My Surgery. An Information Guide and Personal-Care Tool. This binder is meant to be your guide and personal tool to help

Transcription

1 2 nd edition, 2012 My Surgery An Information Guide and Personal-Care Tool This binder is meant to be your guide and personal tool to help you understand and take part in your care as you have your surgery at University Health Network. Patient Education

2 An Information Guide and Personal-Care Tool This binder can help you while you have your surgery at University Health Network. Most of the important information you will need has been added. You can add to this information at any time, so please bring this binder with you to the hospital for your Pre-Admission Clinic visit and on the day of your surgery. Valuable information about our UHN surgical services, hospital news, directions and other important information may be downloaded from Feel free to look through each section of the online binder using the navigation tabs at the top of the page. You will find more information for you that is not in your binder; read and print any information you like and, add it to this binder. My Surgery Name: Hospital: My Surgeon: My Doctor(s): Phone: Surgery Date(s): Time(s): Need help? Automated Surgery Helpline Toronto Western Hospital: Call For Toronto General Hospital or Princess Margaret patients: Call your surgeon s office

3 Index I NT R O D U C T I O N Section A M Y S U R G E RY Section A Section B A B O U T T H E H O S P I TA L Section B Section C B E F O R E A N D D U R I N G M Y S U R G E RY Section C Section D A F T E R M Y S U R G E RY Section D Section E P L A N N I N G TO G O H O M E Section E Section F M Y T E S T S, M Y Q U E S T I O N S A N D M Y W E B S I T E S Section F

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5 I NT R O D U C T I O N Welcome to University Health Network Welcome to University Health Network (UHN) where you will be having your surgery. UHN is a University of Toronto teaching hospital including four sites: The Princess Margaret (PM), Toronto General Hospital (TGH), Toronto Western Hospital (TWH), and the Toronto Rehabilitation Institute (TRI). You will have your surgery at one of three locations: TGH, TWH or PM. You may have your Pre-Admission Clinic visit at a different location than your surgery. This binder has general information to help you prepare for your surgery. We will also give you detailed information about your specific surgery and how to care for yourself afterwards. This may include extra brochures, pamphlets and guides. The healthcare team at UHN is committed to help you in every way we can at this difficult time. We will work very hard to get you back home to your family as soon as possible and, expect that you and your family and friends will work with us during your hospital stay. We believe that you and your family are partners in your care and your point of view is very important to us. We are committed to providing excellent patient care. Feel free to talk to us about your care and ask questions at any time. We have prepared this binder using a series of questions, but please ask your healthcare team if you have more questions. 1

6 Throughout this binder, you will find this symbol. This means that the information beside that symbol is important and is something you need to remember. As well, you may also see this symbol. This means that more video information for you can be found on our website - just click the Before and During my Surgery tab at the top of the page. To view these videos on your computer, you will need Windows 2000 OS (at minimum) and Flash Player 9.0 (an online guide will help you to download this player if needed). You may view the surgery binder website on your Smartphone. Please be aware that some Smartphones may have limitations (for example, iphones cannot play videos in Flash format). 2

7 Dear Patient: You are scheduled to have surgery at one of the University Health Network hospital sites in the near future. We realize that facing surgery is difficult for you, and that you need to organize a number of things in advance. We are planning that the surgery will take place at the scheduled time and we want to assure you that your doctors and nurses at University Health Network will do everything that they can do to make sure that your surgery is performed at the scheduled time. However, while we do our best to maintain the surgical schedule, sometimes things occur that are beyond our control, often at the last moment. For example, your surgery might be delayed or cancelled because another patient might require emergency surgery. We realize that this will cause you to be upset and inconvenienced, and we do apologize in advance should such a regrettable cancellation be necessary. Unfortunately, this situation is impossible to predict and if it does occur, we hope you will understand. In the unlikely event that your procedure must be postponed, we will contact you as soon as possible to reschedule it at the earliest date that is convenient for you and your family. Thank you for your understanding. Dr. Robert Bell President & C.E.O. Dr. Shaf Keshavjee Surgeon-in-Chief 3

8 Providing you with the right care, at the right time Dear Patient, At University Health Network, we are committed to providing you with the highest quality and safest health care to meet your needs. If you have to be admitted to the hospital, it is our job to make sure that you get a bed in the area of the hospital that best meets your care needs. To make sure that we can provide you with a bed in the right place as soon as possible, we may ask to place you in a room that is shared by both men and women. You may hear your health care provider call this a mixed gender room. The use of mixed gender rooms helps us reduce the amount of time you have to spend waiting for a bed and helps us to reduce the number of times that we might need to move you from one area to another while you are receiving care at University Health Network. If you are not comfortable receiving your care in a mixed gender room, please let us know. We will keep looking for a bed that best meets your needs but, this may mean that you will have to wait longer before we can move you to a more appropriate unit within the hospital. Regardless of where you receive your care at University Health Network, you will always be treated with dignity, compassion and respect and your privacy will be protected by every member of our health care team. Thank you, University Health Network, Toronto 4

9 Section A My Surgery Information that is right for you helps you make decisions about your health care. This section has specific information about your surgery. Your surgeon may give you a detailed picture of the procedure you will have. Please add it to this section of your binder. This section includes: Preparing for my surgery Important things to remember Keep any new information that your healthcare team gives you about your surgery.

