General Surgical Wards - About the Pre-operative Assessment Clinic

What is a Pre-Operative Assessment?

A Pre-Operative (Pre-Op) Assessment is an appointment where your fitness for surgery and anaesthesia is assessed.

This involves a Nurse asking you about your health and fitness, previous surgeries, hospital admissions and medications you take. This will be performed over the telephone or in a clinic.

It also involves recording observations such as height, weight & blood pressure and performing tests such as MRSA swabs or blood tests by a senior support worker.

The appointment gives you the opportunity to ask any questions about your admission to hospital and allows us to give you information in relation to your surgery, anaesthesia, post-operative pain relief and admission/ discharge from hospital, where possible.

Is a Pre-Operative Assessment necessary?

Attending the Pre-Operative Assessment clinic means that your operation or procedure is less likely to be cancelled on the day of admission.

It gives us an opportunity to identify and optimise any conditions that you may have prior to your operation, so that you are as fit as possible before undergoing anaesthetic and surgery.

It also gives the hospital time to plan for any special requirements or equipment you may need during your hospital stay.

If you are unable to attend your appointment, please telephone the Booking and Scheduling team who will re-arrange this for you. Their number can be found on your appointment letter
 
Please note that failure to attend your pre-operative assessment without prior notice may result in your operation being postponed or cancelled.

How long will my appointment take?

We are aiming to carry out as much of your assessment as we can over the phone, reducing the amount of time you spend in the Pre-Operative department.

The telephone assessment will take between 30 and 60 minutes. Not all patients are able to have their assessment over the phone; therefore some patients will be invited to attend the Pre- Operative Assessment Clinic for the full assessment. This will be indicated on your appointment letter.

Following the telephone assessment, you will be made an appointment to attend clinic for your Pre-Op tests which will include:

• Height and weight measurements
• Blood pressure, heart rate and oxygen levels
• MRSA swabbing. (Please see page 19 for further information)
• Additional tests (depending on your medical history) such as blood tests and an electrocardiogram (ECG)

It is important that you arrive for your appointment on time and to allow extra time for parking if you are travelling by car. If you are late for your appointment, we may not be able to see you and you may be asked to re-book your appointment.

If you are arriving by ambulance or have any special needs, it would be helpful to let us know in advance so that we can book an appropriate time slot for you.

Please eat and drink normally on the day of your assessment and take any regular medications as normal.
 
Please note that friends and relatives are not permitted to interpret for you during your assessment.

Therefore, if your English is limited or if you need the services of a sign-language interpreter, please inform the clerk who arranges your appointment.

What to bring with you to your appointment/have available for your telephone assessment

• Please bring all the medications that you are currently taking or an up to date prescription. This includes any tablets, inhalers, liquids, eye drops etc. Please also tell the nurse if you take any over the counter or herbal medications, the contraceptive pill or have any contraceptive implants
• Some medications interfere with anaesthetics and surgery so they may need to be stopped before admission. Your Pre-op nurse will provide you with written medication instructions. It is important to follow these instructions. After surgery, advice will be given when to recommence your routine medications
• If you have a peak flow machine at home, please bring this to your appointment
• If you have a medical alert card, medical implant e.g. pacemaker or have an Advance Directive (if you are a Jehovah’s Witness), it is important to bring these details with you to show the nurse when you attend for your assessment

You will also be required to bring the following with you:

• A list of any allergies you might have to foods, medicines, metals, latex
• A list of questions you might want to ask
• Any medical correspondence you may have about your medical history or previous surgeries

NHS app

Before you attend you Pre-op assessment appointment, you may like to consider downloading the NHS app. Owned and run by the NHS, the NHS App is a simple and secure way to access a range of NHS services on your smartphone or tablet. You can then bring this to your appointment to help with your assessment

You can use this service to:

• Share your COVID-19 status
• Order repeat prescriptions
• Book and manage appointments
• Get health information and advice
• View your health record securely
• View your NHS number

What happens after my assessment?

