Surgical care

• Arrange for language interpretation services through your surgeon’s office, if needed.
• Ask your surgeon if you will need a special car seat (for example, children having orthopedic surgery sometimes need one).
• Ask your surgeon if you will need any special equipment at home to care for your child or youth.
• Make sure your child does not take ibuprofen or anti-inflammatory medications for one week before surgery. Do not give:
  • Advil® or Motrin®
  • Aspirin®, Aleve® (ASA) or Pepto-Bismal® Naprosyn®
  • Gingko
  • St. John’s Wort

Make a note of the following:

Name of surgery:
Name of surgeon:
Surgeon’s office phone number:
Pre-anesthesia clinic (C3) appointment, date and time:
Date of surgery:
(The admitting team will call you 1 - 2 days before your surgery and tell you when to arrive at the hospital)
Time to arrive:

If you know what to expect, you will be better able to help your child or youth:

• Ask your doctor for resources to read.
• Ask staff at CHEO’s Kaitlin Atkinson Family Resource Library to help you find information. Call 613-738-3942.

Your care provider may ask for a consent form to be signed during a clinic visit in advance of the procedure, or – if this does not happen – on the day.

The consent form must be signed by the patient if they are capable of making their own decisions with respect to the procedure. If they are not capable, the consent form must be signed by a caregiver with authority to make healthcare-related decisions. This could be a parent with decision-making responsibility or a legal guardian. If you are not already listed as a parent with decision-making responsibility or a legal guardian in the patient’s medical record, please ensure that you bring appropriate documentation with you. CHEO will need to review this documentation before you sign the consent form.

The law provides that consent must be voluntary and informed. This means that, before the consent form is signed, the care provider needs to explain:

• the procedure and why it is needed
• why it will help (the benefits)
• what problems could happen (the risks)
• any other ways to treat the problem (if there are any); and,
• what might happen if the procedure is not performed

Please do not hesitate to ask your care provider any questions you may have about the procedure. There are no silly questions.

Epic eConsent FAQ

What is electronic consent (eConsent)?

It’s an electronic version of CHEO’s informed consent form. After having the discussion with your care provider as to why the procedure is necessary, what will happen during the procedure and what the benefits and risks might be, your signature will be captured digitally, indicating you’ve provided informed consent for the procedure to go ahead. The electronic form will be stored in your chart in the Electronic Medical Records System. This replaces the previous paper-based consent form.

Is an electronic signature less ‘valid’ than a wet ink signature on paper?

No, the law in Ontario allows for e-signatures.

What if I am not comfortable using a tablet or computer or prefer a paper version to sign?

The provider will fill out the Consent to Procedure form in the Electronic Medical Records system and will print a paper copy for the child or parent/guardian to sign. The form will later be scanned and stored in the Electronic Medical Record system.

Can someone help me if I have trouble signing the form digitally?

Yes. Your care provider will be there to help you sign.

What happens if I press the wrong button or make a mistake while signing?

Your provider can start over and create a new version to replace what is there.

Is my child’s personal and health information secure when I sign digitally?

When you sign digitally, the consent form is stored directly in our Electronic Medical Records system as part of your child’s chart. There is not an additional risk associated with the electronic version.

Who can see the consent form after it is signed?

Those people involved in your/your child’s care who have access to your/your child’s personal health information in the Electronic Medical Records system can access the form.

Will the consent form become part of my child’s medical record?

Yes.

Can I get a copy of the consent form after I sign it?

Yes. Your provider can print off a copy of the form for you.

Can I review the consent form later if I have questions?

Yes.

What if both parents or guardians need to give consent?

There is no legal requirement for both parents/guardians to sign the consent form unless there is a family court order which says both parents must make healthcare-related decisions together.

What if I change my mind after signing the form digitally?

If you wish to withdraw your consent to this procedure, please let your care provider know as soon as possible. Your are provider may wish to discuss this with you.

What options are available if someone cannot read the form easily on a screen or needs language support?

Your provider can print a paper copy if you cannot easily read the screen. Translation services continue to be available as required.

If you have any questions or feedback related to the digital consent procedure, please contact CHEO’s Patient Experience Team at 613-737-7600 ext. 3078 or experience@cheo.on.ca who can help best navigate next steps.

During surgery, your child or youth will have medications to keep them comfortable. This is called anesthesia. It can involve many levels of sedation from numbing the area to a deep sleep (general anesthesia).

