Palomar Medical Center | Pomerado Hospital

Palomar Health Downtown Campus

Preparing for Your Surgery

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WelcomeAs you get ready for surgery, you may have a lot of questions. This booklet will help you know what to expect before, during and after surgery.

You and your family are the most important members of your health care team. Do not be afraid to speak up and take an active role in your care. We encourage you to ask questions and learn all that you can about your surgery and recovery.

We look forward to caring for you.

Thank you for trusting your care to Palomar Health.

What’s in This Booklet ■ Page 3 Getting Ready for Surgery

■ Page 3 Insurance Information

■ Page 4 Day of Surgery

■ Page 6 Anesthesia Care

■ Page 7 Types of Anesthesia

■ Page 8-9 Surgery & Recovery

■ Page 10-12 Parking & Your Arrival

■ Page 13 Going Home

■ Page 14 Comments

■ Page 15 Pre-Surgery/Procedure Patient Checklist

■ Page 16 Notes

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Getting Ready for Surgery

Pre-Admission InterviewSeveral days before your surgery, you will be interviewed by a registered nurse from our assessment team. This is a confidential health history interview to identify specific things about you that help us plan ahead for your care. Please be prepared to tell us about your current medications, health conditions, allergies and other important health information. Our registered nurse will answer your questions and review any special instructions with you. For example, you may be asked to have diagnostic testing done, such as an EKG, blood draw, or X-ray before the surgery. Be sure to ask about taking any of your current medications before surgery.

Lower Your Risk for Infection ■ Before your surgery/procedure, shower 3 times using a 4% chlorahexidine gluconate wash (“Hibiclens”)

available at most drug stores. Skin bacteria are the most common cause of post-operative surgical wound infections. These showers should be taken within 48 hours of your scheduled surgery/procedure. Follow the product label instructions. Use clean towels to dry.

■ Do not shave around your surgical area for at least two days prior to your surgery/procedure. Shaving will cause tiny nicks and cuts that increase your risk of infection.

■ Stop smoking at least 2 weeks prior to your surgery/procedure. Smoking constricts your blood vessels and makes normal healing more difficult.

■ Stay warm. Make sure you are warm when you come in for your surgery/procedure. Maintaining a warm body temperature lowers your chance for infection.

■ If you have diabetes, keep your blood sugar below 200mg/dl. High blood sugar increases your risk for infection.

Insurance InformationSeveral days before your surgery you will receive a call from a member of our pre-arrival financial clearance team.

Your medical insurance may require that you pay a co-payment or deductible for this surgery/procedure. The amount depends on your insurance plan. Please plan to make this payment at the time your surgery/procedure is done. If you have questions regarding a co-payment or need financial assistance, please call Palomar Health Patient Financial Services at: 760.739.3309.

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Day of Surgery

Preparing at Home ■ Do not eat or drink anything except clear liquids after midnight the night before your surgery (clear

liquids include water, black coffee (no creamer), tea, apple juice, clear soda and other non-red juices you can see through).

■ Leave valuables at home. (Do not bring large amounts of money, jewelry or valuables such as cell phones and laptops to the hospital. The staff cannot be held responsible for your valuables.)

■ Do not drink any liquids four hours before you arrive for surgery.

■ Caregivers of pediatric and infant patients should ask their doctor for specific eating and drinking instructions.

■ Wear loose, comfortable clothing.

■ Do not wear make-up, nail polish, contact lenses, watches or jewelry.

■ Take medications ONLY as instructed by your doctor or pre-admission nurse the day of your surgery.

What to Bring ■ Insurance and prescription cards

■ A list of medications, including name, dose and how often you take each one

■ Inhalers (if needed)

■ Eye drops (if needed)

■ Financial payment, if required by your insurance provider.

■ If you are being admitted to the hospital following your surgery, bring personal hygiene items like a toothbrush and hair brush

■ A copy of your Advance Directive (if available)

■ A case to hold items such as dentures or glasses

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Arrival TimeWhen you arrive, please proceed to Registration to begin your check-in process. It is important to arrive two hours before your scheduled surgery time in order to complete the following items prior to your surgery:

■ Registration paperwork

■ Preparation for surgery with your admitting nurse

■ Meeting with your anesthesiologist

Preparing You for SurgeryAfter registration, you will be escorted to the surgical area where you will be prepared for surgery and the following will occur:

■ Taking your blood pressure, pulse and temperature

■ Clipping of any hair in the area of your surgery

■ Starting an IV (intravenous) in your arm or hand to be used for medicine and /or fluids during and after surgery

Your family and friends may be able to join you in the surgical area while you are being prepared for surgery. During surgery, they may relax in the Surgery Waiting Area.

For Your SafetyYou will be asked to sign a consent form confirming that you understand and agree to the surgery/procedure you are going to have. Before you sign, make sure you verify that your name, your doctor’s name and the surgery/procedure being performed are correct. If there is anything you don’t understand, or if you have any questions, please ask us.

