Routine tests

These tests are routine investigations. They are NOT the whole plan! (see below)

FBP

U&E - must include K+ and Mg++

              Liver profile

CXR

ECG

Coagulation screen

Xmatch

Plan

Not all patients will need all the following investigations. Some will already have been done. In that case the results and films will need to be obtained.

Treat the main condition

Surgery planned (which list?).

It might sound obvious but, on a surgical ward, surgery is the main feature of the plan. Writing down the planned surgery will focus your mind on what investigations need to be requested and what orders are to be written.

Trauma patients

Oxygenation

Pain relief

Secretion management

Chest drains

Palliative patients

What procedure?

What support services?

What discharge arrangements?

What resuscitation?

Surgical/Anaesthetic requirements

Theatre List

Is the patient booked for theatre? If not, why not?

Stop Aspirin

Stop Plavix (if coronary stents present check with cardiology)

Change Warfarin to Heparin if it cannot be stopped

Hold oral medication for surgical patients, write up IM/IV alternatives.

IV fluids

Fasting

1. •All patients to fast from 12 midnight before anaesthetic.
   

2. •For patient whose oral intake has been poor and for those on the afternoon lists IV fluids should be erected.
   

Treat co-morbidity

CKMB/troponin if indicated

Cultures e.g. sputum

Continue cardiac medications (do NOT stop B Blockers)

Diabetics

1. •Put first on list
   

2. •Inform anaesthetist
   

3. •Consult metabolic registrar
   

4. •sliding scale Insulin,
   

5. •Dextrose IV if fasting
   

Predict and prepare for complications

Thrombo-prophylaxis

Start Clexane (not for pleurectomy)

TED stockings and SCD compression device will be provided by the nursing staff

Sputum retention/pulmonary

Change bronchodilators to nebulised preparations

Start all smokers and others at risk of respiratory complications on nebulised bronchodilators

Extra physio/rehab if necessary

Are preop antibiotics needed for chest infection?

Arrhythmias

Correct K+ and Mg++

May need B blockers etc.

Specific to the working diagnoses

Cancer patients

Histology/Cytology – usually we will not be operating if there is no confirmation of diagnosis. Has it been obtained elsewhere: do we need to obtain tissue? e.g.sputum cytology, FNA bronchial washings

MacMillan/Palliative care consult

Oesophageal

Malignant

CT scan

Ultrasound abdo

PET scan

Benign

pH study

Manometry

Barium swallow

If dysphagia - change to clear liquid diet

Complete dysphagia – nil by mouth, IV fluids, ?TPN

Lung/mediastinal

CXR

CT scan

PET scan

PFT’s

CPEST (cardiopulmonary exercise stress test)

Ventilation perfusion lung scan

Other Investigations suggested by differential diagnoses

Discharge planning

Discharge planning should start when the patient is admitted (if not already started at pre-assessment clinic!)

Who is at home?

Will extra home services be needed?

Will they need convalescent care?

Will patient be transferred back to peripheral hospital?

Admission checklist.pdf

Admission checklist.doc