If we find any problems during the assessment such as high blood pressure or anaemia the nurse may need to refer you back to your GP for further investigations and/ or treatment or you may be referred for an assessment with a Consultant Anaesthetist.

When results are abnormal, you will be informed and appropriate referrals will be made. This may mean that your operation date needs to be postponed.

You will be given information leaflets about having anaesthetic, your procedure (if available) and preventing infection, amongst others. You will also be given advice around shielding prior to surgery and be given written instructions about stopping medication prior to surgery, if necessary.
 
If you have been allocated a date for surgery and no further action needs to be taken following your assessment, you will be given an admission letter with your fasting instructions, which must be strictly followed.

The integrity of your skin is vital to ensure your surgery can proceed safely. It is essential that you inform your nurse if you have any skin conditions as this may affect your surgery. A personal check will be made of your skin when you attend the Preop Assessment clinic prior to surgery. Please avoid any activities that may damage your skin before surgery, such as gardening, DIY and itching/ scratching the skin.

Additional COVID19 information with subject to change

You will need to attend for a Covid-19 swab 2 to 4 days prior to your admission date. This appointment will be given to you when you attend clinic if we know the date of your surgery.

If the date of your operation cannot be confirmed at the pre- operative assessment clinic, your Covid-19 swab appointment, admission details and fasting instructions will be sent to you by post at a later date.

Smoking and health

We aim to promote good health. Therefore smoking is not allowed anywhere in the hospital or on the hospital grounds, by staff, patients or visitors alike. If you want to give up smoking before your hospital stay, please talk to your GP, practice nurse or local pharmacist or contact the local NHS Stop Smoking Service on:

Bury - 0161 253 7554
Rochdale - 0161 655 1581
Oldham - 0161 621 7128
Manchester - 0161 205 5998
 
National NHS Stop Smoking helpline - 0300 123 1014
 
If you have any questions or concerns regarding your preoperative assessment appointment, please contact the relevant clinic on the telephone number below:

Pre-operative assessment clinic contact numbers:

Fairfield General Hospital - 0161 778 3861
North Manchester General Hospital - 0161 922 3563
The Royal Oldham Hospital - 0161 627 8272

Please write down any questions you may have here:
 

 

 

 

 

Your role

Having surgery is a big moment in your life and it’s normal to feel anxious about it.

Fitter patients who are able to improve their health and activity levels recover from surgery more quickly. What you do now can have a really big impact on your recovery.

Taking an active role in planning and preparing for your operation will help you feel in control, leave hospital sooner and get back to normal more quickly.

This leaflet will give you general advice on what you can do to get the best outcome from your surgery.

The healthcare team

Many healthcare professionals from different medical specialties will work together to make your surgery and recovery go smoothly. They will look after you before, during and after your surgery.

This is often referred to as the perioperative team, but it all starts with you.

The perioperative team might consist of:

• Physiotherapists
• Elderly Care Physicians
• Preoperative Assessment Nurses
• GP
• Practice Nurse
• Anaesthetist
• Surgeons and Ward Doctors
• Nurses
• Occupational Therapists

Preparing your body

There are many lifestyle changes that you can make to reduce the risks of surgery. Even small changes can make a big difference.

Exercise

Your heart and lungs have to work harder after an operation to help the body to heal. If you are already active, they will be used to this. While you are waiting for your operation, try and increase your activity levels.

Brisk walking, swimming, cycling, gardening, or playing with your children are all helpful. Try to do any activity which makes you feel out of breath at least three times per week, but always check with your doctor first what type of exercise is most appropriate for you.

Activities that improve strength and balance will also be useful for your recovery.

Who can help me?

Your GP surgery may be able to refer you to an exercise scheme at your local gym. Some people find a personal trainer helpful.

