Preoperative Testing The Preoperative Testing Policy has been revised. The following presentation is a review of the policy (KH# CL46) and the preoperative testing requirements.
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Transcript Preoperative Testing The Preoperative Testing Policy has been revised. The following presentation is a review of the policy (KH# CL46) and the preoperative testing requirements.
Preoperative Testing
The Preoperative Testing Policy has been
revised.
The following presentation is a review of
the policy (KH# CL46) and the preoperative
testing requirements within it.
Preoperative Testing
Objectives
The employee will be able to:
Establish uniform guidelines for preoperative testing
Ensure patient safety while minimizing the cost of
unnecessary lab work
Assure the anesthesiologist will have all the necessary
information
Minimize procedure delay
Assure the surgeon that the procedure will not be
delayed provided these guidelines are followed.
Who does this policy apply to?
It is the communication and responsibility of:
The Department of Anesthesia
Site Chief of Surgery
Surgical Directors
Managers of Preoperative
Testing Areas
Operating Rooms
Ambulatory Surgery Areas
Scope of Practice
This policy falls under the scope of practice
of the followig individuals:
Physicians
Physicians Assistants
Residents
Nurse Practitioners
Preoperative
Testing Guidelines
Preoperative testing may be conducted at any Kaleida lab
This ensures that tests are performed under appropriate
quality controls.
If a surgeon wishes to use a lab outside Kaleida Health,
all information must be available preoperatively for
review by Nursing and Anesthesia.
All abnormal labs must be reviewed and explained.
It will be the surgeon’s responsibility to ensure this.
Medical Clearance
Medical clearances and consultations need
not be long
They must be comprehensive
Medical Clearance
The medical clearance needs to include the
following:
A thorough review of all major organ systems with a
focus on the cardio-pulmonary system
A thorough review of all preoperative tests
A definitive statement as to the patient’s peri-operative
risks
A definitive list of recommendations for perioperative
management
Clearance of both regional and general anesthesia
Testing Grid
A testing grid is included in the preoperative
testing policy to simplify the ordering of
preoperative tests (see policy KH#46 for grid)
It represents the minimum acceptable standards.
It remains the surgeon’s responsibility to order
additional testing, as appropriate.
The need for supplemental testing will be based
upon the patient’s history and physical and tests
appropriate to any given surgical procedure.
Delay for Lab Work
Should the surgeon face a delay due to an
anesthesiologist asking for lab work not
indicated on the testing grid, and in the
surgeon’s opinion, is not indicated for the
procedure; the anesthesia site coordinator
will review and mediate the case.
Delay for Lab Work
If the anesthesia site coordinator’s ruling is
in favor of the anesthesiologist:
All steps will be taken to rearrange the
schedule to accommodate the surgeon
Delay for Lab Work
If the Anesthesia Site Coordinator’s ruling
is in favor of the surgeon:
The procedure will proceed without delay
If necessary, a new anesthesiologist will be
assigned to the case.
Pre-Surgical Pregnancy Testing
Pre-surgical pregnancy testing must be
done on all female patients of childbearing
age
This includes pregnancy testing on females
age 9 years and older.
Exceptions to Pre-surgical
Pregnancy Testing
Exceptions to pre-surgical Pregnancy
testing include:
Any woman who is post menopausal.
Has undergone surgical menopause
(removal of uterus or ovaries)
Is known to be pregnant
Who has delivered and is a post partum
inpatient
Definition of Menopause
The definition of post-menopausal is any
woman who has gone twelve months
without a menstrual period.
Pregnancy Testing
In the presence of a negative result, if while
interviewing the patient on the day of surgery
there is a suspicion that the patient could be
pregnant, the test can be repeated immediately
prior to the procedure
HCG (Human Chorionic Gonadotropin)
pregnancy test will be obtained within 7 days of
procedure.
Guidelines of Pregnancy (HCG)
testing for Elective procedures
The last menstrual period and use of contraception
will be documented in the patient’s record.
