rev. 2/2014 Surgery: Before, During, and After • 1 Welcome to Upstate University Hospital SURGERY: BEFORE, DURING, AND AFTER Introduction Information in the booklet includes what you must do preoperatively or before surgery. We will let you know what you need to bring to the hospital, what happens at the hospital, and what you need to do to be PATIENT ED: discharged to home. There are RESOURCES many patient education and informational materials available www.upstate.edu/patiented on the Upstate Patient education website at www.upstate.edu/ patiented. PATIENT ED: Pre-Surgery Insurance Authorization RESOURCES • Call your insurance companywww.upstate.edu/patiented when you are told of your surgery or procedure date. • Your insurance company may ask for information or give “pre-approval” in order for payments to occur. PATIENT ED: RESOURCES If you do not have insurance and need to speak to www.upstate.edu/patiented a social worker then please let us know. Pre-Anesthesia Screening • Before the day of admission you will be called on the phone or come in person for a doctor, licensed health care provider, or Registered Nurse to review your health history with you. • It is important for you to tell them all of your medical history including medications (name, dose and frequency), allergies (medication, food and environmental) and other important information about your health (like if you have obstructive sleep apnea). • If you are seen in Pre-Testing before your surgery, you may have a physical exam by a licensed healthcare provider if you did not get one at your providers. • Staff will give you instructions about your surgery and tell you how to prepare for it. • If the patient is under age 18 years old or has a court appointed guardian, you will need to bring this person with you and bring copies of all the legal guardianship papers with you. PATIENT ED: RESOURCES If you are under 18 years old and live with a parent www.upstate.edu/patiented or guardian then they must come with you to Pretesting and Surgery. Screening Tests •PATIENT Tests ED: and lab work may be ordered before RESOURCES your surgery. www.upstate.edu/patiented • You may have this done at the hospital or another testing location. • If the test results show concern, another appointment may be needed before your PATIENT ED: surgery. RESOURCES www.upstate.edu/patiented Donating Blood • Let your doctor know if you wish to donate blood for your procedure. • You must donate at least one week before your surgery. • Contact the Red Cross and they will schedule your donation according to your procedure date. • If you have donated your own blood, please tell the nurse when you arrive at the hospital. Quit Tobacco • There is no smoking or tobacco use at Upstate University Hospital. • Smoking is not advised following surgery because it can slow down the healing of the surgical incision. 2 • Surgery: Before, During, and After • If you smoke, you should try to stop one week before surgery. • For information on how to quit smoking, visit the New York State Department of Health Quit line website or call the NYS Quit line (866) 697-8487. What to Bring the Day of Your Surgery or Procedure • A list of current medications including dosages and reasons you use them, as well as any over-the-counter medications and herbal supplements list • Living Wills, Health Care Proxy, DNR and/ or guardianship paperwork • Photo ID Community Campus If your surgery is at the Community Campus then you will receive an automated call 3 days prior to the surgery. If you have questions after the call then please call us at (315) 492-5614. Downtown Campus • The day before the admission a staff member will call to confirm your arrival time the day before the surgery day. • If you miss the call or have questions about your arrival time, please call: Upstate Hospital Downtown Adults: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (315) 464-2900 Upstate Hospital Downtown Children: . . . . . . . . . . . . . . . . . . . . . . . . . . . . (315) 464- 3636 Upstate Outpatient Surgery Center: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (315) 464-2626 Upstate Hospital Community Campus: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (315) 492-5614 Lodging • If your drive from home to the hospital is far or it is winter, you may choose to stay in Syracuse at a hotel the night before your surgery. • The Case Management Department has a list of local hotels with special rates for patients and families. If interested, please call: Upstate Hospital Downtown and Community Campus: . . . . . . . . . . . . . . . . . . . . . . (315) 464-6161 • Insurance information and cards • One small bag with personal belongings. Bring loose, comfortable clothing. • Obstructive sleep apnea patients must bring their CPAP machine to the hospital if they are staying overnight • Parents or guardians must stay with children who are having surgery • One book or comfort item Leave Home • Jewelry and large sums of money. This includes wedding rings • Credit cards and all valuables • Do not bring your medications, only a list of medications Preoperative/ Pre-Procedural Diet • Follow the instructions given to you by your provider regarding your diet on the night before surgery • Most patients will have nothing to eat or drink after midnight • Patients with Diabetes should follow the instructions from their provider • If you need to take medication in the morning, only take a small