Are your elderly patients safe to go home?

has no one to drive her home and no one to care for her at home after surgery. How would nurses in your ambulatory surgery facility handle this situation? It’s an increasingly important question as the population ages and more surgery is performed on an outpatient basis. “It can be challenging to meet the needs of this age group,” says Donna DeFazio Quinn, RN, BSN, MBA, CPAN, CAPA. “They’re from a stoic generation. Many don’t want to impose on anyone to help them. But ambulatory surgery requires some athome postoperative care, and elderly people can’t always do that.” She says ASC managers need to make sure their centers have a well-developed program of preoperative assessment and discharge planning to ensure the needs of elderly patients are planned for. Nurses need to be especially attuned to eliciting preoperative information and reinforcing discharge instructions for older patients. When the 75-year-old patient was scheduled for surgery at Quinn’s facility, the Orthopaedic Surgery Center in Concord, NH, the preoperative nurse persisted in asking the patient about her postoperative plans. “We were just about to cancel the surgery, when she finally told us she had a son from Massachusetts who would come up for the day of surgery,” says Quinn. Discharge planning for elderly ambulatory surgery patients should begin as soon the surgery is booked, advises Nancy Burden, MS, RN, CPAN, CAPA, director of health services at Morton Plant Mease Health Care in Clearwater, Fla. Writing in the Journal of PeriAnesthesia Nursing, Burden says successful discharge planning relies on: • comprehensive preoperative assessment • effective communication among the surgical facility’s caregivers, physician’s office, patient, and family • consideration of the patient’s preoperative status • strong patient and family education. During the preoperative interview, nurses need to act like detectives, identifying any issues that might affect the patient during or after surgery, especially at home, Burden says. These issues include: Underlying medical issues Elderly patients may have more underlying medical conditions that could make outpatient surgery riskier, Burden says. They must have a thorough medical evaluation before surgery to determine if the ambulatory setting is appropriate. At Mease Countryside Hospital in Safety Harbor, Fla, about 95% of patients, and 100% of the geriatric population (defined as 85 and older) visit the Preadmission Testing and Teaching (PaTT) unit prior to outpatient surgery, says Debbie Goodwin, RN, BSN, MS, CAPA, manager of ambulatory care, PACU and PaTT. The PaTT unit is part of the main hospital, an advantage for a hospital-based outpatient surgery center, Goodwin says, adding that more than 60% of her surgery patients are age 65 and over. After a phone interview by an outpatient surgery nurse, patients visit the PaTT unit 1 to 2 days prior to surgery for an anesthesia assessment. They come with OR Manager