The HCG will be obtained within 7 days of the
surgical procedure
Either a urine or serum HCG may be obtained
(Serum requires a 24 hour turnaround). Results will
be placed in the patients chart
IF HCG testing is performed in a physician’s office,
the physician must provide in the patient chart, test,
date, and results in the admission’s note.
Positive Pregnancy Test (HCG)
In the event the pregnancy test (HCG) is
positive, the physician is notified by the
lab, or a responsible person as designated
by each area.
Hemoglobin Indications for
testing
Hemoglobin testing is required for:
Any procedure for which the patient is
typed and screened
Any patient who is tachycardic or
hypotensive
Any patient who is short of breath or has
dyspnea on exertion.
Any patient with a history of anemia
Age Criteria for Hemoglobin
Indications for obtaining a hemoglobin
include the age criteria of:
Neonates
Menstruating Women
Women and Men over the age of 65.
Chemistry testing
Chemistry testing includes testing for:
Sodium
Potassium
Creatinine
Glucose
Indications for Chemistry
Testing
Indications for chemistry testing include:
Chronic renal failure/dialysis
History of diabetes
Diuretic therapy
History of abnormal chemistries
Liver Function Tests
Liver function tests include tests such as:
LDH levels, AST levels and albumin
Liver function tests are performed on
patients with suspected liver disease.
Platelet Count Indications
The indications for perioperative testing for platelet
count include:
Patients with bleeding disorders
History of Petechiae, hemarthrosis, or chronic
spontaneous epistaxis
Patients with cancer, especially status post
chemotherapy or radiation treatments
Patients with HIV
Chronic Alcoholics
Patients with hypersplenism
Indications for Ordering
Clotting studies (PT/APTT)
Indications for Ordering Clotting Studies
include:
Patients with bleeding disorders
History of hemarthrosis or chronic
spontaneous epistaxis.
Patients with suspected liver disease.
APTT is for patients on IV heparin.
PT/INR for patients on coumadin.
Blood Test results
All Blood tests are good for 1 months except:
In patients with renal failure, potassium levels
should be drawn within 24 hours of surgery.
In patients on insulin therapy, a finger stick
glucose level should be drawn on the morning of
surgery.
Blood bank specimens have a maximum number
of days between collection and surgery in order to
meet specific criteria
HCG will be obtained within 7 days of the
procedure.
Urinalysis indications for
patients
Urinalysis testing is ordered for:
Patients with suspected urinary tract
infections
Patients for prosthetic surgical implants.
Chest X-ray
Indications
The are no age criteria for ordering a chest
x-ray
Any patient with unexplained shortness of
breath or dysnea on exertion may have a
chest x-ray ordered
Febrile patients with productive cough or
new onset wheezing may have a chest x-ray
ordered.
EKG Indications
EKG indications include any patient over
40 years of age
Any patient with a history of:
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coronary artery disease,
cardiac arrhythmia,
hypertension,
diabetes,
cocaine use.
Chest x-ray and EKG results
All Chest x-ray and EKG results are good
for 3 months, provided the patient has had
no apparent change in health.
Other testing
Other testing for Digoxin Levels may be ordered
for patients on digoxin and no level has been
performed in the last 6 months, or unexplained
nausea, or heart rate less than 60 beats/minute.
TSH and/or Free T4 tests will be ordered on any
patient on thyroid medication and no level has
been performed in the last 12 months, patient has
unexplained changes in weight, or level of
activity, or patient is experiencing arrhythmias.
Preoperative Testing Policy
The preoperative testing policy can be viewed by
going to the Kaleidascope Web Page
Directions for finding the policy are as follows:
– Click on the Policy/Document icon at the top of the
page
– Click on Policy and Procedure Manual icon under
Corporate- Related column
– Type in “CL.46” (or scroll down to find policy CL.46)
– The click on the policy to view