DMGHSURGICALPRE-

ADMISSI
ONEVALUATI
ON Eval
pr
uat
ot
i
on
ocol
PROTOCOL

Ther
ear
el es
sthan200,
000s ur
geriesperf
ormedevery
yeari
nEt
hiopi
a.Thedel
ayinelecti
ves ur
gic
aladmi
ssion
rangesf r
om 2t o16weeks.
I
. Bac
kgr
ound

Ethi
opiaisAf r
ica’soldestandindependentcountry.Itist hetenth
lar
gestc ountryinAf r
ica,coveri
ng1,104,300s quarekilometers(wit
h
shareof1mi l
lions qkml andareaand104, 300s qkm wat er)andis
themaj orc onstituentoft helandmas sknownast heHor nofAf ri
ca.
I
ti sborderedont henor thandnor theastbyEr it
rea,ont heeastby
Dji
boutiandSomal ia,ont hesouthbyKenya,andont hewes tand
Southwes tbySudanandSout hSudanrespect
ively.I
tsgeographical
coordi
natesar e80Nand3800E.

Cur
rent
lyt
hec ount
ryi
simpl
ement i
ngt helastphase,HSDP-I
V
whi
chgaveemphasi
sontheimprovementofqual i
ty&ac ces
sibi
li
ty
ofheal
thser
vic
esascl
ear
lys
tat
edi nit
sobject
ives
.