Expect that we will ask your name and date of birth several times. Don’t be alarmed. This is done for your safety. It ensures that everyone knows we have the correct patient for the correct surgery/procedure. Your doctor may place a mark on your body where the surgery/procedure is to be done.

Tell the anesthesiologist about all of your medications and supplements/vitamins you are taking. Talk about any medical conditions you may have, including diabetes or high blood sugar. Let the anesthesiologist know about any past experiences you may have had with anesthesia.

Surgery Schedule Time ChangesWe do everything we can to assure schedule changes are not made, but time changes may occur. If we need to change the start time of your surgery/procedure, you will be notified of the most updated schedule as soon as we know that your scheduled time has changed.

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Anesthesia CareBecause your safety is our primary concern at Palomar Health, we are proud to provide our patients an all-physician anesthesia team. These members of Anesthesia Consultants of California Medical Group (ACCMG) are all highly trained, Board Certified (or eligible) specialists.

These highly-trained doctors will take charge of your safety and comfort before, during and immediately after your procedure. They will stay with you throughout your surgery, keeping a close eye on your vital body functions while giving you medications to relax you, block pain and/or make you unconscious for your surgery.

You will meet your anesthesia doctor shortly before your surgery for an examination and to review your medical history, allergies, current medications, surgical history and previous experience with anesthesia.

The best anesthesia for you will depend on your past and current health, your test results and the type of surgery/procedure you are having. Your anesthesia doctor will discuss your options, including the benefits and possible risks or side effects.

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Types of Anesthesia

General AnesthesiaYou will be completely unconscious (deeply asleep), have no sensation of pain and be unaware of surgery.

Regional AnesthesiaAn injection of medication will block the nerves to a part of your body depending on where your surgery will be. This may be done for surgical anesthesia and/or to treat after-surgery pain. Epidural or spinal blocks numb the abdomen and lower body. Other nerve blocks may be done to numb only certain nerves in the arms or legs. With regional anesthesia, IV medications are given to relax you and blur your memory. Sometimes regional anesthesia is combined with general anesthesia.

Monitored Anesthesia Care (MAC)IV medication is given to you to keep you relaxed and sleepy. Your surgeon will inject numbing medication in the area of surgery so you will not feel pain. Your memory will be blurred by the IV sedation so you may not remember the procedure.

Local AnesthesiaThis is used for minor procedures. Numbing medicine is injected by the surgeon at the surgery site. An anesthesia doctor is usually not present for these procedures.

Post Anesthesia Care Unit (PACU)You will be transferred to a recovery area after your procedure. Your anesthesiologist will ensure your well-being and then hand over your care to a highly-trained post-anesthesia care unit (PACU) nurse. This nurse will treat any discomfort that you might have and watch over your health while you are recovering from anesthesia.

We apologize but we are not able to allow visitors into the recovery area. We want you to be with your family and friends as soon as possible but we have two major concerns that prevent you from having visitors. The first concern is for your safety. Our recovery nurses need to intensely focus on you and your health monitoring systems. Even the minor distraction of visitors could affect your health. The second concern has to do with patient privacy. The recovery period can be a difficult transition. Most patients have expressed a strong belief that they are not comfortable with other patient’s visitors seeing them during this sensitive time.

Your family and friends will be able to speak with the surgeon immediately after the procedure and they can get periodic updates on your PACU status through our patient liaisons. They will be able to join you in the prep area if you are heading home or in your room if you be staying overnight. The PACU process usually takes between 1 and 2 hours.

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Surgery and Recovery

If You Are Staying in the Hospital After Your Surgery ■ You will be brought to your hospital room on a bed or in a wheelchair.

■ You can expect your nurse to check on you regularly.

■ You may not be able to drink or eat right away.

■ Your nurse will help you order room service when you are ready to eat and drink again.

Pain ManagementRemember that all pain is real. There are many ways to control pain. Ask for medication to control pain when you need it. Don’t try to “tough it out” as this can make you feel worse.

Follow these medication tips to help control your pain following surgery:

■ Take your medication as ordered.

■ Take your medication 30 to 40 minutes before you get up, move around or go to therapy.

■ Ask about possible side effects.

■ Tell your nurse, anesthesiologist or doctor if the pain does not improve.

■ Know that it is rare to become addicted to the pain medication used in surgery.

■ Know that medication will reduce but not take away all of your pain.

We recognize that pain is an individual experience and not all regimes and plans suit everybody. Your pain will be assessed at regular intervals.

During your recovery, your nurse will ask you to rate your pain using this pain management scale.

0No Hurt

1 - 2Hurts Little

Bit

3 - 4Hurts Little

More

5 - 6Hurts Even

More

7 - 8Hurts Whole

Lot

9 - 10Hurts Worst

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Your Role in Recovery ■ Do not try to get out of bed alone. Your nurse will help you when you first try to walk, as you might

be at risk for falling. You may also have compression devices on your legs which prevent blood clots.

■ You may have monitoring equipment that you may continue to wear during your hospital stay.

■ As soon as directed by your doctor, your role is to do mild physical activity, while still giving yourself time to heal. Rest when you feel tired.

