• STOP the following medications 7 days prior to surgery:
• - Ibuprofen (Motrin, Advil)
• -NSAIDS (Aleve, Relafen)
• -Gout medications (indomethacin, colchicine).
• STOP Aspirin 7 days prior to surgery unless prescribed by your physician. In that case, consult your physician regarding the aspirin and alert the surgical center nurse if you are not allowed to stop.
• At the time of the phone interview, notify the nurse of any supplements you may be taking.
• ALERT the surgical center call nurse if you are taking MAO inhibitors (Nardil, Parnate). These must be withheld for 14 days before surgery.
• Heart, blood pressure, and asthma medications should be taken the day of surgery with a sip of water.
• Glucophage/Metformin should be taken no later than 9:00 a.m. the day before surgery. DO NOT TAKE the day of surgery.
• If using an inhaler for asthma, bring it with you to the center.
• Allergy medication may be taken, if needed, on the morning of surgery with a sip of water.
• If taking anti-anxiety medications, they should be taken on the morning of surgery with a sip of water and they may also be taken the night before surgery.
• INSULIN: Contact your primary care physician or endocrinologist for dosing instructions.
• If you have questions regarding the information in this packet or your medications, please call 203.483.2024 Monday through Friday 8:00 a.m. - 4:00 p.m. and ask to speak to a nurse.

• You will need medical clearance from your Primary Care Physician within 30 days of your surgery date. You should arrange an appointment with your Primary Care Physician within that time frame as soon as possible.
• Your doctor may order preoperative tests, such as blood work and/or an EKG. Depending on your medical history, you may need additional tests or consults.
• You are required to have a responsible adult drive you home and remain with you the first 24 hours after surgery. Your surgery will be cancelled if you do not have these arrangements in place. You cannot drive or be left alone. You cannot use public transportation or walk home. Your companion should anticipate remaining at the center throughout your stay.
• A nurse from the surgical center will call you a week or two before surgery to obtain a health history, give instructions, and answer any questions or concerns. Please advise the nurse if you suffer from sleep apnea.
• On the day before surgery, please call 203.483.2024 between 9:00 a.m. - 2:00 p.m. to find out what time to arrive for your surgery. If your surgery is on Monday, please call on the previous Friday. The time is not available prior to that day. It is important to keep the entire day available as we may not be able to accommodate a specific time request.
• Call your surgeon if there is any change in your physical condition such as flu, fever, or injury to the operative area before your surgery.
• If you are having hand or foot surgery, remove all nail polish and acrylic/gel or artificial nails on the hand/foot upon which you will be operated.
• If your surgeon has given you a prescription prior to your surgery date, you may want to fill it prior to your surgery to minimize travel time on your surgery day.

• Please bathe or shower prior to your surgery. Remove all make-up, and do not use lotions or oils after bathing.
• Please REMOVE all jewelry and body piercings prior to coming to the center.
• Do not eat or drink anything after midnight the night before your surgery unless instructed otherwise by the surgical center staff. This includes water, candy, mints, gum, chewing tobacco, and ice chips. If you were instructed to take medication, please take it with only a sip of water. Failure to follow these instructions may result in cancellation of your surgery.
• If having lower extremity surgery, please do not wear slip-on sandals.
• If having shoulder surgery, wear an extra-large shirt with buttons. You will not be able to put the operative arm through a sleeve after your surgery and women will not be able to wear a bra after surgery.
• Leave all valuables, including jewelry or cash, at home. We cannot be responsible for damaged or lost property.
• Do not wear contact lenses. If you wear glasses, bring a case for their safekeeping. We provide containers for removable dentures and bridgework.
• A nurse will provide you with a patient gown, slippers, and a
  locker to store your clothing.
• The admitting nurse will check your temperature, blood pressure, and pulse. You will be asked to rate your level of pain on a pain scale of 0 - 10 before and after your surgery. (0 = no pain 10 = the worst pain imaginable.)
• An anesthesia staff member will see you on the day of surgery and you will have the opportunity to speak with your surgeon.
• Your family will be asked to wait in the waiting room during the operation. The surgeon will speak with your family immediately following surgery.
• Be prepared to sign forms giving your consent for anesthesia and the operation. If you are under 18, a parent or legal guardian must accompany you, sign the consent form, and remain at the center during your surgery.
• For the privacy and comfort of all patients, only one visitor is allowed in the recovery area.

