Preoperative assessment

Preoperative assessment – Core Learning Outcomes

  • To perform a structured preoperative anaesthetic assessment of a patient prior to surgery and recognise when further assessment/optimisation is required
  • To explain options and risks of routine anaesthesia to patients, in a way they understand, and obtain their consent for anaesthesia
  • To formulate a plan for the management of common co-existing diseases, in particular the perioperative plan for the patient with diabetes

History Taking: Knowledge

  • PA_BHK_01 History Taking – Lists the important elements of anaesthetic history taking
  • PA_BHK_02 Recognises that patients do not always present history in a structured fashion
  • PA_BHK_03 Lists the likely causes and risk factors for conditions relevant to mode of presentation
  • PA_BHK_04 Uses the patient’s agenda and history to inform examination, investigation and management

History Taking: Skills

  • PA_BHS_01 Identifies and overcomes barriers to effective communication
  • PA_BHS_02 Manages time and draws consultations to a close appropriately
  • PA_BHS_03 Recognises that effective history taking in non-urgent cases may require several discussions with the patient and other parties over time
  • PA_BHS_04 Supplements history with standardised instruments or questionnaires when relevant
  • PA_BHS_05 Identifies alternative and conflicting views from family, carers, friends and members of the multi-professional team
  • PA_BHS_06 Assimilates history from the available information from the patient and other sources
  • PA_BHS_07 Interprets and uses non-verbal communication to and from patients and carers
  • PA_BHS_08 Focuses on relevant aspects of history

Clinical Evaluation: Knowledge

  • PA_BCK_01 Describes the need for a targeted and relevant clinical examination
  • PA_BCK_02 Describes the basis for clinical signs and the relevance of positive and negative physical signs
  • PA_BCK_03 Recognises constraints to performing physical examination and uses strategies to overcome them
  • PA_BCK_04 Recognises the limitations of physical examination and the need for adjunctive forms of assessment to confirm diagnoses
  • PA_BCK_05 Offers or uses a chaperone when appropriate

Clinical Evaluation: Skills

  • PA_BCS_01 Performs an examination relevant to the presentation and risk factors that is valid, targeted and time efficient
  • PA_BCS_02 Reports the possibility of deliberate harm [both self-harm and harm by others] in vulnerable patients to appropriate agencies
  • PA_BCS_03 Actively elicits important clinical findings
  • PA_BCS_04 Performs relevant additional examinations

Investigations: Knowledge

  • PA_BIK_01 Interprets clinical data including, but not exclusively:
    • * Patient clinical case notes and associated records
    • * Clinical parameters such as: – BP, Pulse, CVP – BMI
    • * Fluid balance
    • * Physiological investigations such as: – ECGs – Echocardiography and stress testing – Pulmonary function tests

Investigations: Skills

  • PA_BIS_01 Interprets clinical laboratory data including:
    • * Haematology such as – Routine report of Hb, WBC, haematocrit etc.
    • * Biochemistry such as
      • Arterial blood gases/acid-base balance
      • Urea and electrolytes
      • Liver function – Endocrine biochemistry such as blood glucose and thyroid function
  • PA_BIS_02 Identifies normal appearances and significant abnormalities in radiographs including:
    • * Chest X-rays
    • * Trauma films ‘ cervical spine, chest, pelvis, long bones
    • * Head CT and MRI showing clear abnormalities

Specific Anaesthetic Evaluation: Knowledge

  • PA_BSK_01 Gives examples of methods of anaesthesia that are suitable for common operations
  • PA_BSK_02 Describes the ASA and NCEPOD classifications and their implications in preparing for and planning anaesthesia andpostoperative care
  • PA_BSK_03 Explains the indications for and interpretation of preoperative investigations
  • PA_BSK_04 Lists the indications for preoperative fasting and appropriate regimens
  • PA_BSK_05 Explains the methods commonly used for assessing the airway to predict difficulty with tracheal intubation
  • PA_BSK_06 Lists the indications for Rapid Sequence Induction
  • PA_BSK_07 Gives examples of the effect of common co-existing diseases on anaesthesia and surgery including but not exclusively: obesity; diabetes; asthma; ischaemic heart disease; hypertension; rheumatoid disease; epilepsy
  • PA_BSK_08 Discusses how to manage drug therapy for co-existing disease in the perioperative period including, but not exclusively: diabetic treatment; steroids; anti-coagulants; cardiovascular and respiratory medication; anti-convulsants
  • PA_BSK_09 Explains the available methods to minimise the risk of thromboembolic disease following surgery
  • PA_BSK_10 Describes the complications of anaesthetic drugs [including anaphylaxis, suxamethonium apnoea and malignanthyperpyrexia] and how to predict patients who are at increased risk of these complications
  • PA_BSK_11 Identifies the principles of consent for surgery and anaesthesia, including the issue of capacity
  • PA_BSK_12 Explains the guidance given by the GMC on consent, in particular:
    • * Understands that consent is a process that may culminate in, but is not limited to, the completion of a consent form
    • * Understands the particular importance of considering the patient’s level of understanding and mental state [and alsothat of the parents, relatives or carers when appropriate] and how this may impair their capacity for consent
  • PA_BSK_13Summarises the factors determining a patient’s suitability for treatment as an ambulant or day-stay patient
  • PA_BSK_14 Recalls the factors that affect the risk of a patient suffering post-operative nausea & vomiting

Specific Anaesthetic Evaluation: Skills

  • PA_BSS_01 Obtains a history specifically relevant to the planned anaesthesia and surgery including:
    • * A history of the presenting complaint for surgery
    • * A systematic comprehensive relevant medical history
    • * Information about current and past medication
    • * Drug allergy and intolerance
    • * Information about previous anaesthetics and relevant family history
  • PA_BSS_02 Performs a relevant clinical examination including when appropriate:
    • * Cardiovascular system
    • * Respiratory system
    • * Central and peripheral nervous system: GCS, peripheral deficit
    • * Musculoskeletal system: patient positioning, neck stability/movement, anatomy for regional blockade
    • * Other: nutrition, anaemia, jaundice
    • * Airway assessment/dentition
  • PA_BSS_06 Makes appropriate plans for anaesthesia:
    • * Reviews current medication and seeks advice where appropriate
    • * Plans appropriate anaesthetic technique[s]
    • * Secures consent for anaesthesia
    • * Recognises the need for additional investigation and acts accordingly
    • * Discusses issues of concern with relevant members of the team
    • * Reliably predicts the level of supervision they will require
  • PA_BSS_07 Presents information to patients [and carers] in a format they understand, checking understanding and allowing time for reflection on the decision to give consent
  • PA_BSS_08 Provides a balanced view of care options