This page is for physicians and health care providers who are booking patients for surgery within Island Health.
Patients are required to have anesthetic consultation prior to booked surgery if they have any of the following conditions:
- American Society of Anesthesiology (ASA) Classification of 3, 4, or 5
- Cardiac history with impact on daily living e.g. valve disease, myocardial infarction within the last 6 months, angina, multiple admissions, implantable cardio-verter defibrillator (ICD)
- Poorly controlled diabetes
- Anti-coagulant therapy associated with mechanical heart valve (unless anticoagulant bridging arrangements have already been made)
- Moderate to severe respiratory disease e.g. asthma, COPD, restrictive lung disease, bronchiectasis, TB, shortness of breath
- Diagnosed or suspected Obstructive Sleep Apnea Syndrome with co-morbidities, or if undergoing major surgery, airway surgery or any surgery that will involve significant pain afterward
- Known or possible difficult intubation e.g. loose teeth, reduced neck extension, reduced jaw opening
- Personal or family history of major anesthesia problem
- Morbid obesity (i.e. BMI of greater than 35) in conjunction with other identified triggers
- Severe liver disease
- Severe renal disease if for surgery other than AV fistula or shunt insertion
- Debilitating neuro-muscular disease e.g. muscular dystrophy, very severe Parkinson's
- All major vascular surgery
- Any disorder that the referring health care provider thinks may affect the patients well being peri-operatively
Physicans can refer patients for anesthetic consultation through the OR Booking office.
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Obstructive Sleep Apnea (OSA) Assessment
Patients suspected of having obstructive sleep apnea need to be assessed and diagnosed before surgery. Physicans can refer patients for assessment by contacting:
Royal Jubilee Hospital Sleep Lab at 250-370-8008
Cowichan District Hospital or Nanaimo Regional General Hospital at 250-716-7705 or toll free at 1-877-711-7705.
Medication Reconciliation -Pharmacist in Pre-admission Clinic (PAC)
Medication Reconciliation is an accreditation standard. It has been proven to dramatically decrease the potential for adverse drug events from occurring by decreasing unintentional discrepancies (physician unintentionally omits/adds/changes a medication the patient was taking prior to admission).
Medication Reconciliation at the Pre-Admission Clinic begins with a pharmacist documenting a Best Possible Medication History (BPMH). Various sources of information are used to ensure the accuracy of the BPMH (PharmaNet, family doctor pre-op assessment, patient interview). The BPMH is available on the chart post-op for the Most Responsible Physician (Surgeon) to use when writing medication orders.
Medication Reconciliation is performed for the following patients: all Same Day Surgical Admission patients, Aneurysm patients, and Joint Replacement Clinic patients who are scheduled for an anesthetic consult.
Medication Reconciliation is currently offered at the Royal Jubilee and Victoria General Hospital's Pre-admission Clinics. Plans to implement this process in other the pre-admission clinics within Island Health are underway.
Medication Reconciliation Patient Pamphlet (PDF)
Contact: Cynthia Turner
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