10 M Y S U R G E RY Important Dates & Times to Remember Your surgeon s office will call you with your Pre-Admission Clinic appointment and surgery dates and times. My Pre-Admission Clinic Visit: Date: Time: Telephone number: Interpreter or American Sign Language (ASL) needed? Yes (Staff: please book) No Location of clinic: My Surgery Day: Date: Time: Time I need to be at hospital: Where I should go the day of my surgery: Telephone Number: Where I will go after my Surgery: Nursing Unit: Telephone number: Approximate length of stay in hospital: 6

11 Preparing for my Surgery What can I do to get ready for my surgery? It is important to be ready for your surgery, both physically and mentally. You need to take care of yourself. Here is how you can do that: Think positively! Stay active as much as you are able to. A balanced diet is important. Try to eat healthy foods before your surgery, if you can. Call your family doctor or surgeon if you have medical concerns. Remember: Tell your surgeon if you smoke or drink alcohol. Be honest about how much you smoke or drink because it can affect how you recover after your surgery. If you do smoke, try to quit. If you cannot quit, decrease the amount that you smoke. Smoking irritates your lungs, so smokers have more breathing problems after surgery. Ask your Pre-Admission Clinic team about smoking cessation programs. Remember: Tell your surgeon or your Anaesthetist if you are taking any drugs, blood thinners, herbal medicines or street drugs. Examples of blood thinners include Coumadin, (Warfarin), Aspirin or Plavix Continue to take all your usual medications unless your surgeon or Anaesthetist has told you otherwise. Planning to go home after your surgery Start now! It is important to plan early, even before your surgery day, for when you will leave the hospital (this is called being discharged ). By planning early for your return home, you will have all the help you need ready and waiting for you. This will help you feel less worried and anxious. How do I plan for when I leave the hospital after my surgery? Please do the following before coming to the hospital for your surgery: 1. You must arrange transportation to take you home from the hospital. 2. Arrange for someone to help you at home after your surgery. Depending on your surgery, you may need help for some time (at least 1 week, sometimes several weeks) with things like laundry, cleaning, cooking, and grocery shopping. 3. Arrange for someone to help you look after the people or pets in your care. You may also wish to plan this before coming to the hospital for surgery as well. 4. Plan your meals ahead of time. 5. Ask your surgeon when you can drive or work again and, when you can return to your usual activities like cleaning, exercise, or laundry. 7

12 How can I help the healthcare team plan for my return home? Talk to your healthcare team (surgeon, nurse or social worker) about your needs and worries. We will try to help with any concerns you have about going home. How can my family be involved in my care? Your family may be involved in these ways: Sharing information with your healthcare team that will help us meet your needs. Helping you and your healthcare team make decisions about your care. Coming with you when you have tests or clinic appointments in the hospital. Helping with your care at the hospital and at home. Your family can bring you food from home, but please check with your nurse or the dietician first. You may have special needs after surgery that your family should know about. Your family should take care of themselves. Your relatives may become very tired while you are in hospital. They should make sure they get some rest. Each floor has a visitor s lounge or waiting room. Where can my family and I stay near the hospital? The Pre-Admission Clinic, or one of our social workers, may have a list of hotels near the hospital. Some hotels offer a reduced rate for patients of the hospital and their families. You can also find this information at this website: - just click the My Surgery tab at the top of the page. Do not hesitate to make arrangements with family members or friends who may live in the Toronto area. Usually, they are happy to help out. You may also wish to call the UHN Social Work and Discharge Planning Office at , extension 5969 for more help. 8

13 When are visiting hours? We know that visitors are important for your recovery. University Health Network has a flexible visiting policy. Check with the nursing staff about the arrangements on your unit. Please know that only 2 people may visit you at one time. You also need your rest after your surgery, so some units have a daily rest period. Visitors are asked not to visit during those hours so that you can rest. Talk to the staff on the unit for more information. UHN cares about patient safety Protecting yourself, your family and friends from infectious illnesses when at our hospital We all have a role to play in helping to protect you, your family members, friends and other patients from serious infectious illnesses that can be spread in hospital. It is important to make sure that you and your visitors are feeling well before coming to the hospital. If you or your visitors are sick, you may make other patients or healthcare workers in the hospital sick. Self screening Before coming to the hospital, all patients and visitors need to check if they have had any of these symptoms in the past 24 hours: A new cough; or a cough that is getting worse? A fever (above 38 C or 100 F), or chills, or both? Diarrhea? Shortness of breath (worse than your usual)? Severe headache (worse than your usual)? Muscle aches? Extreme fatigue or feeling very tired? Vomiting (throwing up)? If you have any of these symptoms and you are having surgery soon, call your surgeon s office right away. Your surgeon will give you more instructions. If your visitors have any of these symptoms, they should let your nurse or unit receptionist know right away, or they should not come to the hospital to visit you. Your visitors can come to see you when they feel better. 9