• The average stay in recovery is 30 to 60 minutes depending on the type of surgery and your own personal recovery.
• Patients having an ACL Reconstruction are usually more comfortable in the back seat of the car for the ride home. An immobilizer will be on the leg to prevent bending at the knee.
• After you have returned home, be sure to reread the discharge instructions and follow your doctor's orders regarding rest, medication, and activity.
• It is not unusual to feel a little sleepy, lightheaded, or dizzy for several hours after your surgery.
• Slight swelling of the hands is normal after shoulder, elbow, and hand surgery. Slight swelling of the feet and ankle is normal after knee, ankle, and foot surgery.
• Over-the-counter chewable Dramamine can be helpful in minimizing post-operative nausea and vomiting. (If diabetic, notify your physician of prolonged nausea and vomiting.)
• A slightly elevated temperature can occur for a few days after surgery. If greater than 101 degrees, call your surgeon.
• If you have any questions or problems after surgery, please contact your physician. Please be sure to review the discharge instructions before calling your doctor's office.
• Do not drive a car, smoke, drink alcoholic beverages, operate machinery, or cook for 24 hours after surgery.

Pain Control

• Surgery, in general, and orthopedic surgery specifically, result in some post-operative pain. Pain management is an important component of your post-operative care. For most surgeries, this management starts in the operating room when the anesthesiologist and/or your surgeon give long-acting local anesthetics.
• In recovery and at home, pain medication is used to reduce pain to a tolerable level, usually to 5 and under on a scale of 0 - 10.
• Remember that pain medication takes 20 - 40 minutes before becoming effective.
• Do not take additional Tylenol! Acetaminophen while taking pain medication. Most pain medication already has Tylenol!
• Acetaminophen in it. The maximum dose for Tylenol in a 24-hour period is 4000 mg.
• Keep the operative limb elevated above the level of the heart when possible for the first few days after surgery.
• Ice is often an effective pain reliever. If advised by your surgeon on your discharge instructions, please use it. Although it seems that the coldness will not penetrate the big dressing, it does get through and can be very effective. Always keep your dressing dry.

Connecticut Orthopaedic Specialists Surgical Center presents a Patient's Bill of Rights with the expectation that observance of these rights will contribute to more effective patient care and greater satisfaction for the patient, his/ her physician, and the organization. It is recognized that a personal relationship between the physician and the patient is essential for the provision of proper medical care. The traditional physician-patient relationship takes a new dimension when care is rendered within an organizational structure. Legal precedent has established that the facility itself also has a responsibility to the patient. It is in recognition of these factors that these rights ore affirmed.