Risks and side effects

Use of anesthesia in children is common, but may have side effects. These side effects depend on your child’s or youth’s medical condition and history. A recent cough or cold can increase the risks of anesthesia. See the section called “What if my child or youth is sick before surgery?”

It’s important to prepare children and youth for the anesthetic. Explain to your child or youth that they will:

• get medicine to help them feel comfortable and sleep before the surgery and during surgery
• breathe the medicine in through a mask or get it through an IV (a soft tube placed in a vein in the hand or arm)
• have an IV, no matter how the anesthetic is started. A numbing cream/spray is often applied to the site before insertion of the IV if it is placed while awake
• receive additional oxygen or gas through a mask or small breathing tube
• will be taken care of the whole time by the anesthesiologist

Your child or youth may need to see an anesthesiologist or nurse practitioner in the pre-anesthesia clinic. This will depend on the medical history of your child or youth and the surgery or procedure they are having.

A nurse or nurse practitioner may do an assessment over the phone. This will be decided by your surgeon. If you don’t require a pre- anesthesia clinic visit, you will be assessed on the day of surgery. If you live a far distance from the hospital, we can sometimes arrange an appointment with the anesthesiologist through videoconferencing.

If you need to see the anesthesiologist or nurse practitioner, you’ll have an appointment in the pre-anesthesia clinic about two weeks before the surgery. You’ll find the clinic at C3, on Level 2 of CHEO. Please register at the desk when you arrive. We offer services in French and English. We have translation services available if you speak another language, but your doctor’s office will need to call us ahead of time to make these arrangements.

Anesthesiologist: A doctor who specializes in giving patients medicine to go to sleep and stay asleep during surgery. They help control pain and manage vital body functions during surgery

What you need to bring to the clinic:

• your child’s or youth’s most recent health card
• proof of your address (like a driver’s licence)
• medical insurance information (if needed)
• your child’s or youth’s immunization record
• a list of medications, homeopathic or herbal remedies and dietary supplements your child is taking

What will happen during the appointment?

You will first meet the nurse, followed by the anesthesiologist or nurse practitioner. They will:

• ask questions about your child’s or youth’s health
• measure their weight and height
• check their heart rate, blood pressure and oxygen level
• let you know what to expect on the day of the procedure or surgery

The doctor you meet in the pre-anesthesia clinic may not be the anesthesiologist on the day of the surgery. The doctors may decide your child or youth needs investigations (e.g. blood tests or X-rays) before surgery. If your child or youth needs these tests, your visit to CHEO will be longer.

Having surgery can be stressful for your child or youth and their whole family. Knowing what to expect on the day of surgery will help everyone to be better prepared. Make sure to:

• Tell the truth about what will happen — this helps your child or youth trust you and CHEO staff. The truth is often less scary than what children are thinking.
• Ask questions and have your child or youth tell you what they know. This is a good way to find out what they are thinking, so you can correct any misunderstandings.
• Avoid bribes or threats.
• Reassure them that it is OK to feel nervous or scared.
• Give your child or youth some control by giving age-appropriate choices: “Which toy/activity would you like to bring?”

Talking to babies and toddlers (birth to 3 years)

Bring along comfort items like pacifiers, favourite toys or blankets. After surgery, babies who are not breastfeeding are more likely to drink from a familiar bottle nipple or sippy cup, so bring empty ones with you.

Toddlers may react to changes in their routine. Reassure your child that the surgical team is there to help them get better. On the day of the surgery, you can help by:

• rocking and holding your child
• talking calmly and gently
• distracting your child with toys or books
• using simple explanations like, “The doctor is going to fix the bump on your tummy.”

Talking to preschool and school-aged children (3 to 12 years)

Children need time and encouragement to ask questions and share their feelings. You can help by:

• talking about the surgery or procedure ahead of time using a calm and relaxed voice
• using play to help your younger child understand the surgery (toy medical kits or books)
• explaining that the hospital is a safe place and staff is there to help
• preparing your child for any stitches or bandages they may see

Talking to youth (12 to 18 years)

Youth are more independent and they will be involved in their health-care decisions. They may ask for detailed explanations. They are often worried about privacy. You can help by:

• being honest — they have a right to know about everything that will happen
• encouraging them to ask questions of you or hospital staff
• giving space, so they can speak to the doctor or nurse alone