My Department’s Operasyon Pinoy - Meningocoele 2005

Point by Point notes

1. Patients were seen at PGH were scheduled for Mission, funds were secured by NSS to facilitate the needs of the patients. They were then instructed to go to OM to be admitted at the OPD at around 8 am.

2. Patients come into the OPD, get an OPD chart, history and PE will be taken by a clerk, intern, or resident. Admitting notes and history will be done by the resident and will be admitted at room 306. For excess patients, room 303 will be the back up room, for clean cases.

3. Patients will then proceed to admitting section for interview, then they will proceed to social service for classification: AS MISSION. The chart will be left with the social worker and the patients will walk back to the OPD at a designated spot. The surgery OPD nurse will get the chart for social service, will get the weight of the patients, will call the ward nurse to endorse the patient, and will take the patient up to the ward for admission.

4. The ward nurse will give the orientation to the newly admitted patients and provide the appropriate nursing care as they occupy the designated beds.

5. By 11 AM, admitted patients will be confirmed by the GS coordinator and will make an OR schedule for two OR suites, booking forms will also be made for the AROD. Certain patients may require laboratories like cranial CT scan, CBC, CXR, urinalysis will be asked to bring the results done outside prior to admission.

6. Materials for OR and the medications will be prepared by the NSS and GS coordinator and will be placed inside individual plastic bags and will be labelled with the appropriate names of the patient. For expensive OR needs like shunts, and fragile anesthetics in bottles and ampules, these will be dispensed inside the OR by the designated NSS resident or GS resident.

7. At around 2 PM, the AROD will make a pre-operative assessment of the patients. Laboratories requested by the AROD will be done in OM if applicable, otherwise these will be done outside and will be funded by the concerned patients.

8. The AROD will order the pre-meds in the charts. The patients will be placed on NPO for 8 hours prior to the contemplated procedure. They will be hooked to D5IMB 500ml to run for maintenance rate. The venous catheter guage will be # 20 or 22, attached to a microset. This will be done by clerk manning the ward, appropriate referral will be made as needed.

9. The first 2 cases will be wheeled into the OR by the from night nurse at the ward at 6 AM, together with OR needs and medications, the pre-meds will be given as ordered in the chart.

10. The ward nurse will endorse the patient to the OR nurse, along with the materials and the medications.
11. The patient will be wheeled into the OR, the parents will be instructed to go back to the ward and wait for the call from the OR after the operation.
12. The operation will be done by the NSS team from PGH and will be assisted by an OM team, as indicated in the OR schedule. A designated GS resident will take pictures to document the event from start to finish. The GS resident will also take video clips for instructional use in the future.
13. Preparation of the OR will be delegated to the NSS residents, any assistance form the GS resident is welcome in terms of certain needs that may arise. A GS resident will be stationed inside the OR as the OR monitor for unexpected problems that may arise. He will also be in charge to make the OR flow as smooth and as sequential as possible.
14. After the operation, the patient will be transferred out to PACU, where one parent will be allowed inside the PACU beside the patient, as long as they will wear proper PACU attire (gown, cap, and slippers).
15. The vital signs and neuro VS of patients will be taken by a designated anesthesia clerk, every 5 minutes for the first hour, with increasing increments if the patient is stable. If there are problems that may arise, the clerk will refer to the AROD, NSS resident or GS resident.
16. Precautions will be made for seizures, dyspnea, marked changes in blood pressure, changes in sensorium. Instructions will be made by the NSS resident at the start of the mission and special endorsements will be made after each patient is wheeled into the PACU, on a case to case basis.
17. After a few hours stay in the PACU, when indicated, the patient will be transferred out to the ward. The vital signs and neuro VS will be taken by a designated surgery clerk every 1 hour at the ward. And will refer to a GS resident assigned at the ward for that day as needed.
18. Precautions will be made for seizures, dyspnea, marked changes in blood pressure, changes in sensorium. Instructions will be made by the NSS resident at the start of the mission and special endorsements will be made after each patient is wheeled into the WARD, on a case to case basis.
19. NSS residents will make a morning rounds on the first OR day, catheter care and wound care will also be provided. GS residents will assist the NSS residents. GS neurosurgery rotators will include the patients in their team daily endorsement for the team on duty.
20. Duty GS residents will make afternoon rounds on the patients and will inform the NSS coordinator on the status of the patients, if there will be a toxic patient, the NSS resident-in-charge will be asked to come and personally evaluate the patient, through the NSS coordinator.
21. Plans for discharge
22. Follow-up will be scheduled by NSS residents at NSS OPD