Preoperative Shower

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BLR1-Preop Shower References:

1-1 Bert, F; Giacomelli, S; Amprino, V; Pieve, G; Ceresetti, D; Testa, M & Zotti, CM (2017) The bundle approach to reduce the surgical site infection rate. Journal of Evaluation in Clincal Practice, 23(3); 642-647.

1-2 Edmiston, CE; Lee, CJ; Krepel, CJ; Spencer, M; Leaper, D; Brown, KR; Lewis, BD; Rossi, PJ; Malinowski, MJ & Seabrook, GR. (2015) Evidence for a standardized preadmission showering regimen to achieve maximal antiseptic skin surface concentrations of chlorhexidine gluconate 4% in surgical patients. JAMA Surgery, 150, (11). 1027-1033 1-3 Colling, K;,Statz, C, Glover, J; Banton, K & Beilman G. (2015) Pre-Operative Antiseptic Shower and Bath Policy Decreases the Rate of S. aureusand Methicillin-Resistant S. aureus Surgical Site Infections in Patients Undergoing Joint Arthroplasty, Surgical Infections,16(2): 124-132. https://doi.org/10.1089/sur.2013.16 1-4 Cowperthwaite L. & Holm RL (2015) Guideline implementation: preoperative patient skin antisepsis.AORN Journal 101, (1), 71-77. DOI:10.1016/j.aorn.2014.11.009

1-5 Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S., Solomkin JS., Mazuski JE., Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi, J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP; Healthcare Infection Control Practices Advisory Committee. (2017). JAMA Surgery. Centers for Disease Control and Prevention guideline for the preventiion of surgical site infection. 152(8). 784-791. doi: 10.1001/jamasurg.2017.0904. https://www.ncbi.nlm.nih.gov/pubmed/28467526

GUIDELINES: AHRQ-Global guidelines for the prevention of surgical site infection. https://www.guideline.gov/summaries/summary/50706/global-guidelines-for-the-prevention-of-surgical-site-infection

National Institute for Health and Care Excellence- Surgical Site Infection. Developed 2013, reviewed 2017. https://www.nice.org.uk/guidance/qs49 AORN, Inc Guideline for preoperative patient skin antisepsis. In: Guidelines for Perioperative Practice. Denver, CO. (2018)..51-54.

PATIENT EDUCATION: Before surgery, you can play an important role in your health. Because skin is not sterile, you can reduce the number of germs on your skin by carefully washing before surgery. IMPORTANT:  You will need to shower with a special soap called chlorhexidine gluconate (CHG). A common brand name for this soap is Hibiclens, but any brand is acceptable. The soap comes in a liquid form and (can be purchased at most pharmacies or will be provided to you in the surgeon’s office). (Whatever the process is), You will only need a small bottle, about 4-6 ounces. Bathing Instructions You will take _ CHG showers. The first shower should be taken __ day(s) before surgery, the shower the day before surgery. The shower will be the morning of surgery. With each shower, if you are going to wash your hair, wash as usual with your normal shampoo. Rinse your hair and body thoroughly afterward to remove the residue. Do not shave the area of your body where your surgery will be performed. Any new cut, abrasion or rash on your surgical extremity will need to be evaluated and may cause a delay in your procedure. Turn water off before applying the CHG soap to prevent rinsing it off too soon. Apply the soap to your entire body from the jaw down, using a clean washcloth or your hands. Do not use CHG near your eyes, ears, nose or mouth. Wash thoroughly for five minutes, paying special attention to the area where your surgery will be performed. Do not scrub your skin too hard. Do not wash with your regular soap after using the CHG. Turn the water back on and rinse your body well. Pat yourself dry with a fresh, clean, soft towel after each shower. Put on clean clothes or pajamas. Use freshly laundered bed linens for the first night. Do not apply any lotions, perfumes or powders after use. Reference: https://www.who.int/infection-prevention/tools/surgical/appendix2.pdf?ua=1

RN Pre Procedure Testing (PPT)/Pre Anaesthesia Testing(PAT)/Preop Patient Assessment

Print Name: __ Nursing Unit: ____

This competency can only be completed by direct observation/review with a validator. Performance (check one for each key element) Competent Cannot perform independently (requires practice and supervision) Demonstration: RN completes the following skills
Provides assistance to PPT/PAT or Preop RN with PPT intake assessment for scheduled patients. Follows protocol for time management during the actual assessment.
Identifies all demographic information, scheduled procedure, past medical history, allergies, ASA scoring, and accurately places in EMR.
Provides assistance to PPT/PAT RN with patient education needs regarding what to expect on day of surgery and educates patient to the process. (NPO status, arrival time, preop routines, etc) (handout)
Verbalizes the need for Anesthesia Care Provider to review the information for an anesthesia plan of care and order any other treatments needed prior to date of surgery. i.e. EKG, echocardiogram, stopping medications, etc.
Verbalizes identification of completed assessment in terms of required information and how to systematically close out each patient assessment.
Scans Preop orders to pharmacy, Read Post-op Surgeon’s orders to ID equipment needed prior to arrival date, and process orders for stat labs/x-rays as needed

Final Rating: □ Independent – performs independently □ Not met () – unable to perform, even with coaching
(check one) □ Novice () – performs with coaching NOTE: * = action plan required (send to unit manger for follow-up)
Action Plan: Revalidation Date

Validator’s signature: __ Date: ___

QI SUITE: TEAM

Clinical Leadership	Has the authority to test and implement a change and understands how this might affect the clinical care process and its impact on the organization
Technical Expertise	Has deep knowledge of the process or area in question. Several experts may be needed, technical, clinical, processes / protocols, etc.
Day-to-Day Leadership	Is the QI-lead and ensures tasks are completed and works closely with team members and understands the impact of activities on the target area and organization
Project Sponsorship	Has executive authority and serves as the link with the senior team and stays apprised of the process and progress. Can assist in obtaining resources and addressing barriers.
Optimum Size	Between 5-8 individuals, the most important requirement is the diversity of participants. Participants should have different rules and perspectives on patient care, processes.

Potential Members of a QI Team Might Be: Chief executive officer, Medical directors, Physicians, Nursing staff, Physician assistants, Medical assistants, Patient representatives, Operations manager/director, Health educators, Community health workers, Peer mentors, Patients, Community representatives, Directors of clinical services, Practice managers, Medical records staff, Receptionists, Lab technicians, Pharmacy or dispensary staff, Case managers, Physical plant operations, Billing department staff, Finance director. (Source: https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod14.html)

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