Journal of Perioperative Practice

The handover of the care of patients is acknowledged as a vulnerable period in the perioperative patient journey, and handovers given within the perioperative environment present the risk of potentially harmful errors occurring. These errors can result from poor communication and inaccurate information transfer, and may be avoided through the implementation of standardised protocols. This article presents an in depth literature review and discussion allowing for the examination of best practice in the delivery of a handover within the perioperative environment, drawing clear conclusions and presenting recommendations for best practice.

We report a case of a patient with severe postoperative bleeding complication, secondary to dietary and herbal supplements induced platelet dysfunction. This case demonstrates the importance of preoperative assessment which includes questioning the patient with regards to their dietary and herbal supplements and of stressing the importance of discontinuing them prior to surgery.

Communication failures can lead to sentinel events in the operating room. Knowledge of basic surgical steps is important for all team members to ensure work flow efficiency. Surgeons and non-surgeons were surveyed to determine perceived and actual quality of communication between team members, using knowledge of surgical steps as a marker of communication quality. Participants agreed that communication was important, but non-surgeons were unable to name the four key steps of a laparoscopic cholecystectomy (p = 5.0E-07), indicating poor communication between surgeons and non-surgeons.

Surgical care practitioners (SCPs) have become recognised as integral members of the surgical team in many healthcare establishments. Seeking informed consent either as the operating practitioner or on behalf of the surgeon, as their delegate, has becoming routine for many SCPs. Informed consent is a critical step in the patient’s care pathway and fundamental in fostering shared decision making and safer surgical practice. The relatively recent case of Montgomery v Lanarkshire Health Board has highlighted a need for those practitioners seeking informed consent to critically examine their practice and revisit the founding principles of the process.

Patients should be at the heart of everything we do. The aim should always be to achieve healthcare outcomes by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone: ‘no decision about me, without me’ (DH 2012). This article details a plan of care for an 18 year old male patient with a moderate level of learning disability who was scheduled for a tonsillectomy at a local NHS trust hospital. It focuses on the management of the patient’s anxiety, nausea and pain. In accordance with the Health and Care Professions Council’s code of confidentiality (HCPC 2014) the location and individual names of places and people concerned will not be disclosed. The patient presented at the pre-assessment appointment as having a learning disability consistent with a diagnosis of being on the autistic spectrum. More specifically, he had cognitive impairment which affected his ability to understand complex information. This, combined with a reduced ability to cope independently, formed the rationale for the attendance of a carer throughout his perioperative journey. According to the National Autistic Society (NAS) there are approximately 700,000 people with autism spectrum disorder (ASD) in the UK ie more than 1 in 100. Autism is a part of daily life for 2.8 million people (NAS nd).