14 Important Things To Remember My Surgery Please remember to make sure you and your family members are well before coming to the hospital. If you feel unwell before coming for your surgery, call your surgeon right away. We encourage your family to be with you and to help in your care. Ask for a list of hotels where your family members or friends may stay while you are in hospital or, log on to this website: - just click the My Surgery tab at the top of the page. UHN has flexible visiting hours. Please check with the nursing unit staff. Plan early for your return home. Arrange to have someone take you home after your surgery. Arrange for someone to help you once you return home. 10

15 Section B About the Hospital There are things you need to know about our hospital before you arrive for your surgery. This section will help you learn about our services and understand how we all work together to give you the best possible care. This section includes: Your healthcare team Your privacy and confidentiality while in the hospital Services available to you while in the hospital For more information about University Health Network (UHN), log on to

16 A B O U T T H E H O S P I TA L Your healthcare team at UHN The University Health Network is a teaching and research hospital linked with the University of Toronto. We use a team approach to care for you. What is a teaching hospital? A teaching hospital trains new doctors, nurses, and other health care professionals. We have healthcare students from across Canada and from around the world who work with your health care team under the guidance of qualified teachers UHN: A team approach to your care UHN uses a team approach to deliver health care. This means that you will be cared for by different medical professionals, rather than a single surgeon. This team may include: Doctors Staff surgeons, Anesthesiologists, Surgical fellows, Medical Residents,Clinical Associates and Medical students Nurses - Registered Nurses, Nurse Practitioners, Clinical Nurse Specialists, Nursing Coordinators and Nursing students Pharmacists Physiotherapists Respiratory Therapists Occupational Therapists Social workers Dieticians Technologists Patient Care Assistants Many other professionals Please feel free to speak to any member of your team, at any time, about your questions, worries or needs. Confidentiality at UHN 12 Keeping your personal information private At University Health Network, your health information is kept private and shared only with those professionals who are involved in your care, your next of kin or someone close to you who you agree may have your information, and public authorities or government agencies. We are committed to protect your information.

17 For more questions about your privacy at UHN, please call our Privacy Office at ext What services are available while I am in the hospital? Gift shops Pharmacy Bank machines Food court and Coffee shops Television and telephone services Wireless Internet UHN offers wireless Internet service, on a best effort basis, Monday to Friday from 9:00 a.m. to 5:00 p.m., excluding all statutory holidays. To log in, please ask a healthcare team member for the instructions and password. The television and telephone services are available for a fee. If you want a TV or telephone, please ask the unit staff for an order form or dial 4090 for automatic service. You can pay in cash, by cheque or credit card. There are 4 free TV channels available to you that offer health information and music. You do not need a cable subscription to watch these channels from your bedside TV. All video and educational programming have been carefully selected for you by the UHN Patient and Family Education Program. Channel 76 Hospital and health information Channel 78 Health information videos in English Channel 80 Health information videos in other languages Channel 82 Music for pain management Cellular telephones may be used in most waiting rooms, common areas and lobbies. However, in some special areas of the hospital, you cannot use your cell. Look around; if you see a blue sign that says, No cell phones, please, please move to another area to make your call. Semi-private and private rooms may be available at an extra cost per night unless you have insurance coverage. If you have semi-private coverage, you may upgrade to a private room by paying the difference in cost. Confirm your coverage with your insurance company before your admission. Some policies may have daily maximum coverage for semi-private and private rooms. 13

18 UHN Patient and Family Education Program Patient Education Patient & Family Libraries Our patients and families have the right to be active partners in their care and to feel informed about their health conditions. Our Patient and Family Libraries can help you to learn more about your surgery, how to care for yourself, and help you find other health information that may be useful for you. We have books, E-Books, videos, CDs and DVDs that you can borrow We have free brochures, audiobrochures, and pamphlets on many topics We can do an information search, just for you, on any health topic We can help you to access the Internet for reliable health information You can view videos or DVDs you can watch your surgery videos here We can help you find community services and discharge planning information You can find us on the Internet at: Princess Margaret Hospital Patient & Family Library Hours of service: Monday to Thursday: 9:00 a.m. 5:00 p.m. Location: Main Floor Atrium Phone: ext Friday: 9:00 a.m. 4:00 p.m. Toronto General Hospital Patient & Family Library Hours of service: Monday to Friday: 9:00 a.m. - 4:00 p.m. Location: Eaton Lobby, Ground Floor, Room 216 Phone: ext tgpen@uhn.ca Toronto Western Hospital Patient & Family Library Hours of service: Monday to Friday: 8:30 a.m. - 4:30 p.m. Location: West Wing, 1st floor, Room 421 Phone: ext twpfl@uhn.ca Sun Life Financial Patient and Family Resource Centre, University Centre, Toronto Rehabilitation Institute Location: 1st Floor, University Avenue entrance Opening: Spring Lyndhurst Centre Patient and Family Resource Centre Hours of service: Mondays, Wednesday, Fridays: 9:00 a.m. - 5:00 p.m. Tuesdays & Thursdays: 9:00 a.m. - 8:00 p.m. Location: 1st floor, Lyndhurst Centre Phone: ext. 267

