Principles and Goals

This guideline supports nursing staff members to provide individual care for a child or young person
undergoing surgical procedures and/or anaesthesia. All aspects of nursing care delivery are
underpinned within a developmental and family centred approach:
 The nurse introduces (name and role) themselves to the child/young person and their
family/caregiver, and establishes the primary caregiver.
 The nurse communicates at all times with the child/young person and their whānau/caregiver in a
respectful and empathetic manner, upholding family centred care principles .
 The nurse ensures patients and their whānau are given space and the opportunity to explore
questions with the medical and multi-disciplinary teams and exercise Tino Rangatiratanga.
 Confidentiality and privacy is maintained at all times pursuant to the Nursing Council Code of
Conduct.
 The whānau, in negotiation with nursing and medical teams, are empowered and actively
encouraged to be involved in the child’s preparation for and recovery from surgery , whenever
appropriate to do so.
Preoperative Care
Child and family preparation
The child and family are prepared physically and emotionally for the procedure. Consideration is
owed to the child's developmental stage. Input from the Hospital Play Service should be considered
and offered where appropriate.
The nurse ensures that:
 The child and family receive an adequate explanation of procedure in age appropriate language
using an interpreter if required
 The child is fasted as indicated according to fasting guidelines
 The child has their identification bracelet on that has been checked by the nurse and matches the
patient's registration form.
 The pain scale tool is explained to the child and family , and a pre-operative pain assessment is
completed.
 Ordered blood tests are taken by appropriate staff members in advance of being taken to theatre.
 Prescribed fluids are administered as charted, or clear oral fluids are given (as per the
Starship fasting guideline) . Additional fluids may be required as per the pre-operative plan or the
condition specific guideline. Ensure both are reviewed prior to transfer to theatre.
 Inpatients have a soapy shower or wash and wear clean pyjamas or gown to the operating room. If
the child is unable to change into pyjamas or a gown please discuss with operating room staff
members .
 A day stay child should wear a single layer of clean loose clothing to the operating room. Note no
bras or denim. If clothing is soiled or unsuitable, the child should be changed into a gown .
 The child’s linen is clean .
 The parent or legal guardian has signed consent (anaesthetic and surgical) in the ward or is
available to do so pre-operatively.
 The family understand the estimated timeframe of the procedure, are kept informed about any
delays , and encouraged to voice any concerns or queries to the nursing team.
Documentation is completed
The nurse ensures that:
 All current clinical records are compiled to accompany the child, including any hard copy images if
requested. All previous clinical records are available electronically (CRIS, Concerto) and
documented accordingly.
 A minimum of twenty patient labels are available in the child’s clinical record
 CR8815: Anaesthetic Preoperative Record has been completed on the ward or available in the
clinical notes for completion in pre-op (both sides)
 CR4115: Anaesthetic Screening Questionnaire has been completed with the parent or legal
guardian.
 CR4048: Preoperative Checklist has been completed in full
 Baseline observations are also documented on current PEWS chart
 Child is escorted to the preoperative area
The nurse:
 Accompanies the child to the operating room pre-operative area
 Ensures the caregiver accompanies the child to the operating room pre-operative area
 Caregivers may be given the option to accompany their child during the induction phase of
anaesthetic if desired, and deemed appropriate by the anaesthetic team. Covered footwear is
required for caregivers who wish to accompany their child into theatre for anaesthetic induction.
 Waits with the child and caregiver to hand over to operating room staff members using the SBARR
format.
 Ensures the caregiver knows where to wait while the child is in the operating room and is shown
where the Post Anaesthetic Care Unit (PACU) is located .
Postoperative Care
Hand over
The child is handed over to the ward nurse by PACU staff members using the SBARR format. The
nurse ensures that handover includes:
 Type of operation and anaesthesia
 Specific postoperative orders and management plan
 Current PEWS score. The PEWS is repeated by the receiving nurse prior to leaving PACU
 IV Fluids received in theatre, and further fluid prescription as per post-operative plan
 Medication administered in theatre, noting timings and dose.
 Pain modalities in situ and prescribed - check the pain modalities running against prescription
 Current pain score
 Catheters and drains are inspected for output . Drain sites are inspected for strike-through.
 A check of all wound sites for signs of bleeding or ooze
 Oxygen therapy administered and prescribed
 Review of PACU score: ensure breathing and circulation are scored 2/2. Others can be 1/2
(minimum score >8/10. If <8/10, the patient requires a review by Anaesthetist and documentation
stating appropriate for ward)
 Level of consciousness and rousability
 The nurse accompanies the child from PACU to the ward with oxygen, oxygen tubing and an
appropriately sized mask. Monitoring equipment may also be indicated.
 A child transferring to an Intensive Observation Area should have the same level of care as per the
Intensive Observation Area guideline (see associated Auckland DHB documents section).
Recovery

