EYE TO EYE Nothing calms patient nerves more than an anesthesia provider who's sincere, interested and attentive.

One of the most important elements of anesthesia care is the pre-operative visit between patient and provider. Yet the pre-surgical assessment also tends to be one of the areas that we're most lax about doing properly. Here are several points to consider when trying to establish trust and confidence in the patient, and learning all you can about her health history.

Avoid the cookie-cutter interview. First, be certain to identify yourself by name and title. You'd be amazed at the number of people who neglect this very important facet of the interview. I've overheard many pre-op interviews performed as if they were coming from a tape recorder in the pocket of the provider. Each patient needs to be recognized and treated as an individual. What one patient sees as a simple procedure may strike terror in another. You need to do much more than just ask when was the last time you ate or drank, and are you allergic to any medications.

Thoroughly review the chart before speaking to the patient. Patients are often given a pre-anesthesia assessment sheet to fill out before they arrive for surgery. The sheet and the chart can help you quickly familiarize yourself with the patient. You'll boost patient confidence if you say things like, "Tell me about the problem you had with nausea and vomiting with your past procedures." Let patients realize you've actually reviewed their histories and that you don't have to play 20 Questions with them. Work into your pre-op interview anything charted that relates to anesthesia, as though you're well aware of the issue and just want to show that you're there to listen, provide encouragement and assure patients you want to provide the best, safest and most-effective care possible.

Keep patients informed. You can instill confidence in patients by discussing aspects of the surgery in addition to anesthesia. You don't have to go into great detail, but make it clear you're familiar with the procedure and the anesthetic management it requires. Tell them what to expect from the time they leave the pre-op area until the time they're anesthetized. Leave no room for surprises. If they know they're going to be going into a cold room and that people will be coming at them from all angles to position them and apply monitors, they won't be surprised.

Act interested, make eye contact and gestures. Patients want to be treated as if they're the No. 1 person on your mind. You can't establish this bond if you're constantly looking away, writing while you talk or acting as if you have 3 more patients to see and want to get it over with. Nothing reduces anxiety or instills confidence more in patients than a person who is sincerely talking to them, looking them in the eye and not simultaneously writing on the pre-op evaluation sheet. A brief moment of silence between conversation and writing serves both the patient and the provider well.

CALMING INFLUENCE
Pre-op Visit Goals

IN THE MOMENT Courtesy, genuine interest and diligence are integral parts of the pre-op assessment.

The pre-operative interview can calm a patient more than small doses of medication. Keep in mind the 2 paramount goals of the assessment:

• To alleviate patients' anxieties while still making them fully aware of the anesthesia techniques and hazards.
• To make the provider aware of any modifications to the anesthesia plan that he needs to make.

ON THE WEB

Download a sample Pre-Anesthesia Evaluation
Form at outpatientsurgery.net/resources/forms.

Avoid ghastly graphics. Perhaps the worst pre-operative description I've heard was given at a hospital to a patient who was scheduled for a thoracoscopic procedure. The anesthesiologist told the patient he would be given medicine to paralyze his reflexes so he wouldn't gag and choke when the endotracheal tube was inserted. And as if that weren't bad enough, he was told that if the surgery became more involved than anticipated, the tube would be left in and he would be given sedatives if he felt its presence and coughed!

The entire description could have been as simple as: "You'll be anesthetized, and after you're completely asleep, we'll insert a tube to help you breathe. It will be removed when the procedure is over and all of your reflexes are back, but still sedated enough not to have discomfort. On occasion, the tube may be left in for a short period of time after the procedure, but you'll be kept very comfortable until it's removed."

Anesthesia care does not end when the patient leaves the procedure room. Let the patient know that the pre-op visit is only a small part of the anesthetic care plan, that there will be an anesthesia provider in attendance at all times during the procedure (preferably say the name of the provider, and introduce him or her before leaving pre-op area) and stress that a member of the department will be available after the procedure to tend to any post-operative issues, such as pain or nausea.