19 Section C Before and During My Surgery Some people may or may not need to go to the Pre-Admission Clinic before their surgery. In either case, this section will help you understand how we will prepare you for your surgery. This section will also refer you to a link to our surgery patient education binder website at This website includes helpful videos for you to watch before and during your recovery. If you do not have computer or Internet access, just let your healthcare team know. Suggested videos that can help you recover from your surgery: 1. Deep breathing and coughing 2. Incentive spirometry 3. Pain management Part I and II 4. Leg Exercises 5. Planning your discharge home Part I and II These videos may also been viewed at our Patient Education Libraries (see page 14 for more information) This section includes: My Pre-Admission Clinic visit Helpful check lists for before my surgery Day of my surgery Important Things to Remember Keep any new information that your healthcare team gives you at this time.

20 B E F O R E A N D D U R I N G M Y S U R G E RY Pre-Admission Clinic Visit Your visit to the Pre-Admission Clinic is very important and is needed to prepare you for your surgery. This is a chance for you to ask any questions that you may have since the time you saw your surgeon. If you have questions, or you have to cancel your appointment, call the Pre- Admission Clinic office. TGH: TWH: You should come with a friend or family member. They may have questions that will help you to understand the information that you get at your Pre-Admission Clinic visit. If you are scheduled to visit the Pre-Admission Clinic before your surgery, you must attend this Pre-Admission appointment. If you do not come for your Pre-Admission visit, we cannot do your surgery. If you need to make other arrangements, please talk to your surgeon. What can I expect during my Pre-Admission Clinic visit? 1. You may be asked to come to the Pre-Admission Clinic at any of our two sites. Your visit may take anywhere from 2½ hours to up to 6 hours to complete, depending on your care needs. During the visit, a Registered Nurse will do an in-depth health assessment. Depending on your health history, you may also need other healthcare professionals to take part in your care. 2. You may have other tests which include: Blood work ECG (Electrocardiogram or a recording of your heartbeat) Chest X-ray Swabs for drug-resistant bacteria 16

21 We will screen you for: MRSA (Methicillin-resistant Staphylococcus aureus). Staphylococcus Aureus is a bacterium that is normally found in the skin and in the nose of healthy people. The bacteria have become resistant to several antibiotics used to treat infections, including Methicillin. When Staphyloccoccus Aureus becomes resistant to Methicillin, it is called Methicillin-resistant Staphylococcus aureus. To find out if you have MRSA, we will take swabs (wipe with a cotton-tipped applicator) of certain areas of your body and test them. We will swab you in the following areas: Nose Axilla (armpits) Groin Perineum (genital area) nose armpits groin and perineum We will let you know if you have a positive MRSA result. This may not happen until you return for your surgery, but this will not affect the date of your surgery. Once you are admitted to hospital, we may give you a special treatment to clear you of MRSA. Please ask your doctor or nurse for more information on MRSA or, log on to asp - just click the Before and During my Surgery tab at the top of the page, then click Infection Prevention and Control under the UHN Services section. 17

22 What else will happen in the Pre-Admission Clinic? The Pre-Admission Clinic staff will find out what kind of help you might need as you recover from surgery. We may also ask you to join a Pre-Admission education class or watch a video to help you prepare. We will talk to you about: Preparing to come to hospital Your surgery; we will also remind you of this date and time Your care and how you can help in your recovery Managing your pain and other symptoms Exercises and types of activities you must do after your surgery and after you leave the hospital Please log on to our video section of our website at UHNsurgerybinder.asp - just click the Before and During my Surgery tab at the top of the page. Try to watch the pre-operative videos listed there before your surgery day. The information in the videos will help you prepare for your recovery. Please practice any exercises shown in the videos. Plans for your discharge home Peri-operative Blood Conservation Program (PBCP) Blood management and preparing for surgery Blood management or blood conservation aims to reduce or avoid the need for a blood transfusion during or after your surgery. Your surgeon and the Blood Conservation team will assess your need for a transfusion. They may suggest the use of one, or a combination of treatments to improve your own blood supply before surgery. They may also, if needed, suggest other measures which might help to reduce the need for a blood transfusion during or after your surgery. If you have any questions about the UHN Peri-operative Blood Conservation Program, please call the Blood Conservation Coordinator: For patients at TGH or PM, call ext.6102 For patients at TWH, call ext.5164 You can also speak to a member of your healthcare team. 18