Toimpr ovetheac cess

ibili
ty,qual
ity&ef fi
ci
encyofthes ur
gical
ser
vic
esi nt hecountry
,t hisperi
-operat
iveguidel
ineisdevelopedas
anintegralpartoft heiniti
ati
veofi mprovi
ngi n-
pati
entservic
eand
par
t&par celofEHRI Gimpl ementati
on.
I
I. I
ntr
oduc
tion
Itisestimatedt hatupt ohal ftheworld’
spopulationlacks
accesstobas ics urgi
calcare.Inadditi
on,theunmetneed
forsurgicalcar einSub- SaharanAf r
icaisawel l
-doc umented
fact
.Bes i
det hei nadequateac cesstobasicsurgic
alc are
thatremai nst obeamaj orc oncer
ni nlow-i
ncomes ett
ing,
complicati
onsofs urgi
calc ar
ehavebec omeamaj orc auseof
deathanddi sabilityworldwide.
Therear el es
sthan200,000s ur
geri
esperfor
medever yyear
inEt hi
opia.Thedelayi
nel ect
ivesurgi
caladmis
sionranges
from 2t o16weeks .Thei nc
reasi
ngdemandf orsurgi
cal
careandt hegrowi
ngemphas i
sont hequali
tyands af
ety
ofc areare
drivi
ngtheneedforthehealt
hc ar
esys
tem t
oimpr
ovet
he
levelandqual
it
yofsurgi
calc
are.
Problemsr elat
edt oqualityandeffi
ci
encyiss
uesoft he
peri-
oper ativesys t
emwor kfl
ow c
anc ausesur
gic
aldel ays
,
cancellati
ons ,adverseevents&c ompli
cati
on,
unplanned
returnt otheoper ati
ngtheatr
eandsubopti
malcar
ef or
surgi
c alpatients.
Therefor
e,t heoperat
ingroom (OR)andt hepr ocess
est hat
supporttheORwhi chmakesupt heperi-operati
ves yst
em
requir
eac onsi
derabl
eamountofpl anning,pr
epar at
ion,and
coordi
nationwithi
nt heperi-
operati
ves ystem toens ure
that
Pat
ient
srec
eivequal
it
ysur
gic
alc
aret
hati
ssaf
eandt
imel
y.
1.
Preoper
ati
veEval
uat
ion
A.Cl
ini
cal
Themoder nprepar ationofapat ientf oroper ation
char act eri
z esthec onver genc eoft hear tands cienc eof
surgi caldi s c
ipli
ne.Thec ontexti nwhi chpr eoper ati
ve
prepar ati
oni sconduc tedr angesf rom out pat ientof fi
cevi si
t
tohos pi t
ali npat ientc ons ul
tati
ont ot heemer genc y
depar tmenteval uat i
onofapat ient.Theappr oac hest o
preoper ativeeval uat i
ondi f
fers ignificant l
y,dependi ngon
thenat ureoft hec ompl aintandpr opos eds ur gical
intervent ion, patientheal t handas sess mentofr iskf actors,and
ther es ul
tsofdi r ec t
edi nves ti
gat i
onandi nt ervent i
ont o
opt i
mi z et hePat ient sover allst
at usandr eadi nes sofoper ation.
Failuret omakeapr operas sessmentoft hepat ient’s
condi tioni soneoft hec ommones tandmos teas i
ly
avoidabl ec ausesofmi shapas sociat edwi thanes thes i
a.
Ther ei snos ucht hingasami noranes t hesia!Ac ompr ehens i
ve
pre- oper ativeas s es s
mentmus ti nc ludeever yas pectoft he
patient ’sc ondition,andnotj ustt hepat hol ogic alpr oblem
requi rings urgery.
B.
Anes
thes
iaas
ses
sment
ManagementofAnes thes
iabegi nswi t
hpr eoper ati
ve
assessmentandpl anni
ng,psychologic
alpr eparationofthe
patient
,preparati
onofbas i
canes thesiaequipment ’
sand
admi ni
str
ationofpremedi
cationdr ugs.Therefore,sett
ingthi
s
preoperati
veanesthesi
aguidelinesispar amountt okeep
standardanes t
hesi
aservi
ce.
Pr
eoper
ati
veAnes
thes
iaGui
del
iness
houl
dinc
lude:
i
.Pr
eoper
ati
veas
ses
smentandpl
anni
ng
i
i.Ps
ychol
ogi
calpr
epar
ati
onoft
hepat
ient
i
ii
. Admi
nis
trat
ionofpr
epar
ati
vedr
ugs
.
i
.Pr
eoper
ati
veas
ses
smentandpl
anni
ng
Pre-anestheti
cas s
ess mentiseval uati
onoft hepat ients
’
medi cal
,physicalandment alstatusbef or
et akingthepat i
ent
tot heoper at
iont heatre.Anestheticdrugsandt ec
hniqueshave
profoundeffectsonhumanphys i
ology.Henc e,afocusedreview
ofal lmajoror gans yst
emss houl
dbec ompletedpr i
orto
surgery.
I
nadequatepreoper
ati
veplanni
nganderr
orsinpati
ent
prepar
ati
onaret hemostc
ommonc aus
esofanes
thet
ic
compli
cati
ons
.
Thegoal softhepr eoperat
iveevaluati
onar etoens ur
ethat
thepat i
entisint hebest(oroptimal)condit
ion.The
anesthesi
ologi
sts/
anestheti
stsshallberesponsi
bleforre-
asses
s i
ngt hestatusoft hepat
ient,developi
ngapl anof
anesthesiaandac quai ntingt hepatient/carewi tht he
proposedpl an.Itmus tbec l
earl
yemphas is
edt hatt heai mofpr e
-anesthesi
aeval uationi snott ofi
ndr easontoc anc elpat ients
from theoper ationl ist,butt omakes ureal lt henec essar y
evaluati
onsandt estsar ereadybef orethepr ocedur e. Thisisthe
reasonwhys uchas s
es smentmus tbeper formedbef oreadmi ssion
forelecti
vepat i
ent s
, butatl east12hour sbef or
et hepl anned
procedure.Thiswi l
lpr ovideenought imet oaddr essal lconcer ns
rais
eddur ingt heas ses s
ment .Apr e-anesthes i
aas sessment
shallbedonebyanes theti
storanes thesi
ologis tpr iort ot he
inducti
onofanes t
hes ia.Ananes t
hes i
ologis
t /anes thetist
shouldf ol
low thef ol l
owi nggui del i
nesi ndoi ngpr e-oper ative
assessmentandpl anning.

