Examining Peri-operative Care: A Literature Review of Key Practices

This literature review provides a comparative analysis of traditional and fast-track peri-operative care protocols, drawing upon various studies and guidelines. Traditional practices, as exemplified by historical figures like John Snow and Florence Nightingale, emphasized careful patient observation, pain prevention, and antiseptic techniques. Modern approaches, such as Enhanced Recovery After Surgery (ERAS) and NICE guidelines, advocate for early mobilization, standardized analgesics, optimized nutrition, and thorough patient education. Key elements include preoperative counseling, meticulous wound care, infection prevention, and comprehensive patient monitoring, particularly within the Post-Anesthetic Care Unit (PACU), adhering to standards set by organizations like the American Society of Anesthesiologists and the World Health Organization (WHO). The review underscores the importance of standardized handovers using ISBAR principles and evidence-based measures for surgical site infection prevention, aiming to enhance patient safety and outcomes.

Yeung, J., Gillies, M. A., & Pearse, R. M.
(2018). Pragmatic trials in peri‐operative
medicine: why, when and how?.
Ball, J. E., Bruyneel, L., Aiken, L. H.,
Sermeus, W., Sloane, D. M., Rafferty, A. M.,
... & Griffiths, P. (2018). Post-operative
mortality, missed care and nurse staffing in
nine countries: a cross-sectional study.
International journal of nursing studies, 78,
10-15.
Macleod, J. B. (2016). Critical care in
Africa: A surgical intensivist perspective.
East and Central African Journal of
Surgery, 21(1), 3-10.
Traditional practices
Trad Prolonged preoperative fasting
(nil by mouth), bowel cleansing,
and reintroduction of oral
nutrition
Multimodal care/Current
practices
Trad Enhanced recovery after surgery
Trad Anaesthetic regime
Trad Preoperative counselling
Trad Optimisation of nutrition
Trad Standardised analgesics
Trad Early mobilisation
Nanavati, A. J., & Prabhakar, S. (2014). A comparative study of
‘fast-track’versus traditional peri-operative care protocols
in gastrointestinal surgeries. Journal of gastrointestinal
surgery, 18(4), 757-767
Steenhagen, E. (2016).
Enhanced Recovery After
Surgery: it’s time to change
practice!. Nutrition in Clinical
Practice, 31(1), 18-29.
American society of Anaesthiologist- PACU
 Provision of oxygen.
 Measurement and recording of vital signs by the nurse
 A report by the anaesthesiologist to
the PACU nurse (Brief medical history,
preanesthetic assessment including allergies,
anticipated need for pain medications, Pre-
transfer laboratory data)
 Postanesthetic orders (e.g.
oxygen administration, fluid
administration, antiemetic and
analgesic treatment).
Trad WHO guidelines post
operative care
Patient education
Allegranzi, B., Zayed, B., Bischoff, P., Kubilay, N. Z., de Jonge, S., de Vries, F.,
... & Abbas, M. (2016). New WHO recommendations on intraoperative and
postoperative measures for surgical site infection prevention: an evidence-based
global perspective. The Lancet Infectious Diseases, 16(12), e288-e303.
Florence
Nightingale
John snow
Careful patient selection, pain
prevention by inhalation, careful
observation, maintenance of respiration
Careful patient observation, antiseptic
technique, wound infection prevention
Dandy and Firor
Three bed neurosurgical unit
Leave patients comfortably after anaesthesia, use pillows
for head and shoulder. Leave patient without movement
for recovery
NICE guidelines
Trad Wound care, infection prevention,
patient monitoring
National Safety and Quality
Health Service Standards
Kitney, P., Tam, R., Bennett, P., Buttigieg, D., Bramley, D., & Wang, W.
(2016). Handover between anaesthetists and post-anaesthetic care unit nursing
staff using ISBAR principles: A quality improvement study. ACORN: The
Journal of Perioperative Nursing in Australia, 29(1), 30.