23 Your Medications and your Pre-Admission Clinic Visit It is important for your healthcare team to know about any medications you have been taking before your surgery. Please: 1. Bring ALL your medications in their original bottles, and a complete medication list to your Pre-Admission Clinic visit. You will want to include: Prescription medications, such as Antibiotics, Water pills (Lasix ) Non-prescription medications, such as Acetaminophen (Tylenol ), Aspirin Vitamins and minerals, such as Vitamin D, Calcium Herbal medications, such as St. John s Wort Supplements, such as Glucosamine, Coenzyme Q10 Don t forget: Eye or ear drops Inhalers or nasal sprays Medicated patches or creams Injectable medications (like Insulin) Medication samples from your doctor Any medications you have recently stopped taking 2. Tell your healthcare team about any allergies or reactions you have had to any medications, including any reactions to anesthetic medications, injectable contrast for scans, or latex. 3. Bring your pharmacy contact information (found on your pill bottles) and your family doctor contact information. 19

24 You should also know that: A doctor, nurse, or pharmacist will review your medications with you while you are at your Pre-Admission Clinic visit and, during your hospital stay. While at your Pre-Admission Clinic visit, you may get special instructions about stopping certain medications before your surgery. This will be written down for you so you will not forget. You may also get special instructions about which medication(s) you should bring with you to the hospital on the day of surgery. Is it possible that the date of my surgery will change? Yes. The Operating Rooms may be needed for life-threatening emergencies. We will tell you as soon as possible if your surgery is going to be postponed. You may already be at the hospital when this happens. Your surgery date or time might be changed for other reasons too. If your surgery is postponed to another day, your surgeon s office will call you with a new date. We will do everything we can to not change the date of your surgery. We thank you for your understanding and cooperation. Your Pre-Admission clinic visit offers a chance for you to ask any questions you may still have about your surgery. Please talk to the nurse about your questions and concerns. 20

25 My Check List #1 What should I bring to my Pre-Admission Clinic visit? This binder you can use it to remember the details of your surgery or keep new information given to you during your visit. Your health card and blue hospital card. Information on coverage from your extended health insurance plan such as policy numbers and identification numbers. Please tell us if you have private or semi-private coverage. Name and contact information for an emergency contact and your Power of Attorney for Personal Care (POA). All your medications in their original bottles, and a complete medication list. This includes prescription medications, non-prescription medications, herbal remedies and vitamins. You may want to label these and put them in a plastic bag. Name and contact number for your pharmacy. Your surgeon may request a letter from your family doctor about your general health. Make sure that you have enough time to make an appointment with your family doctor and get any tests done before he or she signs the form for your surgeon. All letters, reports, or notes given to you by your family doctor or specialist. All tests results given to you by your family doctor or specialist, such as cardiology reports, a cardiac stress test, Echocardiogram, ECG, CT or MRI scan, or a pulmonary function test etc. Name and contact information for your family doctor. Something to do if you need to wait (such as a book, knitting, a magazine). What should I do before my Pre-Admission Clinic visit? If you are known to have MRSA, VRE or C. difficile, please call the Pre- Admission Clinic before your scheduled appointment. This will help us to plan for your care during your surgery and hospital stay. If you have flu like symptoms, please call the Pre-Admission Clinic before your scheduled appointment. You can eat as you normally would before you come to the Clinic. Take all your medications as you normally would before you come to the Clinic. If you have any challenges or need extra help, please ask someone to come with you. Please tell us if there are changes to the information on your health card or hospital card at the time of your Pre-Admission Clinic visit (For example, change of name or address, or a new telephone number). If you have questions or you have to cancel your Pre-Admission Clinic appointment, call the Pre-Admission office (see page 25). 21

26 My Check List #2 What instructions do I follow before my surgery? When to get to the hospital Please come to the hospital about 2 hours before your scheduled surgery time. For example, if your surgery is scheduled at 8:00 a.m., you will need to be at the hospital at 6:00 a.m. Or arrive at the time told to you by your surgeon. Eating and Drinking Do not eat solid foods after midnight (12:00 a.m.) the night before your surgery You may drink clear fluids up to 5 hours before your time of surgery, unless told otherwise Clear fluids include clear, non-alcoholic beverages such as any juice without pulp, broth, tea or coffee without milk, ginger ale, Jello Other instructions Do not smoke or drink alcohol for 24 hours before your surgery day. Do not use any recreational drugs (such as pot, or crack ) for 3 days before your surgery. If you have been told by the Anaesthetist, Registered Nurse or Pharmacist to take a medicine on the morning of surgery, take it at home with a sip of water. Remove all nail polish, acrylic nails, jewellery, contact lenses and body piercings at home before surgery. Brush your teeth or rinse out your mouth, but do not swallow any water. Shower and shampoo your hair on the night before your surgery. Do not use lotions, moisturizers, or make-up on the day of your surgery. UHN is a scent-free hospital. Do not wear perfumes, colognes or other scented products. Follow all special instructions and preparations explained to you during your Pre- Admission Clinic visit. Your surgery could be cancelled if you do not follow the instructions. Please call your surgeon if you have questions. What should I do if I do not feel well? Call your surgeon s office as soon as possible if there is a change in your health before your surgery (such as a cold or a fever). 22 Need help? Automated Surgery Helpline Toronto Western Hospital: Call For Toronto General Hospital or Princess Margaret patients: Call your surgeon s office