sip of water • Chewing gum or throat lozenges are not allowed the morning of surgery • Children having surgery may have special guidelines, please discuss with your doctor/provider Surgery: Before, During, and After • 3 Bathing • Special soap may be needed to clean your skin before surgery and we have a handout for you on this depending on where your surgery will take place. We will give you the special soap or your provider will let you know what to get and where to get this. Surgeries on the Community Campus will be get instructions at the Pretesting appointments. • Do not shave or remove any hair from your surgical site before surgery. Types of Admissions: • Outpatient admission: You will come to the hospital for your procedure and go home the same day. You will need someone to drive you home and stay with you for the first 24 hours. • One Day Stay Procedures: You will stay for the night after your procedure and then go home the next day. • Operative Day Admission/ Same Day Admission: You will be admitted the day of your procedure to an Inpatient unit of the hospital. The Day of Arrival and Presurgical Care Building Location of Surgery Ask for a map if you are uncertain of the building location of your surgery. You can also find maps and directions on the Upstate Website at www. upstate.edu/patiented.There are different surgery locations and they include: Upstate University Hospital Downtown • Pre-Surgical Holding area: 5th floor • Center for Children’s Surgery: 3rd floor • Ambulatory Procedures: 1st floor • Heart and Vascular Center: 6th floor • Endoscopy: 3rd Floor Upstate Outpatient Surgery Center • Go to Suite K Upstate Community Campus • Check in at the main lobby or Diagnostic area volunteer desk and the volunteers will direct you to the Surgery Center on the 1st floor. This is for both adult and pediatric patients. Other Locations • If your surgery/procedure is at another location, your provider will give you a building name and location. Let them know if you need a map. • Nursing staff will let you know where your procedure is being done in the hospital and where your family should wait. Once at the Surgery/Procedure Location: • You will be shown where to get ready for your procedure. • You will wear a bracelet that lets everyone know who you are. The healthcare team will look at the bracelet and they will ask for your name and your date of birth. As a safety precaution, staff members will verify this information many times during your hospital stay. • After you change into a hospital gown, a registered nurse will go over your health history and medication list in order to update and confirm your information. • You will also meet other members of the health care team to go over your final plan for surgery. • Before going to surgery/procedure, an intravenous catheter (IV) will be placed into your arm or hand to give you fluid and medication. • While you are in surgery/procedure, your family should keep your clothes and belongings. 4 • Surgery: Before, During, and After The other members of the healthcare team that you may meet before your surgery are: • Operating room nurse • Anesthesiologist (the doctor who will provide your anesthesia) • Certified Registered Nurse Anesthetist (CRNA) • Anesthesia Resident • Surgeon or licensed provider doing the procedure Please speak up and ask any questions when you meet your healthcare team. Confirming Your Procedure Each team member will ask what surgery or procedure you are having done. This is for your safety and will help to make sure you are getting the right procedure and the team will verify this with you. • You will be asked several times to confirm your surgery or procedure. • Your surgical site will be marked by your surgeon. • All members of the health care team are focused on your safety. • Please ask questions if you are unsure about your surgical site or procedure. Anesthesia • An Anesthesia Doctor (Anesthesiologist) or Anesthesia provider (resident or CRNA) will meet with you before the procedure or surgery and will provide care to you before, during, and after your surgery or procedure. • The type of anesthesia you receive will be discussed with you and will be based on your medical condition and surgery. You will be asked to sign a consent for your specific anesthesia plan. • The Anesthesiologist will provide pain control and will support life functions during the procedure and during your recovery phase. Types of Anesthesia General Anesthesia Medication is given in your IV (intravenous catheter) or by a mask that will put you into a sleep-like state. A breathing tube may be placed after this to help you breath during surgery. You will be deeply asleep and will not feel pain or remember the procedure. Monitored Anesthesia (MAC) You will be sedated with medicine but will be breathing on your own. The doctor will monitor you closely and you may or may not remember the procedure and you will feel no pain. Regional Anesthesia This type of Anesthesia numbs part of the body so you do not feel pain at the surgical site. This can be done before, during or after the procedure. Types of regional Anesthesia include either an “epidural” or “spinal”, where medicine is injected near the spinal cord and a small tube may be placed to give you the medication steadily and all the time during your procedure. A Peripheral Nerve Block is when medicine is injected around the nerves in a leg or arm to block the sensation of