Gui
del
inesf
orpr
e-anes
thet
iceval
uat
ion
1.Thepat
ients
houl
dbec
orr
ect
lyi
dent
if
ied.
2.Theent
iremedi
calr
ecor
dss
houl
dber
evi
ewed.
3.I
nter
viewi
ngandexami
ningt
hepat
ientt
o:
a.
Discusst
hemedicalhi
stor
y,Famil
yhistory,Soc
ialhis
tory,
Drughis
toryandall
ergi
es;Previ
ousanes
t heti
cexperi
encesand
dr
ugtherapy…etc
.
b.Asses
sthos
eas
pec
tsoft
hephys
icalc
ondi
ti
ont
hatmi
ght
af
fec
t
deci
si
onsregardi
ngper i
-operat
iveri
skandmanagementand
cl
assi
fythehealt
hs t
atusoft hepati
entacc
ordi
ngtoASA
Physi
calStat
usSyst
em. (
Ass eenbel
ow).
c
.Per
for
m anAi
rwayAs
ses
smentbyus
ingc
ommonai
rway
as
ses
smentmet
hodsanddet
ermi
nedi
ff
icul
tai
rway.
4.Obt
ainingand/orrevi
ewi
ngtes
tsandc
ons
ult
ati
onsnec
ess
ary
tothec onductofanest
hes
ia.
a.
Deter
miningtheappropr
iat
epres
cri
pti
onofpreoper
ati
ve
medi
cat
ionsasnecess
arytothec
onductofanes
thesi
a.
b.
Theanes
thes
iol
ogi
st/
anes
thet
ists
hal
ldi
scus
spos
sibl
epl
ans
of
managementwiththepatientandexpl
ainsanyopt
ions
avai
labl
e,t
oenablethepat
ientt
omakeani nf
ormedc
hoic
e.
7.Theresponsi
bleanes
thes
iol
ogi
st/
anest
heti
sts/shal
lveri
fy
thattheabovehasbeenproperl
yperf
ormedanddocument
edin
thepati
ent'
srecord.
8.Dec
idet
heNPO/
Fas
ting/t
imebas
edont
het
ypeofpl
anned
sur
ger
y.
9.Thepati
ents
hal
lber
e-as
sessedi
mmediatel
ypri
orto
i
nducti
ontomakes
uret
heprevi
ousandc
urrentas
sess
ment
sar
e
cons
ist
ent
.
10.Theanes
thesiol
ogi
st/
anest
hetis
tmus tmakes
urethe
pati
enthassignedthewrit
tenconsentf
ormandt
hefor
mi s
att
achedtot
hepat i
entr
ecord.
i
i.
Psyc
hol
ogi
calPr
epar
ati
onoft
hePat
ient
1.Psyc
hol
ogi
calprepar
ationispr
ovidedbytheanes
thet
ist
duri
ngthepr
eoperat
ivevi
sitandint
erviewwit
hthepati
entand
famil
ymembers.
2.Athoroughdesc
ript
ionoftheplannedanest
hesi
aandevent
s
toant
icipat
eint
hepr eoper
ati
veperiodshal
lbecl
ear
ly
dis
cussed.
Theanes
thes
iol
ogi
st/
anes
thet
ists
houl
dadmi
nis
ter
:
1.Premedic
ati
on(pre-
anesthes
iamedicat
ions
)or
all
yor
i
ntramuscul
arl
y1–2hour sbefor
einducti
onofanest
hes
ia
(ac
cordi
nglytoeachpatent
).
2.Foroutpati
entsur
ger
y,pr
emedicat
ionmaybeadmi ni
ster
ed
i
ntravenousl
yinthei
mmediatepr
eoperat
iveper
iod.
C.
Nur
singAs
ses
sment
Preoperati
venur si
ngc arebeginswhent hepatientis
i
nformedoft heneedf orsur
gery,makest hedecisi
ontohave
theproceduredone&endswhent hepat i
entistr
ansfer
redto
theoper at
ingroom.Nur si
ngac ti
vit
iesint hepreoper
ati
ve
phasear edir
ectedt owardpat i
ents upport
,teachi
ngand
preparati
onfort hepr ocedur
e.The
Fol
lowi
ngf
ormats
hal
lbeus
edt
ogui
det
hepr
e-oper
ati
venur
sing
car
e.
I
nfor
medc
ons
ent
Thedocumentapati
entsignstoveri
fythathehasengagedi
na
dial
ogwit
hahealthcarepracti
ti
oneraboutaproposedmedi
cal
tr
eatmentisc
ommonl yrefer
redtoasan
―inf
ormedcons
ent.
‖However
,itisthedial
ogits
elft
hat
cons
tit
utest
heact
uali
nfor
medconsentpr
ocess
.
Cons enti sanoppor t unityt ogui det hepat ientt ot her i
ght
decisionf ort hem,andal sodi spelanyunr ealisti
cexpec tations
conc erningt hepr ocedur e. Ultimat el
yi ti sanoppor t
uni t
yt o
createar elations hi
pofopennes sandt rustbet weendoc t
or
andpat ient,whi c hmayhel pi foper ati
vec ompl i
cati
onsar e
encount ered.Wi thhi ghheal th-c areexpec tat i
ons ,apoor ert han
expec tedout comemayl eadt os urpriseands ubsequentanger :
goodpat i
enteduc ation,dur ingt hei nfor medc onsentpr ocess,
isthes urgeon' sc hanc etof orgear elat i
ons hipwi tht he
patientandmakes ur et hatt hepat i
ent 'sexpec tat
ionsar e
realistic
.I tiss trongl yr ec ommendedt hatt hepat ient sshoul d
ideallybeas kedf ort heirc ons entatt het i
meofl i
st ingfor
surger y.Thi sisbebes tper formedbyt heoper atingsur geon
hims elf/hersel f,
orawel linfor medandr akingdel egatei nthe
absenc eoft hes eniors t
af f.Allpat ientss houl d,asami nimum,
bei nf ormedaboutt her is kofc ompl ic
at i
onst hatpos ea
subs tant i
alr iskofgr aveadver sec onsequenc es.
HOSPI
TAALAWALIGALAADALLOOMANNAATTIGUCA
WALII
GALTEEYAALABAQAQSANI
ISUPHUUDURAGUUTAMU
DELOMENAGENERALHOSPI
TALOPERATI
ONCONSENTFORM
Guyyaa_____________________l
akkoof
sakaar
dii
__________

