Hospital Discharge Planning after Surgery
Horizons in Hemophilia, November 2011
By Rueleen Kapsch, RN, Quality Assurance Nurse
Hospital discharge planning can be quite involved if you have a bleeding disorder but you can ask for help from your Hemophilia Treatment Center (HTC) nurse coordinator and your HoG outreach nurse. Call your HoG outreach nurse if you plan to have surgery, and she/he can help smooth the path of your treatment and possibly help prevent bleeding complications during and after surgery.
If you have an elective (planned) surgery, it is essential to work closely with your HTC to be sure that you have a treatment plan and that there is time and capacity to execute the plan. There are several things that you will need to do prior to having your surgery. First, order the factor you need for the procedure and the follow up treatment you will need after the surgery. Second, ask your HTC if the procedure can be done safely at your local hospital. If specific laboratory monitoring is required, as is the case with major surgery in patients with hemophilia or von Willebrand Disease, the HTC staff will need to determine if the local hospital laboratory has the capacity to perform the testing required to monitor factor replacement. Many local hospitals are unable to perform factor VIII and IX levels at the hospital. In that case, it may take days to determine if your factor infusions are being dosed correctly. Third, find out if the hospital has the factor you need and if it has hematologists familiar with treatment for surgery in people with bleeding disorders. If your local hospital cannot perform the necessary monitoring, cannot stock the appropriate factor replacement product, or doesn’t have a hematologist to monitor you after surgery, you should reconsider having surgery at your local hospital. Rather, it may be safest to have your surgery performed at the hospital associated with your HTC.
Some minor procedures may include stitches, biopsies, minor dental procedures (not total mouth extractions) or colonoscopy. Even if you are assured by non-HTC doctors that the procedure will not cause any bleeding, always ask your HTC for input as many of these minor procedures can cause serious complications in the absence of appropriate treatment.
If you have unexpected or emergency surgery, inform the HTC as soon as possible and request that your surgeon or doctor at the hospital speak directly to the HTC hematologist for guidance on management of your bleeding disorder around the time of surgery.
Let your HoG nurse know how she/he can help with your plan of treatment--can you self infuse factor or do you need home care following discharge? It is important that you always wear your Medic Alert® and carry your Emergency Action Plan wallet card with you. This card explains your bleeding disorder and lists HTC care provider names and numbers and emergency contacts. Make sure that your family members are aware of the need to contact your HTC on your behalf if you are unable to speak for yourself.
You can ask your HoG Outreach Nurse to contact the hospital you’re in to help provide education to the nursing and hospital staff about your bleeding disorder and factor products while you are hospitalized.
Partnering with the HTC and your HoG Outreach Nurse can greatly improve your outcome and prevent bleeding complications before and after surgery.