Depending on where you live you may have access to NHS ‘health trainers’ who can help motivate you and offer advice. There are also a number of mobile apps to help you set goals and track your progress, such as ‘Active 10 walking tracker’ and ‘Couch to 5K’.

Try joining a free council or community walking group or environmental volunteering scheme in your local area such as ‘Walks on Prescription’. As well as giving you encouragement and support to start walking and exercising, they are enjoyable and will boost your mood. Ask your GP surgery what is available in your area.
 
If you have back or joint pain you will often see a physiotherapist before seeing a consultant. You may be more limited than others but ask your physiotherapist for exercises that you can do.

These are only some ideas and there will be many health and fitness programmes that you can explore in your local area.

Diet

Your body needs to repair itself after surgery – eating a healthy diet before and after your surgery can really help.

Who can help me?

Your GP surgery should be able to give you some advice and information on healthy eating. NHS Choices can offer useful help at www.nhs.uk/live-well/eat-well/

Weight

If you are overweight, losing weight can help reduce the stress on your heart and lungs. In addition, it can help to:

• Lower your blood pressure
• Improve your blood sugar level
• Reduce pain in your joints
• Reduce your risk of blood clots after surgery
• Reduce your risk of wound infections after surgery
• Allow you to exercise more easily

Who can help me?

There will likely be a weight loss clinic at your GP surgery. Alternatively, there will be a nurse who can weigh you and give you advice on healthy eating and exercise.

You may find it helpful to join a weight loss class. In some areas NHS health trainers may be available to help you. It has been shown that people who improve their lifestyle in the run up to surgery are much more likely to keep up these changes after surgery. This can have a really positive impact on their health in the long term.

There are many changes you can make to reduce the risks of surgery. Even small changes can make a big difference.

Alcohol

Alcohol can have effects on the body, but importantly it can reduce the liver’s ability to produce the building blocks necessary for healing. Make sure you are drinking within the recommended limits, or lower, to improve your body’s ability to heal after surgery.

Who can help me?

You can find useful information on how to reduce alcohol and the benefits to you at NHS Choices www.nhs.uk/live-well/alcohol- support/tips-on-cutting-down-alcohol/. Also see the Drinkaware website www.drinkaware.co.uk

Smoking

Stopping smoking is hard, but the good news is that quitting or cutting down shortly before surgery can reduce the length of stay in hospital, improve wound healing and lung function.

Preparing for surgery offers a real opportunity to commit to stopping smoking.

Who can help me?

Your GP practice will be able to offer help in reducing or stopping, so ask them about the best options for you.

There may be charities or support groups in your local area. Action on Smoking and Health (ASH) is a public health charity that works to reduce the harm caused by smoking. They have helpful advice on quitting. www.ash.org.uk

Medical conditions

Many medical conditions can affect recovery from surgery. It is important to make sure any known conditions are controlled as well as possible ahead of your surgery. You can also book a general health check at your GP surgery if you are between 40 and 74 years old.

Diabetes

Good control of your blood sugar is really important to reduce your risk of infections after surgery. Think about your diet and weight. Talk to your diabetes nurse or team early to see if they need to make any changes to your treatment.

Blood pressure

Blood pressure should be controlled to safe levels to reduce your risk of stroke. Sometimes operations may be delayed if it is too high.

Have your blood pressure checked at your surgery well ahead of your operation – some GP surgeries have automated machines so you can pop in any time. If it is high, your GP can check your medications and make any changes needed ahead of the operation.

Anaemia (low blood count)

If you have been bleeding or have a chronic medical condition, a blood test can check whether you are anaemic. If you are, you should talk to your GP about treatment to improve your blood count before surgery.

Treating your anaemia before surgery reduces the chance of you needing a blood transfusion. It will also help your recovery and make you feel less tired after your surgery.

Heart, lung, and other medical problems

If you have any other long-term medical problems, consider asking your GP or nurse for a review of your medications, especially if you think your health is not as good as it could be.

Anxiety and mental health

Most people feel some anxiety about having surgery. If the thought of going into hospital is making you very anxious or upset, it may be helpful to talk about your concerns with your GP. In some areas GPs can refer you for specific support.

Many techniques including mindfulness, relaxation and breathing exercises or yoga could help you relax before and after your surgery.

If you are taking medication for mental health problems it is important to let the nurse at the hospital know about your medication. They will usually not want to stop this; they can help organise any particular support you need for your time in hospital or return home.

Dental health

If you have loose teeth or crowns, a visit to the dentist may reduce the risk of damage to your teeth during an operation.

It is important to make sure any known conditions are controlled as well as possible ahead of your surgery.

Practical preparation for your operation

We know that coming into hospital for surgery can be a worrying time. Talk to your family and friends about going into hospital and tell them how they can help you. Do not underestimate how tired you may feel afterwards.

Give the below checklist some thought well in advance of the operation:

• How will I pass the time? – Have some headphones and music, books, tablet computer or puzzles, don’t forget chargers
• What can I do to relax? – Learn some breathing techniques, try yoga or listen to music. Read about mindfulness
• What do I need to prepare at home? – Some patients may find it difficult to move around when you return from hospital – before you come into hospital, consider moving your furniture to allow enough space for you to move around safely, whilst using walking aids. The physiotherapy team will assess your need to use mobility aids and provide you with any aids that will help you to mobilise at home. If you need to use stairs at home the therapists will assess your ability to perform stairs as part of your hospital treatment. If stairs are difficult you may need to consider sleeping on the ground floor
• Who can look after my elderly relatives? – If friends and family cannot help, contact your local council and your local carer service - www.carers.org
• How will I get to and from the hospital? – Can someone drive you? If you are eligible for hospital transport, the hospital may be able to organise transport for you
• Do I have enough easy-to-cook meals and healthy snacks for when I get home? – Think who might be able to help prepare meals or help with your shopping afterwards. Consider purchasing some ready meals prior to surgery
• Who can look after my children or pets? – Ask friends and family to help or to be on standby. To help you with childcare, they may need to arrange time off work too. If you have significant difficulties looking after your children following an operation, talk to your local council or your health visitor
•  Do I have enough medication and batteries for my hearing aid to last me in hospital and when I get home? – Remember to take your usual medication into hospital with you
• Do I have some over the counter painkillers at home? – You may need to take some during your recovery as instructed by the hospital
• What do I need to pack? – If you are staying in hospital overnight you should think about toiletries, nightwear, comfortable clothes and footwear. It is important to have stable footwear such as slippers with full backs (not backless), full backed shoes or trainers. Orthopaedic patients who are having lower limb surgery may experience some swelling of their feet, so try to bring in shoes that can be adjusted by expanding laces/Velcro. It is important to get out of bed, get dressed and start to move as soon as your operation allows as those who do this get home sooner and recover quicker. Temperatures in hospital can vary so some layers of clothing can be useful. See NHS Choices for further information: www.nhs.uk/conditions/ having-surgery/preparation
• What else would be helpful to do? – Get your house and garden in order. Get up to date with your general affairs and finances. This will mean you do not have to worry about these whilst you recover
• Whom should I let know I am going into hospital? – Friends and family can usually give you practical support. It is also good to have people to talk with whilst you are at home recovering. Many people will want to help your recovery, so let them know how they can help in plenty of time
• Make sure I have a shower/bath before going to hospital to minimise the risk of infection

Practical questions to ask your perioperative team about your surgery

Members of the perioperative team at the hospital will discuss your anaesthetic, surgery, and recovery period. They will discuss any particular risks you have from both your anaesthetic and surgery and any choices you have.

They will give you information to read at home. There will be a contact number to ring if you need to ask more questions. The better prepared you are, the easier the process is likely to be. On the following page are some questions that you might want to ask the perioperative team.

