Abstract: This paper documents a successful nurse-led admissions process for same day orthopaedic surgery, on relatively fit patients under 70 years of age. During the 6-month study, 31 patients with a median age of 38 years were categorised into 3 streams. 252 patients (76%) underwent a nursing-admission process without the need for further consultation with a junior medical officer or an anaesthetist. The remaining patients not included in the study were admitted and clerked by a house officer. No safety issues arose and the surgeons and anaesthetists were satisfied with the process. The junior medical officers described improved job satisfaction by being able to attend theatre, other educational opportunities, and working more closely with the consultant. The process has now been incorporated into elective orthopaedic admissions at Burwood Hospital.

Abstract: The author examines the current practices around the surgical counts of sponges, sharps and instruments, which is an integral component of safe perioperative nursing practice. Current practice, legislative requirements are reviewed, and the guidelines from the Perioperative Nurses College of New Zealand are reproduced. Case studies of errors in counts are used to illustrate the legal standards of practice.

Abstract: This article is from a conference paper presented to the 12th World Conference on Surgical Patient Care. It presents cultural safety, as differentiated from transcultural nursing, and investigates how it relates to perioperative nursing. Examples are presented of how nurses can adhere to medical requirements, and address the cultural needs of Maori patients.

Abstract: The incidence of postoperative complications is reduced with early identification of at risk patients and improved postoperative monitoring. This study describes the development and effect of a nursing preoperative assessment tool to identify patients at risk of postoperative complications and to reduce the number of acute admissions to ICU/HDU. All surgical patients admitted to a surgical ward for an elective surgical procedure (n=7832) over a 23-month period were concurrently scored on admission using the preoperative assessment tool. During the time period studied, acute admissions to ICU/HDU reduced from 40.37 to 19.11%. Only 24.04% of patients who had a PAS >4 were identified by the surgeon and/or anesthetist as being at risk of a postoperative complication, or if identified, no provision was made for improved postoperative monitoring. This study supports the involvement of nurses in identifying preoperatively patients at risk of a postoperative complication and in need of improved postoperative monitoring. The postoperative monitoring requirements for the PAS >4 patients were relatively low technology interventions.

Abstract: This reports on an initiative at Whakatane Hospital, where a Nurse-Led pre-assessment (NLPA) was delivered at an outpatients clinic. NLPA involves taking a comprehensive medical history, a nursing assessment, physical examination, airway assessment, ordering appropriate investigations and carefully documenting the process and results. More valuably, it provides an opportunity for the patient to participate in planning their care. The aim of this initative was to short circuit delays and congestion in existing pre-assessment clinics, streamline the pre-assessment process and reduce the number of patient visits to hospital. Reducing cancellations of surgery (often on the day of surgery) and “did not appear” (DNA) numbers were also objectives. After a small pilot, a six-month trial was funded by the Ministry of Health. Over the six-month trial, 373 patients attended NLPA; 178 patients required anaesthetist review before surgery, and 198 could proceed directly to surgery following NLPA. An anonymous postal survey was made of patients, who indicated satisfaction with the service. Other outcomes are discussed, and the trial was deemed successful. Follow up plans have been disrupted by restructuring at the hospital and the clinic has yet to be implemented.

Abstract: This article reports findings from an audit of post-tonsillectomy haemorrhage among patients at South Auckland Health from October 1998 to April 1999. All patients who underwent tonsillectomy or adenotonsillectomy were contacted by telephone, after the 14th day and before the 21st day following surgery.

Abstract: The author provides a review of current protocols and presents new ways to manage the care of patients undergoing total joint arthroplasty, hip and knee replacement surgery.

Abstract: This research paper provides a description and analysis of literature and research focusing on pre-operative education programmes available internationally and nationally for patients receiving total joint replacements. This discussion differentiates between pre-assessment and pre-operative education to provide an understanding that both aspects are important in there own right. Together pre-assessment and pre-operative education complement each other to provide total care for patients awaiting total joint replacement surgery. One way of alleviating apprehension experienced by the patient about their surgery is by providing appropriate joint replacement education programmes that meet their needs. This type of programme is a form of empowerment which provides patients with appropriate and relevant information. This allows the patient to be actively involved in their own care and enable them to make informed decisions. The importance of education, information and communication; anxiety and pain; family and peer support; mobility and insecurity is a common thread in the literature where patients describe their experiences and concerns following a total joint replacement. These concepts are discussed and related to why pre-operative education programmes are recommended to help alleviate patients concerns and are important in providing a total multidisciplinary approach to care.