Manage peri-operative care

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently manage peri-operative care.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3.  The doctor is encouraged to download the key clinical task guidelines and seek the support of his/her supervisor for feedback on performance.

Competent across the many threads of care:

  • Pain management (note local approaches)
  • Diabetes
  • Anticoagulation/DVT prophylaxis
  • Cardiac and respiratory issues
  • Fluid management
  • Sensible use of blood products
  • Antibiotic prophylaxis (cf. treatment)

Related Competencies:

Collaboration and teamwork

Understand both personal and collective responsibility within the team to ensure the safety of patients

Collaboration and teamwork

Maintain accurate records and follow-up on investigation results

Communication

Accurately document medicine prescription, calculations and administration, using recommended terminology, including symbols and abbreviations

Communication

Provide updates to the current health team, e.g. new critical issues or changes in a patient’s condition

Communication

Attend to clarity, structure and appropriate content for specific correspondence, e.g. handover notes and investigation requests

Health advocacy

Demonstrate awareness of the cultural diversity and requirements of patients

Health advocacy

Advise families and carers according to the patient’s condition and wishes

Judgement and clinical decision making

Use basic algorithms and decision trees to manage common problems

Judgement and clinical decision making

Recognise personal limitations and ensure appropriate supervision

Leadership and management

Identify and follow patient care protocols, for example:

Medical expertise

Identify and provide relevant and succinct information when ordering investigations. Ensure tests and results are documented

Medical expertise

Know and work within hospital, state and government policies and legislation relating to prescribing. Make use of guidelines and standard documents, e.g. National Inpatient Medication Chart

  • Accurately and safely prescribe (common) medications and recognise (potential) administration errors
  • Know the types, causes and risks of medication errors and adverse drug reactions
  • Use standard reporting mechanisms to report medication errors and adverse drug reactions
Medical expertise

Understand the key features of antibiotic prophylaxis and appropriate therapeutic use, noting local protocols and the Therapeutic Guidelines (Antibiotics)

Professionalism

Demonstrate empathy, caring and compassion for patients, their families and carers and treat them with dignity and respect

Professionalism

Able to learn from mistakes (own and others)

Professionalism

Identify specific strategies for improving performance based on feedback

Scholarship and teaching

Attend unit or morbidity/mortality meetings. Identify any personal knowledge, skills or behaviour changes required

Scholarship and teaching

Participate in departmental or other continuing education opportunities, e.g. journal club

Scholarship and teaching

Reflect on and learn from own observations of clinical practice

Collaboration and teamwork

Maintain clear, accurate and concise patient records of assessment, clinical issues and planned management

Communication

Keep patients and significant others informed of management plan progress

Communication

Communicate effectively within multidisciplinary teams, reflecting an understanding of, and respect for, different health professional perspectives

Health advocacy

Note and understand the Enduring Power of Attorney and the Advanced Care Directives

Health advocacy

Recognise health needs of an individual patient beyond their immediate condition

Health advocacy

Take into account the impact of history and experience of Indigenous Australians/Maori people, and their spirituality and relationship with the land

Judgement and clinical decision making

Use mechanisms that minimise error, e.g. clinical checklists, Surgical Safety Checklist, handover protocols, unit protocols

Judgement and clinical decision making

Retrieve and use high-quality information from electronic sources for clinical decision making. Document decisions and reasons for same

Judgement and clinical decision making

Recognise when advice and guidance is required in development of management plans

Leadership and management

Accept opportunities for increased autonomy and patient responsibility under direction of supervisor

Medical expertise

Identify common risks in older and complex patients, e.g. falls risk and cognitive decline. Take appropriate actions to prevent or minimise harm

Medical expertise

Follow-up and interpret investigation results appropriately to guide patient management

Medical expertise

Work within unit-based protocols with regard to pre-operative assessment and care, operative procedures and post-operative care:

  • apply medical knowledge to clinical practice
  • implement and evaluate a management plan relevant to the patient following discussion with a senior clinician
  • identify when patient transfer is required, and manage risks prior to and during patient transfer
  • recognise indications for, and risks of, fluid and electrolyte therapy and blood products
  • provide appropriate aftercare and arrange follow up for common procedures 
  • safely manage anti-coagulant therapy and manage diabetes
  • recognise acute cardiac events and use relevant resuscitation/drug protocols
  • initiate resuscitation of the unwell patient. Recognise indicators for sepsis and implement clinically relevant plan
  • maintain a clinically relevant patient management plan of fluid, electrolyte and blood product use
  • recognise and manage fluid and electrolyte imbalances in a patient
  • effectively use semi-automatic and automatic defibrillators
  • provide appropriate aftercare and arrange follow up for more complex procedures
  • recognise when patients are ready for discharge and arrange referral to relevant members of the healthcare team to promote planning for safe discharge
Professionalism

Critically reflect on own performance and make an accurate assessment of this

Scholarship and teaching

Use a range of strategies aimed at improving patient education

Technical expertise

Engage with Basic and Intermediate surgical constructs

Technical expertise

Assist with teaching junior staff

Collaboration and teamwork

Work within the team to identify and remedy errors, particularly using a systems approach

Collaboration and teamwork

Collaborate effectively with other specialist teams involved in the patient’s care

Collaboration and teamwork

Encourage participation of all team members and allocate appropriate tasks to junior members

Communication

Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)

Communication

Collect and collate relevant information from other team members or specialist teams pertinent to decision making or patient management

Communication

Contribute to analysis of complex cases and imperfect outcomes, and identify any changes needed to care processes or systems

Health advocacy

Identify any gaps between management plan and patient wishes

Health advocacy

Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient

Judgement and clinical decision making

Undertake continued timely reviews of patient progress and respond appropriately to any changes of condition

Judgement and clinical decision making

Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan

Judgement and clinical decision making

Recognise instances of uncertainty and conflicting values, and able to alleviate their potential impact

Leadership and management

Demonstrate appropriate self-awareness and insight

Medical expertise

Can supervise/advise and understands medicines with high risk of adverse events. Double check and document dose calculations

Medical expertise

Evaluate outcomes of medication therapy. Monitor and review the patient’s response to treatment

Medical expertise

Provide appropriate aftercare and arrange follow-up for all procedures

Medical expertise

Review and update unit protocols manual regarding pre-operative assessment and care, operative procedures and post-operative care

Professionalism

Recognise signs of a colleague in difficulty and respond with empathy

Professionalism

Act as a role model of professional behaviour in the workplace

Scholarship and teaching

Use multi-disciplinary team meetings as teaching and educational opportunities

Scholarship and teaching

Provide effective supervision using recognised techniques and skills (availability, orientation, learning opportunities, role modelling, delegation)

Technical expertise

Able to assess advanced Essential Surgical Skills constructs (competent with basic and intermediate) both for use in current position as well as for surgical education and training (SET) application – career pathway