• What time do I need to stop eating and drinking before surgery?
• What medication should I take on the day of my surgery?
• What do I need to pack for the hospital?
• Do I need to remove nail varnish, gels, and piercings?
• Can I have visitors? When are the visiting times?
• Will someone at the hospital shave me if needed before my surgery?
• When can I expect to go home?
• What help can I expect to need at home afterwards?
• How long will it be before I can shower/bathe again?
• Are there any important do’s and don’ts for my recovery?
• Will I have stitches or staples that need to be taken out?
• How much time will I need to arrange off work?
• Who will give me a fit/sick note for my employer?
• Will I have a check-up afterwards?
• How long might it be before I can walk/swim/play golf/run again?
• When can I drive afterwards?
• How long will it be before my life is roughly back to normal?

What can I expect during my recovery?

Before you go home your nurse will give you written information about what to expect during your recovery and how to manage any pain you may experience. This will also include anything to look out for and a number to call if you are worried. There are factsheets on some of the most common surgical operations: www.rcoa.ac.uk/patient-information/preparing-surgery-fitter- better-sooner These give more detailed information on how to prepare for different types of surgery and what to expect afterwards.

Before you go home your nurse will tell you:

• Any do’s and don’ts
• Whom to contact if you are worried
• What to look out for
• How to manage your pain
• When to take your medication

Practical help to keep you motivated during your recovery

Depending on what surgery you are having, recovery may take many weeks. Do not worry if some days go better than others, as this is normal. It can be useful to keep a recovery diary which you can continue after you go home. Try and get into a routine and get up in the morning at a regular time.

A list of daily goals can give structure to your day and help monitor your progress. Visits and phone calls from family and friends can cheer you up and encourage you to reach your goals. Be careful though that you don’t tire yourself out from too many visitors.

What does the term ‘enhanced recovery’ mean?

Enhanced recovery is the name given to a programme that aims to get you back to normal health as quickly as possible after a major operation. Hospital staff look at all the evidence of what you and they can do before, during and after your surgery to help give you the best chances for a quick and full recovery. This should get you home sooner.

The programmes will vary depending on what operation you are having and which hospital you are being treated at, but may include:

• Improving your fitness levels before your operation if there is enough time
• Treating any other long-term medical conditions
• Reducing the time you are starved for by giving you water and carbohydrate drinks before your surgery
• Giving you drugs to prevent sickness after surgery
• Considering the best ways of giving pain relief during the operation
• Using local anaesthetic blocks or regional anaesthetics where possible
• Giving you the best pain relief afterwards to get you moving quicker
• Allowing you to start drinking earlier
• Reducing the time you have catheters and drips
• Teaching you exercises to help you recover after your operation

By following an enhanced recovery programme, there are usually fewer complications after surgery. There is also less chance of you needing to go back into hospital again.

Methicillin Resistant Staphylococcus Aureus (MRSA)

What is MRSA?

There are lots of micro-organisms (germs) on our skin and in the environment around us. Most of them are harmless, some are beneficial and a very small proportion can cause harm.

Staphylococcus aureus is a common germ that is found on the skin and in the nostrils of about a third of healthy people. It can cause harm if it enters the body via cuts and sores.

MRSA stands for Methicillin (M) resistant (R) Staphylococcus (S) aureus (A). MRSA are varieties of Staphylococcus aureus that have developed resistance to Methicillin (a type of Penicillin) and some other antibiotics that are used to treat infections.

Some people can carry MRSA on their skin or in their nostrils. They are described as being colonised with MRSA (where the bacteria live harmlessly on the skin). Some people carry MRSA for a few hours or days, while others carry it for weeks or months.
People can be colonised with MRSA but not causing illness and they have no symptoms, unlike people who are infected with MRSA.

MRSA can cause harm when it gets an opportunity to enter the body. It can cause simple local infections such as pimples and boils, or more serious problems such as wound infections, chest infections or blood stream infections.

You will be given an information leaflet with further information on MRSA when you attend clinic.