The nurse ensures that a visual check and documentation of the following is undertaken every 30
minutes for 4 hours or until the child has resumed normal activities. Observations may be required
more frequently as indicated by PEWS escalation:
 Level of consciousness
 Respiratory rate and pattern
 Colour and perfusion of child
 Heart rate
 Pain score
 Wound ooze or strike-through on the dressing(s)
 Postoperative nausea and vomiting
 Neurovascular observations if applicable
 Neuro observations if applicable
 Temperature should be recorded when the child arrives back on ward and four hourly thereafter
(unless otherwise indicated)
 Blood pressure measurements should be recorded on return to the ward and as clinically indicated:
o A child on pain modalities
o A child with known abnormal blood pressure
o As dictated by the Paediatric Early Warning Score (PEWS)
o An abnormal assessment or vital signs should be reported to the doctor. A child who has a history of
sleep apnoeas or has decreased SpO₂ in PACU should be monitored on a saturation monitor.
Pain Control
Pain related to surgical procedure

The nurse ensures that the effectiveness of intraoperative pain relief is assessed hourly for the first
four hours: Typical duration of modalities as outlined below:
 Caudal – may give relief for up to 4-6 hours
 Narcotics – may give relief for up to 2-4 hours
 Local infiltration – may give relief for up to 2-4 hours
 Intrathecal morphine requires monitoring for 24 hours, as per clinical guideline
Following the initial four hour period, until discharge:
 Assess pain levels at time of each set of post op observations and document on the current PEWs
chart using appropriate pain score assessment tool
 Administer analgesics as prescribed
 Reassess pain after analgesia
 Seek medical review and consider pain service referral if pain unresolved
 Utilise comfort measures as appropriate
 Consider developmental stage for use of appropriate distraction
 Refer to Pain Management Guidelines for further direction
Concerns regarding surgery
Potential for infection/haemorrhage related to condition

The nurse:
 Checks wound site regularly (if applicable)
 Ensures drain(s) are secure (if applicable)
 Replaces drain dressing when integrity compromised
 Measures drain output and records on the Fluid Balance Chart
 Administers antibiotics as prescribed
 Observes for signs of infection
Potential inability to meet own hydration needs
The nurse:
 Promotes oral fluids and then light diet as tolerated, unless otherwise stated in post-operative notes
 Ensures the child has passed urine post anaesthetic
 Administers intravenous fluids as prescribed and titrated to oral fluid intake
 Assesses and documents hydration and fluid balance hourly until intravenous fluids are
discontinued
Anxiety related to hospitalization/procedure
The nurse:
 Encourages the family to ask questions
 Empowers the whānau to be involved in their child’s care as negotiated and appropriate
 Explains all procedures
 Involves the play specialist
 Makes sure call bell is accessible
 Involves the family in the child’s care as negotiated and appropriate
 Offer and facilitate the parent/caregiver to take breaks
 Encourages the family to have their own books and toys with them
Discharge
Child and family are prepared for discharge
The nurse will:
 Ensure the child has passed urine post anaesthetic prior to discharge if day case
 Ensure pain is controlled on existing medications
 Provide education regarding any medications prescribed with the family; including timing of
administration and completion of antibiotics
 Ensure the patient and whānau understand how and when to give prescribed medications at home
 Inspect epidural site for redness and swelling if applicable
 Inspect wound sites and dressing prior to discharge (if applicable)
 Change dressings prior to discharge unless otherwise specified
 Discuss management at home with the family prior to discharge
 Check to see if there is any discharge information or patient advice sheets relating to the child's
specific condition
 Ensure any community agencies involved in the child’s care are notified of discharge (and referral
made if needed)
 Ensure the family have written discharge information and follow up plan for either GP or clinic
appointment