Development of a universal post-operative order form

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Overview

Following coronial investigations of cases of peri-operative mortality following surgical procedures, the Coroner made strong recommendations for the various medical colleges to develop a universal post-operative order form to accompany the patient through all stages of treatment and to be used by all hospitals in Victoria and potentially nationally.

The Victorian Surgical Consultative Council (VSCC) and the Consultative Council on Anaesthetic Mortality and Morbidity (CCAMM) support this recommendation and its implication for improving patient safety by avoiding unnecessary post-operative mortality and morbidity.

In May 2005 the VSCC received funding to engage a contractor to undertake a project to develop a set of universal post-operative order principles. In February 2006 the contractor submitted a final report to the VSCC and two example post-operative order forms. These documents can be viewed below. The final report included the following universal post-operative order principles:

1. Post-operative orders are required for all invasive procedures.
2. Clear policies and guidelines should exist to support the implementation of post-operative orders.
3. Standard tools should exist to support implementation of the policies and guidelines regarding post-operative orders.
4. A standard format and form for post-operative orders is required for all procedures and should provide an at a glance overview of the full management plan until the next medical review.
5. Medical staff writing orders should have:
   • Knowledge of the procedure, the expected post-operative course and of potential procedural complications
   • Knowledge of the patient’s condition in relation to the intra-operative course, the patient’s pre-existing co-morbidities and their risk factors for developing complications
   • Understanding of the environment (staffing, facilities) in the location where the patient will be managed post-operatively
6. Communication of post-operative orders must be written and verbal, with sign-off by staff making the orders and receiving the orders in theatre, recovery and ward area.
7. Criteria for escalation of care need to be incorporated into the post-operative orders.
8. Staff responsible for acting on post-operative orders are responsible for ensuring they receive written documentation of the orders, a verbal handover and for clarifying instructions before accepting care of the patient and for escalating care when indicated.
9. Post-operative orders need to include both post-anaesthetic and post-surgical orders. While anaesthetic orders specific to the recovery room may be written on the anaesthetic record, anaesthetic orders or instructions pertinent to the ward need to be recorded as part of the general post-operative orders.

Current status of project

Between March and June 2008 an updated universal post-operative order format was piloted at Austin Hospital, the Alfred Hospital, Barwon Hospital and Wodonga Hospital. A final report dated 19 January 2009, based on the work of the project to date, is available below. The final form template is also available below.

Currently the VSCC, with the support of the DHS, the Victorian Consultative Council on Anaesthetic Mortality and Morbidity (VCCAMM) and the pilot hospitals, will be holding two workshops in 2009 which will provide information to health services who may be considering implementing the form. Further information on these workshops, including dates, will be posted here when available. VSCC has also contacted CEOs of health services in Victoria to inform them of the progress of this project.