Surgical Safety Plan

[Anna5]

After 4 surgical experiences in 3 years. I do have trauma history dating back to childhood. After 2 out of 3 surgeries (out patient) bad experience (because they did not know how to handle the situation made the situation worse and I dissociated and couldn't ground myself) for the last one which was major surgery in the hospital. I had a safety plan for surgery but did not have a plan for discharge. I was in the hospital 4 days.

One thing I did not realize that general anesthesia meant using a mask so I did not create a verbal plan with the anesthesiologist. So caught off guard. When the mask was placed on my hand went up to feel what it is and told to breath and I heard the person said I am holding it wrong as my last memory. My doctor said that person had time to show me that mask, relax and place to mask on. To ease into it, as a transition out. Also you can when surgery is scheduled if you prefer all female staff, make sure they request is known.

Below is my safety plan, the hospital staff did compliment me on it. That so I can feel safe and present. When I am I am able to cope better. First time using a plan and learned more to tighten up the plan further. Where I can take away some information to make sure that the most important things they need to focus on. Like just pointing out different things in the room and asking me what that is, instead of the three options. (I liked when I came to took out the ear phones and tub that was in my noise and in pain, she quickly got the pain under control and pointed out different things in the room as a way to orient me. We made a game out of it she pointed to an object and ask me what it was.) Add do not dim the lights in the prep area and leaving me alone for long period of time in the prep area prior to going to surgery. Also, add in I would like to meet with a case manager as soon as possible to get to know that person and that way their is a plan for afterwards.
Surgery Safety Plan- DOB:
I have Post Traumatic Stress Disorder with dissociative symptoms. This means that when I am fearful or triggered by certain behaviors I can lose my ability to be present in the moment. So while I still may be able to answer questions and talk to people, I am actually disconnected and not fully aware of what is going on in my surroundings.

Triggers that can lead to dissociating:
· People towering over me
· Multiple people speaking to me at the same time
· Multiple people making requests at the same time
· Being rushed to do something or make quick decisions
· Annoyed, condescending, authoritative tones of voice

Signs that indicate that I am dissociating
· Blank look on my face or facing turning white
· Inability to answer questions in full coherent sentences
· Repetitively saying same word or phrase (“no, no, no” or “pain, pain”)
· Inability to speak
· Signaling with my hands and trembling
· Inability to orient to time, date, and place

How to be helpful if I do dissociate (DON’T PANIC - If I do dissociate it won’t last forever and there are numerous things people can do to help me return to the present)
· Make sure the AC is on
· Have only one person talk to me at a time
· Clearly communicate in a slow and calm manner
· Let me know before you do something what you plan to do
· Allow me to listen to my meditation music
· Let me know that you’re leaving the room for a few minutes to give me time to reorient myself
· Prior and post-surgery make sure I’m oriented by asking me grounding questions such as…
o Tell me three things you see in the room
o Tell me three things you hear
o Tell me three things you can touch and feel around you

While I suspect that the most challenging part of this experience will be pre-surgery, I have never been in the hospital for this many days and am uncertain if I will flashbacks while I am in recovery. Therefore, please continue to watch for signs of dissociation. Also, please allow me to get as many hours of consecutive sleep at night, as tend to lower my risk of dissociating.

 

[Luigi]

WOW. That is one rock-star plan. You should be so proud of yourself, handling all of this with respect for your needs.

 

[Anna5]

Thank you, I learned a lot from previous experience and wanted to make sure I give information so they know what to do. I had a wonderful therapist who helped me with the plan. I learned so much from this experience and what I need to do to tighten it up further. I ended up having inadequate post-op care because it was not well planed out. I was given a suggestion to add in at the end, "I would like to speak with the case manager as soon as possible to plan and create a safety plan for discharge." Each patient is assign to a case manager and they can be requested. So hard to remember everything. I meet one briefly but it did not get to really know each other and to formulate a plan, since a discharge planner is familiar with resources out there.

I hope that sharing my surgical safety plan and what I have learned that if needed they can use mine as a template for creating their own safety plan. It can also be used for out patient surgery centers. By having a written plan it made my experience much better and easier to handle each thing in the hospital.

 

[keifer]

I like your plan. I made a living will for mine. So far, they can't read. I'm done with white coats.

 

[Anna5]

I was able to listen to meditation music on my mp3 player prior, during and after surgery. Used the mediation music during different times when needed in my hospital room. When I first was getting out of bed it was painful. Put my headphones on and was able to relax before getting up and then when I got into bed fast. I really helped it reminded me to relax and breath.