Victorian Hospitals Post-Operative Orders Form: The Victorian Surgical Consultative Council - Department of Health, Victoria, Australia

Health home
The Victorian Surgical Consultative Council
Projects
Victorian Hospitals Post-Operative Orders Form

Victorian Hospitals Post-Operative Orders Form

Overview

As a result of 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 Victorian Consultative Council on Anaesthetic Mortality and Morbidity (VCCAMM) support this recommendation and its implication for improving patient safety by avoiding unnecessary post-operative mortality and morbidity.

The final report included the following post-operative order principles:

Post-operative orders are required for all invasive procedures.
Clear policies and guidelines should exist to support the implementation of post-operative orders.
Standard tools should exist to support implementation of the policies and guidelines regarding post-operative orders.
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.
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
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.
Criteria for escalation of care need to be incorporated into the post-operative orders.
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.
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.

Resources for Implementation

Victorian Post-Operative Orders Form (PDF - 193 KB)

Audit and Evaluation Framework - November 2009 (PDF - 165.2 KB)

Implementation Guide - November 2009 (PDF - 144.8 KB)

Consultation Process

Three workshops were organised at the beginning of December 2009 in Melbourne, Ballarat and Bendigo. The Ballarat Workshop was cancelled just prior to the date as local sponsors were unavailable however it is hoped that this workshop will be rescheduled at a later date. A workshop was conducted in Rochester on 24th April and was well attended by over 10 Regional / Rural health services who are all intending to implement the format.

Over 36 Health services were represented at the Melbourne, Bendigo and Rochester Workshops. All major metropolitan, regional and rural hospitals provided representatives. In addition, other key support staff including operating theatre managers and quality/ clinical governance unit support staff were also present. Evaluation of the Workshops were conducted using a survey instrument. The evaluation results from the workshops were very positive with participants highly satisfied with the content of the presentation and the session presenters. The majority of attendees gained valuable knowledge from the session.

Current status of project

Between March and June 2008 an updated post-operative order form was piloted at the 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 entitled “Development of a post-operative order format”.