27 My Check List #3 What should I bring to the hospital on the day of my surgery? You should bring these items in one small bag with your name on it: This binder you can use it to remember the details of your surgery or keep new information given to you during your hospital stay. Toiletries (for example, toothbrush, toothpaste, comb, brush, soap, shampoo, shaving kit, etc.) Tissues. Lip and skin moisturizer (the air in the hospital is dry). A housecoat that opens all the way down the front. Socks and comfortable shoes with rubber, non-skid soles (such as running shoes). Hearing aids, dentures and eyeglasses in their protective cases (all labeled with your name and phone number). Any walking aids, such as canes or walkers (all labeled with your name and phone number). Your blue hospital identification card, your Ontario Health Card, and your health benefits card and drug plan card, if you have one. On your visit to the Pre-Admission Clinic, you may have been told to bring in certain medication(s). Please bring only these medications with you in their original bottles. If you have started any new medications since your Pre-Admission Clinic visit, please bring these to the hospital. If there have been any changes in how you take any of your medications, please let the pharmacist, nurse or doctor know when you are admitted to the hospital. If your Pre-Admission assessment was done by phone and not in the Clinic, please bring in all of your medications in their original bottles. Other suggestions: A telephone calling card, if you want to use the pay phone. A small amount of cash to cover the cost of TV and phone rental, newspapers,coffee shop, etc. Something to read Do not bring: Valuables, such as watches or jewelry Many pieces of identification or credit cards Large pieces of electrical equipment, like a TV Large amounts of cash If you wish to bring your laptop computer or mobile device, UHN offers wireless Internet service on a best effort basis, Monday to Friday from 9:00 a.m. to 5:00 p.m. excluding all statutory holidays. Please note UHN is not responsible for any lost or stolen valuables. 23

28 Your Money and Valuables The hospital does not assume responsibility for patient money or valuables. Patients choosing to bring them into the hospital do so at their own risk. We know that patients will have personal items such as clothing, medications, and personal support aids with them (for example, eyeglasses, contact lenses, dentures, hearing aids, mobility aids such as a cane, walker, prostheses or wheelchair, etc.), but, the hospital will not assume responsibility for these items if they are damaged or go missing. Patients are given a copy of our valuables form at the time of admission. For more information or to download a copy of this binder, please log on to 24

29 Important Things To Remember If you do not come for your Pre-Admission Clinic visit, your surgery will be cancelled unless other arrangements have been made. Please tell us if there are changes to the information on your health card or hospital card during your Pre-Admission Clinic visit (for example, change of name or address, or a new telephone number). Also please call the Admitting Department at: PMH: Call your surgeon. TGH: TWH: Call your surgeon. If you have questions or have to cancel your appointment, call the Pre-Admission Clinic office. TGH: TWH: If an emergency does happen, the time or date of your surgery may be changed. If there is a change in your health before your surgery (for example, a cold or a fever), tell your surgeon as soon as possible. Please do not bring money or valuables into the hospital. The hospital is not responsible for patient money or valuables. Patients choosing to bring them into the hospital do so at their own risk. Cell phones may be used in most waiting rooms, common areas and lobbies. In some special areas, there will be signs that will tell you where you cannot use your phone. 25

30 The Day of My Surgery When is my surgery? Your surgeon s office will tell you the date of your surgery and the time you should arrive at the hospital. If there are any changes to the date or time, your surgeon s office will call you. Make sure your surgeon s office has the correct phone number for where you will be staying the day before surgery. Where do I go to check in on the day of my surgery? Please go to the Pre-Operative Care Unit (POCU) on the day of your surgery Toronto General Hospital POCU Take the west elevators to the 2nd Floor Toronto Western Hospital POCU Take the Fell or burgundy elevators to 2nd Floor Princess Margaret please go to 18B Surgical Admission Unit What will happen when you arrive in the Pre-Operative Care Unit (POCU)? 1. The ward clerk will check you in. 2. Your nurse will double check your chart information. 3. You will change into a hospital gown, removing your underwear, bra (if needed) and socks. 4. Depending on what type of surgery you are having, we may clip your body hair in the area of your surgery. Do not shave or clip your body hair at home as this can increase the risk of infection. If needed, some of your body hair will be removed in the hospital just before your procedure. 5. The nurse may ask you to go to the bathroom to empty your bladder. In the POCU, your nurse and members of your surgical team will review your health information. An intravenous (IV) may be started in your arm and, you may be given medicine to help you relax. You will be taken to the Operating Room from here. What will happen in the Operating Room? 1. You will be helped onto the Operating Room table and kept warm with a blanket. 2. You will have a blood pressure cuff put on your arm and an oxygen monitor will be placed on your finger. 26