Maqaadhukkubs
ataa
guut
uu_______________________________umr
ii
_____s
aal
a____

Animaqaankooas i
ioli
tti
kaneer amedhi bee
koo______________________j edhamuufhaalumaogeeesot
ni f
ayyaanattihi
mani i
n
rakkool
eeyaal
ichaanwalqabataniidhufuudanda’
ankan
Akka______________________________________hubadheeyaal l
ibaqaqsanii
suphuugareeOgeessabaqaqsani yaal
uu_______________fiogeessa/t
tiyaalaa

Hadoochaa(anest
hetis
t)¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬______________________t i
inakka
naafgodhamuwal ii
galeeji
ra.yooyaal
libaqaqsaniis
uphuunaafhingodhaminrakkoo
narr
agahuushubadheer a.yaali
inkunyoohojjatamur akkool
eenar
ragahuudanda’
an
natt
ihimameei t
tigaaf
atamummaaf udhadheer a.

Yaal
aai
rrat
tiyoodhi
igni
nabar
baac
his
e;

Dhii
gafudhac
huufqophi
idha__________________dhi
igahi
nfudhadhu
_____s
ababa_________

Maqaafimall
attoodhukkubs
ataa;maqaa
____________________mallat
too______________

Yookandhukkubsat
aanmal
lat
tees
suuhi
ndandeennet
a;emaqaaf
imal
lat
tooguddi
ft
uu
yknbakkabu’
aa;

Maqaaguddi
ft
uuyknbakkabu’
aa______________mal
lat
too_______________

Ragoot
ayer
ooguc
nikuni
guut
tamubakkakanat
tiar
gaman

Lakk.
Maqaamal
lat
too

1,
____________________________________

2,
_________________________________________

Ogeess
agucakanaguuchise
maqaa______________________________mal
lat
too_________
 Guyyaa____________

Maqaa
dhukkubs
ataa_______________________umr
ii
___s
aal
a__l
akk.
kaar
dii
___________
____

Ani maqaankooarmaaanolit
tikaneer amekar aaogeessayaal
ahadoocha
(anesthet
ist
)_________________________________________Fi waahi l
ootai
saat
ii
n
gos t
iQori
chaahadoochaabarbaachis
aanakkanaafkennamuwal i
igaleeji
ra.Yaal
ii
nkun
yoonaafhojjat
amugos ti
qori
chahadooc haanaafkennamuuf i
dhi
ibbaainnianairr
att
i
fiduudanda’
unattyhimameei t
tigaafatamummaaf udhadheer
a.

Maqaaf
imal
lat
toodhukkubs
ataa;

Maqaa____________________________________________________mal
lat
too__
_____

Yookandhukkubsat
aanmal
lat
tees
suhi
ndandeennet
a’emaqaaf
imal
lat
tooguddi
ft
uu
yooki
inbakkabu’
aa

Maqaaguddi
ft
uuyooki
inbakkabu’
aa___________________
Medi
calCons
ent
Gener
alPr
inc
ipl
es
 Forallpati
entsprepari
ngforORallthi
seval
uati
on
protocol
sshouldbef ol
lowedandtheformat
sshoul
dbe
attachedallpr
e-oppatient
scard.
 Pri
ortoadmissi
onforsurgeryallc
lient
sshouldbe
eval
uatedbymul t
i-di
sci
pli
naryteam( s
urgeon,and
anest
heti
st)atpati
entpreparat
ionunit.
 Al
linves
tigat
ionss
houl
dbedoneonebef
ores
urger
y
 Cons
entf
orms
houl
dbes
ignedonedaypr
iort
osur
ger
y
 Pre-operat
ivepreparat
ion(abdominalpr
epar
ati
on,
prophylact
ic,andcounsel
ing)shoul
dbedonebefor
e
surgery.

Pl
eas
eadher
etot
hispr
otocol
!