pain. Ask your doctor what choice is best for you. The Operating Room • The operating room staff wears surgical caps and masks to keep the environment germ free. You will also be asked to wear a surgical cap before going into the operating room. • Sometimes, emergencies come up and the surgery schedule may change after you have arrived. We apologize for delays, and try our best to stay on time. • Please feel free to ask any questions that you may have. Surgery: Before, During, and After • 5 After Your Procedure Recovery Room: • The Recovery Room is where you will wake up after surgery/procedure. • A Registered Nurse will watch your vital signs closely and you will receive pain medication if needed. • You will be monitored for your heart rate and blood pressure and you may also have oxygen given by a tube in your nose or a mask on your face. • The nurse will call or come and speak with your family when you arrive to the Recovery Room and will update them on your progress. Some patients spend the night in the Recovery Room. An appropriate level of nursing care will be given as you continue to recover. Pain Management Adult patients are asked to rate their pain on a 0 to 10 pain scale. This helps nurses and providers treat your pain effectively. • Other scales are used for children and adults who cannot use the number scale. The nurse will discuss what scale is best for you in order to rate your pain. • The provider will order pain medication that best fits your medical needs. • Please let the healthcare team know if you have been on pain medication before surgery as your needs may change after surgery/procedure. Diet • Your doctor will order your diet for after surgery/procedure. Most patients start with clear liquids and progress to their regular diet. • You may request special foods based on your ethnic or cultural preferences. Discharge • You may have a Nurse Case Manager to help you plan for your discharge needs including any services or equipment needed. • Before your discharge, you will receive written instructions about your care medications (use and side effects) and follow-up appointments. • If there are any changes or additions to your medications then your provider and nurses will let you know in writing about these changes. They will tell you about the use and side effects of the new or different medications. • Discharge time from the hospital is generally between 10 am and 11 am, although times may vary. Many outpatients will go home 1-3 hours after their procedure. • Plan for someone to stay with you for at least 24 hours after your surgery/ procedure. • Childcare should be set up for children while you are in the hospital. • You need someone to drive you to and from the hospital. • You cannot walk home or take the bus or cab alone after your procedure. • Let us know before your surgery/ procedure if you need any help making transportation arrangements to get you home. Please, speak up and ask if you have any questions. Health Information for You Patient and Family Education Upstate Connect: 464-8668 • (800)464-8668 Back to Basics: Good Hygiene Good personal hygiene can make you healthier and less likely to get sick. It also helps you to look good and feel good. Wash Your Hands Often • • Handwashingisthebestwaytopreventinfectionsandthespreadofdiseases. Alwayswashyourhandsbeforeyoueat,beforeyouhandlefood,andafteryouusethetoilet. • • Washyourhandsoftenifyouaresickoraroundpeoplewhoaresick. Usesoapandwatertoworkuplather. Keep Your Body Clean and Healthy • • • • • • • • Takeashowerortubbathatleasttwotothreetimesaweek. Usesoapandwater,rinsewell,anddrycompletely. Shampooyourhaireverytimeyoubathe. Cleanyourgenitalsandarmpitseveryday. Keepfeetcleananddry.Wearcleansocks. Don’twalkbarefootoutside. Usebodylotiontokeepskinsoft. Womenshouldalwayswipefromfronttobackafterusingthetoilet. Take Care of Your Teeth • • • • Brushyourteetheverymorningandnight. Trytobrushaftereverymeal. Flossbetweeneachtootheveryday. Seeyourdentistatleastevery6months. Take Care of Your Nails • • • • Cleanunderneathnailseveryday. Keepingfingernailsshortmakesiteasiertokeepthemclean. Cuttoenailsstraightacross,justlongerthanyourtoe.Ifyouareunabletocareforyournails,askforhelp. Ifyouhavediabetesordecreasedbloodflowtoyourlegs,askyourhealthcareprovideraboutpropercareofyournails. Cover Your Mouth or Nose • • Manydiseasesspreadthroughsneezesandcoughs.Coveryourmouthandnosewhenyousneezeorcoughbecausethelittle diseaseparticlesmovethroughtheairandinfectothers. Usetissueswhenyousneezeorcoughandifyoudonothaveatissueusethebendofyourarmorhand.Thenwashyourhands rightaway. If You are Sick Avoid Close Contact with Others • • Whenyouaresickyoushouldstayhome.Don’ttouchorshakehandswithothers. Whengoingtogetmedicaltreatmentcallaheadtoaskwhatyoucandotonotspreadittoothers.Tellthepeoplewhenyouget totheofficeifyouneedamasktowearifyouarecoughingorsneezing. Get Shots to Avoid Disease and Fight the Spread of Infection • Makesurevaccinationsareuptodateforyouandyourfamily.TherearevaccinationsavailableforFlu,Shingles,Measles (Rubella),Mumps,Diphtheria,Hepatitis,Meningitis,Whoopingcough(Pertussis),andPneumonia. Make sure your Heath Care Providers wash their hands and wear gloves when needed. It is okay for you to ask them if they have washed their hands especially if they are drawing blood, touching wounds or fluids, or touching your mouth or private parts. F81222 Rev. 1/2014 : y r e g r Su During, and After , Before 44140 Rev. 2/2014