31 3. Your heartbeat will be registered on a heart monitor. A plastic mask will be placed over your face to give you oxygen. 4. There are different types of anesthesia available. The type that is best for you will depend on your surgery. All of the options will be discussed with you during your Pre-Admission Clinic visit. When you meet your anesthetist on the morning of your surgery, both of you, together, will talk about the appropriate anesthetic options again, based on your current health status. You will be given medicine through an intravenous line. This will make you go to sleep. Once you are asleep, and depending on your surgery, a breathing tube will be inserted into your mouth if general anesthesia is chosen for your procedure If you are having regional anesthesia, instead of general anaesthesic and no breathing tube is needed, you will only be given oxygen and intravenous drugs to make you sleepy and comfortable. For more information about regional anesthesia instead of general anesthetic, please log on to and click on Before and During my Surgery. You can also click on List of Topics on the upper right side of the page, then Anesthesia. The Operating Room - a team approach to ensure your safety Our Mission The UHN Operating Room team wants to give you and your family the best possible care before, during and after your surgery. We want to make your experience positive by making sure you are safe at all times. We know that the thought of having surgery in our Operating Room may seem both mysterious and frightening for you. It may be very hard for you to know that while you are having surgery, you cannot participate in your care. This information will help you and your 27

32 family members understand what happens in the Operating Room, how the staff stay with you and keep you safe during your surgery, and to answer some common questions to lessen your concerns about the time you will spend with us. Who will be part of my Operating Room team? While you are in our care, a team consisting of surgeons, nurses, anesthesiologists, respiratory therapists, evoked potential technologist, perfusionist and support staff will be working together to provide you with safe care and to make sure you come out of your surgery with the best possible outcome. What will happen before my surgery starts? On the day of your surgery, a member of our team will take you to the Operating Room holding area. A nurse will meet you and review important information about you. You will be given a warm blanket and a soft hat. You will need to place all your hair inside this hat. A member of your family can stay with you in the holding area while you wait to go into the Operating Room. How will the Operating Room team keep me safe while I have my surgery? Your safety is very important while in the Operating Room. You will be closely monitored during your entire surgery. The Operating Room will be cold, bright, with alarms that may or may not make sounds. These safety alarms help staff work and keep you safe. What are some of the important safety checks the team will use to keep me safe during my surgery? There are a few important safety checks that the Operating Room team does to make sure that you receive the best possible care. 1. We make sure all the instruments have been sterilized. All the instruments that will be used for your surgery will be very carefully washed and sterilized using special sanitizers. They cannot be used for your operation until we are confident that they are sterile. 28

33 2. We position your body properly while you are having surgery. When you enter into the Operating Room, you will be helped onto a hard, narrow bed and a safety strap will be placed around your waist. This is to make sure that you do not fall off the bed while you are asleep. While you are lying on the Operating Room bed, we will put pads and cushions under your bony areas (elbows, ankles), to help prevent skin breakdown, pain and discomfort during your surgery. We will support all parts of your body when you are on the table and keep you warm during your time in the Operating Room. 3. We keep track of all the instruments we use by doing a Surgical Count. We use many different tools and items for your operation. To keep track of these, any sponges, small items and instruments that are used will be counted before and after your surgery. If there is an incorrect count at the end of your surgery, an X-Ray of your surgical site will be taken in the Operating Room and read by the surgeon to make sure we have all the items we started with. The Operating Room team also uses a safety checklist to help me stay safe. What is on this list? 1. We make sure that we have Correct patient and the Correct site Before your surgery, your surgeon will verify with you the site where the operation will occur and will initial the site. You will not be taken into the Operating Room until the site on your body is marked. We will also make sure that you have an armband on with your name, allergies and other important information about you. We will check this armband before you enter the Operation Room. If you are having a regional block before your surgery, you should know that the site where the block will be done will be marked by the anesthesia doctor before the procedure. You will be taken to a different room to do the regional block. You will be given something to make you relax while the anesthesia team is doing the procedure. After the regional block is done, your surgeon will come to the procedure room and verify with you the site where your surgery will occur and mark the site. When the team is ready for you, you will be taken to the Operating Room where your surgery will be done. 29

34 2. We use a Briefing session to go over your information Before your surgery begins, all important information about you will be reviewed by the team out loud. This is to make sure that the Operating Room team understands and agrees with what is going to be done. This is also your chance to review what will be done. Before the surgeon starts your surgery, we will talk about the important steps in your surgery, as well as your medications, your allergies and any special needs you may have during your surgery. 3. We use a Time out While you are asleep and before your operation begins, the team in the Operating Room will pause and review that you are the right patient. The side of your body and site of your surgery will be talked about out loud and everyone will agree that this is what will be done. 4. We Debrief when your surgery is over. Before you leave the Operating Room, we will talk about what happened during your surgery. We will make sure of where you are to go (such as the Recovery Room) and make absolutely certain that all instruments, sponges and small items have been counted and taken care of. We will also review all specimens taken during the operation. Who can I contact if I have questions? Keeping you safe while you are having your surgery is very important to our team. We hope this information helps you to feel less worried about your time in the Operating Room. If you have any questions about your surgery, please call your surgeon. Where can my family wait while I am in surgery? Your family may wait in the surgical waiting area. Surgical Waiting Room Locations: Princess Margaret Hospital Main lobby Toronto General Hospital - Take the west elevators to the 3rd floor Toronto Western Hospital - Take the Fell elevators to the 2nd floor 30

