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An Educated Patient Is Your Best Patient
Ann Geier
Publish Date: October 10, 2007   |  Tags:   Staffing

Ann Geier, RN, MS, CNOR Patients who actively participate in their surgical care have shown better outcomes and higher rates of satisfaction. A key element in a patient's active participation is the knowledge they bring to your facility on the day of surgery.

Ann Geier, RN, MS, CNOR\ Pre-admission contact
Whether in person or over the phone, the pre-admission conversation is a great opportunity to teach. Some talking points:

  • Co-pays. Inform patients about the fees he'll be required to pay on the day of the surgery. Stress that all co-pays and deductibles be paid up front, and inform patients that your center's fees are separate from the surgeon's, lab's, and possibly, anesthesia's fees they may incur.
  • Food and meds. Instruct patients on NPO guidelines and medications to take or avoid.
  • Virtual walk-through. Explain the entire process patients will encounter on the day of the surgery. The more you tell them up front, the less anxiety they will feel when entering your facility.
  • Creature comforts. In addition to covering the basics, work comfort measures into the conversation - like bringing along a sweater to combat the typically cold environments of surgery centers.
  • Wrong-site surgery. Warn patients that repeated questions about the type and location of their procedure is not a sign of staff incompetence before surgery, but rather staff protocol to ensure their safety.
  • Anesthesia. In some centers, anesthesia providers speak with patients during the pre-admission conversation. This is very helpful, but not always practical. If the anesthesia provider isn't available, tell patients they'll have ample time to speak with the anesthesia provider on the day of surgery.

Pre-op communication
Once the patient has arrived at your center on the day of surgery, the nursing staff should teach throughout the admission process, explaining in detail what will happen at each step of pre-op. A caveat: instruct your staff not to answer specific questions a patient may have about his condition or procedure. I see nurses make this mistake over and over again. Instead, refer all such questions to the patient's MD - regardless of how much of an attitude you may receive for interrupting a surgeon's busy morning. Any medical advice you give will be held to the same standard as counsel coming from a physician. If something goes wrong with the surgery, you can be held liable for wrong information you may have provided.

Your staff should review discharge instructions before administering sedation. Let a family member hear these instructions and ask questions. Some nurses feel an already-anxious patient will be made more nervous if provided with too much information during the pre-op process. I disagree. After surgery, the patient will remember little or nothing of what is said because of the lasting effects of anesthesia. Better to inform the patient of his discharge responsibilities when he's awake and coherent; you can always review the instructions before discharge.

When your patients reach the OR, they enter a place that can be very frightening. To help ease their nerves, introduce each staff person and his role in the procedure. Also take the time to orient the patient to the room's environment - the equipment, standard noise levels and beeping monitors. Explain that a staff member will stay with him throughout the surgery and stand next to him during induction, offering comfort as needed. Always remember to speak quietly and address the patient by name.

Educating your patients about the OR might take a few extra seconds, but the quick lesson will contribute to the patient's positive recollection of the surgical experience.

Education Starts Early

A patient's education process begins long before surgery. After the physician explains the proposed surgery, the patient might research his procedure by watching videos or by reading educational literature. Patients also rely on referrals from friends and family - and sometimes trust this advice more than guidance received from medical professionals. More and more people are becoming computer literate, however, so most patient research today is done online.

With a great deal of information available to patients at the click of a mouse, patients enter your facility more informed than ever, and they want to be treated accordingly.

- Ann Geier, RN, MSN, CNOR

Post-op lessons
Aside from recovering a patient, a staff's biggest responsibility during post-op is to give informative discharge instructions. If this is the first time the instructions are reviewed, the RN should take extra time to ensure the family understands its responsibilities in the recovery process, especially your facility's policy for seeking help in the case of an emergency that occurs after hours.

The active participation of patients shouldn't end after they leave your center. Engage them during the post-discharge phone call. Use open-ended questions that require detailed answers. For instance, instead of asking if they feel better than when they left your facility, ask them how their night went. Be sure to inquire about what they wish they had known beforehand that would have made their experience better. This will not only provide a platform for the patient to feel empowered; their feedback will also provide valuable insights for future patient-education efforts.

Be a willing teacher
The surgical process is an opportunity for educating patients and their families about not only their procedure, but also about the quality care your facility provides. Demonstrating a willingness to teach will let patients take ownership of their care. As you can see, the opportunities to teach are many. Take advantage of as many as you can.