■ Cough and breathe deeply. This helps to clear and expand your lungs and can prevent pneumonia. You may be given a spirometer to practice deep breathing. Your nurse will show you how to use the spirometer.

■ We will ask you to rate your pain on a scale of zero to 10. It is your responsibility to tell your doctor or nurse where and how much you hurt so your pain can be treated. Actively managing your pain lets you move in comfort.

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Palomar Medical Center – Parking and Arrival 2185 Citracado Parkway Escondido, CA 92029 442.281.5000

Where do I park? On the day of surgery, please arrive at Palomar Medical Center 2 hours before your scheduled surgery time. Valet Parking is available at the main entrance or you can park in any available space near the hospital.

Where do I go once I arrive? Once you have parked, follow the signs toward the hospital’s main entrance. Registration is located on the 1st level. You will be checked in for surgery and escorted to the Family Waiting room on the 2nd level.

Where can my loved ones wait? There is a comfortable Family Waiting room located on the 2nd level.

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Palomar Health Downtown Campus – Parking and Arrival555 East Valley Parkway Escondido, CA 92025 760.739.3000

Where do I park? On the day of surgery, please arrive at Palomar Health Downtown Campus 90 minutes before your scheduled surgery time. Parking is available in the adjacent garage.

Where do I go once I arrive? Once you have parked, go to the main lobby. Directly beyond the lobby, you will see the Registration office. You will be checked in for your surgery and taken to the surgery area on the 4th floor.

Where can my loved ones wait? There is a comfortable waiting room located in the lobby and on the 4th floor.

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Pomerado Hospital – Parking and Arrival 15615 Pomerado Road Poway, CA 92064 858.613.4000

Where do I park?On the day of surgery, please arrive at Pomerado Hospital 2 hours before your scheduled surgery time. Parking is available at the main entrance or in our main parking garage located behind Pomerado Outpatient Pavilion.

Where do I go once I arrive? Once you have parked, follow the signs to the hospital and go to Registration which is located on the 2nd floor. You will be checked in for surgery and escorted to the Family Waiting room on the 2nd floor.

Where can my loved ones wait? There is a comfortable Family Waiting room located across from the main Registration area on the 2nd floor.

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Going HomeBefore you go home, you will be given discharge instructions. Ask a family member or friend to listen to these instructions with you and plan to have someone stay with you for at least 24 hours after your procedure. That way, he or she can help you during recovery.

Things you should askBefore you leave, make sure all your questions are answered. Your discharge instructions may answer most of your questions. If you have additional questions after arriving home, call your physician’s office. The telephone number will be listed on your discharge instructions. Be sure to ask about the following:

■ Bathing and showering

■ Diet – what to eat, what to avoid

■ Driving

■ Incision and dressing care

■ Medications – dosages and when to take

■ Pain control – what to expect, what to do

■ Physical activity

■ Physical and occupational therapy

■ Resuming sexual relations

■ Returning to work

■ Signs of infection

A follow-up visit will need to be scheduled with your surgeon. Information on this will be listed on your discharge instructions. Bring a list of your questions or concerns to this visit.

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Your Comments Are Important To UsFollowing your visit with us, you may receive a survey asking about your experience with Palomar Health. We value your feedback and look forward to receiving your response.

If you have an experience you would like to share with us about your visit to Palomar Health, please contact us directly by calling 760.740.6345 or emailing ContactUs@PalomarHealth.org.

It is our privilege to serve you.

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Pre-Surgery/Procedure Patient ChecklistPreparation is extremely important to assure your best outcome. At this time, you want to prepare yourself physically and emotionally for a successful surgery/procedure. Please go over this list the day before your surgery/procedure.

q Do not eat or drink anything except clear liquids after midnight the night before your surgery/procedure. You may have clear liquids until 4 hours before your arrival time.

q You may brush your teeth and rinse your mouth the day of your surgery/procedure.

q Take your medications as instructed by your doctor or pre-admission nurse. Bring any inhalers with you and your C-PAP machine if you use one.

q Bring a current list of your medications including the dosage and times you take them.

q Complete any paperwork your doctor gave you and bring it with you, for example the Health History Questionnaire.

q Bring your health insurance card, photo identification and co-payment.

q Leave all valuables such as jewelry, watch, purse or cash at home.

q Bring a case for your eyeglasses or contact lenses, hearing aids or dentures.

q Wear comfortable clothing that will be easy for you to put back on after your surgery/procedure. Avoid buttons and snaps if possible.

q If you have a heart defibrillator or an AICD, please let the pre-admission nurse know in advance.

q Please have a responsible adult available to accompany/drive you home and stay with you at home after your surgery/procedure.

q If you feel sick, call your doctor immediately for instructions.

If you have any questions please call us at the facility where you will be having your surgery/procedure:

Palomar Medical Center Pre-Admissions 442.281.1800

Pomerado Hospital Pre-Admissions 858.613.6171

Palomar Health Downtown Campus Pre-Admissions 760.739.2775

Thank you for choosing Palomar Health for your health-care needs. We wish you well and hope you have a speedy recovery.

Questions/Notes: