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Perioperative Medication Management – Adult – Ambulatory [149]

Perioperative Medication Management – Adult – Ambulatory [149] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 149

Delegation Protocol Title:
Perioperative Medication Management – Adult – Ambulatory

Delegation Protocol Applies to:
Patients managed through UW Health Preprocedure Assessment SAFE Service (PASS) Clinic

Target Patient Population:
Patients seen in the UW Health PASS clinic for preoperative evaluation prior to a scheduled
surgery

Delegation Protocol Champion:
Scott Springman, MD ‐ Department of Anesthesiology

Delegation Protocol Reviewers:
Anthony Hennes, PharmD – Department of Pharmacy
Philip Trapskin, PharmD, BCPS – Department of Pharmacy
Christi Albert, PharmD, BCPS – Department of Pharmacy

Responsible Department:
Department of Pharmacy
Drug Policy Program

Purpose Statement:
To delegate authority from the patient’s anesthesiologist/surgeon to registered nurses (RNs) to
instruct patients to temporarily modify medication regimens prior to planned surgical
procedures in accordance with the UW Health Perioperative Medication Management –
Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline. RNs may only provide
instruction on medications included in this guideline.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) who have completed training in the use of this delegation protocol

Guidelines for Implementation:
1. This delegation protocol is initiated when a patient is seen in the PASS Clinic for
preoperative evaluation prior to a scheduled surgery
2. Initial Patient Assessment:
2.1. The RN will review the patient’s medical record including preoperative medications,
anesthesiologist/surgeon’s preoperative notes, problem list, and past medical history
to gather information to carry out this delegation protocol.
2.2. The RN will complete a medication history confirming what medications the patient is
taking at home (both prescription and non‐prescription) and additionally collect
medication name, strength, and route of administration, indications, dosing schedule,
and last dose.
2.2.1. This information will be documented within the medication reconciliation tab in
Healthlink
3. Preoperative Medication Management Planning:
3.1. The RN will utilize the UW Health Perioperative Medication Management clinical
practice guideline in conjunction with the completed medication history to determine a
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


preoperative medication plan for the patient.
3.2. The UW Health Perioperative Medication Management clinical practice guideline
outlines three different actions the RN can take on a preoperative medication:
3.2.1. Can instruct the patient to continue taking the medication prior to surgery
without changes to the medication regimen, or
3.2.2. Can instruct the patient to stop taking the medication at a specified time prior to
surgery, or
3.2.3. Consult the patient’s anesthesiologist/surgeon/prescribing provider for guidance
on preoperative management of the medication.
3.3. If the medication instructions in the anesthesiologist/surgeon’s note are inconsistent
with the instruction in the UW Health Perioperative Medication Management clinical
practice guideline, the patient’s anesthesiologist/surgeon will be consulted prior to the
RN instructing the patient.
4. Patient Instruction and Documentation:
4.1. The RN will verbally instruct the patient on the preoperative medication management
plan.
4.2. The RN will document the preoperative medication management plan in the medical
record.
4.3. The patient will be given a written copy of the preoperative medication management
directions upon completion of the PASS clinic RN evaluation as a part of their after visit
summary (AVS).

Order Mode: Protocol/Policy, Without Cosign

References: N/A

Collateral Documents:
Perioperative Medication Management – Adult/Pediatric – Inpatient/Ambulatory Clinical
Practice Guideline

Approved By:
UW Health Ambulatory Protocol Committee: September 2016
UW Health Nursing Practice Council: October 2016
UW Health Pharmacy and Therapeutics Committee: October 2016
UW Health Medical Board: November 2016
UW Health Chief Clinical Officer: November 2016

Effective Date: November 2016

Scheduled for Review: November 2019
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org