35 In some areas, your family should introduce themselves to the volunteers in the Surgical Waiting area. The volunteers will tell your surgeon, or a member of your healthcare team where your family is waiting. Your surgeon or a member of your healthcare team will speak to your family at the end of your surgery. If your family is not waiting in the hospital, tell the receptionist at check in where they may be reached. Depending on the length of your surgery, the nurse or surgeon may call your family to tell them how your surgery is going and, when it will likely be finished. In some cases, a pager may be given to your family at check in so that they can leave the waiting area, but may be called when your surgery is done. Family and friends are not allowed in the Operating Room or the Post Anaesthetic Care Unit where you will be taken after your surgery. Where should my family and friends call for information about my condition after my surgery? Choose one (1) person to call the hospital to find out how you are doing. This person can pass on the information to your family and friends. You will be asked for the name of this person, their contact information (telephone number) and the type of information that you would be comfortable with them knowing. We will write this information down in your chart. For more information or to download a copy of this binder, please log on to 31

36 Important Things To Remember Before & During My Surgery Your surgeon s office will tell you the date of your surgery and the time you should arrive at the hospital (see page 6 of this binder). You must arrive 2 hours before your surgery OR at the time given to you by your surgeon. On your day of surgery, go to the Pre-Operative Care Unit (POCU) (see page 6 and 26 in this binder). Family and friends are not allowed in the Operating Room or the Post-Anesthetic Care Unit (PACU) where you will be taken after your surgery. They may ask the waiting room volunteers to call for information or, a member of the Operating Room or PACU team may come out to speak to them about your progress. Choose one (1) person to call the hospital to find out how you are doing. This person can pass on the information to your family and friends. 32

37 Section D After My Surgery You have now had your surgery. Here is some more information to help you take part in your care while in hospital. This section includes: What will happen after my surgery? My recovery in hospital My medications Taking care of myself a. Managing my pain b. Exercises and activity after my surgery c. Other things I can do d. Caring for my incision e. Taking care of my skin and preventing pressure ulcers f. Rest and sleep Important things to remember Keep any new information that your healthcare team gives you during your recovery period.

38 A F T E R M Y S U R G E RY What will happen after my Surgery? After your surgery, you will be taken to the Post Anaesthetic Care Unit (PACU). It is also known as the Recovery Room. You will be in a room with other patients and the room may be busy and, at times, noisy. Your nurse will check your pulse and blood pressure often. You may have an oxygen mask that will cover your nose and mouth, and the nurse may tell you to do deep breathing and coughing exercises. The nurse will call you by your first name as you wake up. Everyone experiences pain and discomfort differently after surgery. It is important to tell your nurse if you are having pain. Please see page 36 of this binder for more information on how we will help you manage your pain and how you can also help yourself. You may stay in the PACU for several hours or overnight, depending on the care you need. The time that you need to stay in the PACU will depend on your health and, your recovery from anaesthetic. When your condition is stable, you will be taken to the nursing unit. You will be taken to the Post Anaesthetic Care Unit (PACU) for close monitoring after your surgery. Family and friends will not be allowed to visit. A member of the Operating Room team will update your family. My Recovery in the Hospital What will happen after my transfer to the in-patient nursing unit? While you are on the nursing unit, a team of healthcare professionals will look you after. You may see different team members depending on your needs. 34

39 Your opinion is very important to us. We want you to be as comfortable as possible Please talk to a member of your healthcare team about your plan of care each day, or about any questions or concerns you may have. What will I be given to eat and drink? If needed, you will have an intravenous (IV) line in your hand or arm. This is to give you fluids and medications until you are drinking well. 1. A liquid diet will be started as soon as your nurse assesses you. 2. Depending on the results of your assessment, you may be given solid food to eat. 3. Some patients may need a special diet or a feeding tube after surgery. If you need either of these, your healthcare team will talk to you about this. If right for you, the University Health Network (UHN) Nutrition Services team will provide you with complete meals that will meet your medical and food allergy needs. However, we know that we are not always able to meet the personal choices of all our patients. We understand that a familiar food brought from home may give you comfort during your hospital stay. Before bringing food from home, talk with your Nurse or Dietitian first about the kinds of foods that you will be able to have after your surgery. How will my recovery be monitored? A member of your healthcare team will see you every day. If at any time you want to speak with your surgeon or another member of the healthcare team, ask your nurse to call them as soon as they are available. The healthcare team will tell you how you are doing and answer your questions. Your vital signs (heart rate, blood pressure, temperature, breathing rate and pain score) will be checked throughout your hospital stay. Blood tests, diagnostics tests (CT, MRI, X-rays, and ultrasounds) may be done from time to time after your surgery. You may need daily blood tests to monitor a special condition (such as blood sugar levels). 35