1. The patient has the right to considerate and respectful care.
2. The patient has the right to obtain from his/her physician complete current information concerning his/her diagnosis, treatment, and prognosis in terms the patient can be reasonably expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person on his/her behalf. He/she has the right to know, by name, the physician responsible for coordinating his/her care.
3. The patient has the right to receive from his/her physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily be limited to the specific procedure and or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning a medical alternative, the patient has the right to know the name of the person responsible for the procedures and/or treatment.
4. The patient has the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of his/her action.
5. The patient has the right to every consideration of his/her privacy concerning his/her action.
6. The patient has the right to file a verbal and/or written grievance as outlined in the Patient Complaints/Grievance Procedure Policy.
7. The patient has the right to expect that all communications and records pertaining to his/her care be treated as confidential.
8. The patient has the right to expect that within its capacity, this accredited ambulatory surgery facility must provide evaluation, service and/or referral as indicated by the urgency of the case. When medically permissible, a patient may be transferred to another facility only after he/she has received complete information and explanation concerning the needs for and alternatives to such a transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer.
9. The patient has the right to obtain information as to any relationship of this facility to other healthcare and educational institutions insofar as his/her care is concerned. The patient has the right to obtain information as to the existence of any professional relationships among individuals, by name, who are treating him/her.
10. Connecticut Orthopaedic Specialists Surgical Center does not participate in any human experimentation treatments. However, the patient has the right to be advised if this accredited ambulatory surgery facility does propose to engage in or perform human experimentation affecting his/her care or treatment. The patient has the right to refuse to participate in such research projects.
11. The patient has the right to expect reasonable continuity of care. He/she has the right to know in advance what appointment times and physicians are available and where. The patient has the right to expect that this facility will provide a mechanism whereby he/she is informed by his/her physician of the patient's continuing healthcare requirements following discharge.
12. The patient has the right to examine and receive an explanation of his/her bill regardless of the source of payment.
13. The patient has the right to know that the physicians at Connecticut Orthopaedic Specialists Surgical Center have full ownership of the facility.
14. The patient has the right to know what facility rules and regulations apply to his/her conduct as a patient. No catalog of rights can guarantee for the patient the kind of treatment he/she has a right to expect. This facility has many functions to perform, including the prevention and treatment of disease, the education of both health professionals and patients, and the conduct of clinical research. All these activities must be conducted with an overriding concern for the patient, and above all, the recognition of his/her dignity as a human being. Success in achieving this recognition assures success in the defense of the rights of the patient.

It is the patient's responsibility to fully participate in decisions involving his/her own healthcare and to accept the consequences of these decisions if complications occur.
The patient is expected to follow up on his/her doctor's instructions, take medication when prescribed, to make follow-up appointments as directed, and ask questions
concerning his/her awn healthcare that he/she feels are necessary.

PATIENT COMPLAINTS/GRIEVANCE PROCEDURE - POLICY:

The surgery center provides for and welcomes the expression of complaints/grievances and suggestions by the patient and the patient's family at all times. This feedback allows the center to understand and improve the patient's care and environment.

Every patient has the right to file a complaint or grievance to the facility's surgical services director. In the absence of the director, the associate medical director will address the complaint/grievance.

GRIEVANCE PROCEDURE

All grievances will be investigated upon receipt of such complaints.

The grievance should be provided either verbally or in writing to the facility's surgical services director at 2200 Whitney Ave., Suite 310, Hamden, a 06518. The grievance will be documented in the form of a variance. Any allegations of neglect and/or verbal, mental, sexual or physical abuse will be reported immediately for the CEO. Substantiated allegations will be reported to the state or local authority.

If the patient is still not satisfied, complaints may be made to the Connecticut Orthopaedic Specialists privacy officer in writing, stating the specific incident(s) in terms of subject, date, and other relevant matters. These complaints may be mailed to HIPAA Privacy Officer, Connecticut Orthopaedic Specialists, 2408 Whitney Avenue, Hamden, a 06518. All complaints will be responded for within a two-week period.

Connecticut Orthopaedic Specialists Surgical Center also seeks to comply with the federal and state laws relating to non-discrimination, civil rights, and equal employment opportunities. All persons receiving services and employees of this organization are entitled to courteous, dignified, and equal treatment by right as well as by law.

Suspected discrimination relating to race, color, national origin, ancestry, age, sex, marital status, religious creed, or any other factor should be reported promptly.

Unresolved complaints can further be reported to the state and federal agencies:

• Complaint / Compliance Unit
• Division of Health Systems Regulation
• Connecticut Department of Public Health
• 410 Capitol Ave., MS#12HSR
• Hartford, CT 06134-0308

Complaints can be received by phone at the Connecticut Department of Public Health, Division of Health Systems Regulation by calling (860) 509-7400.

Complaints to the Federal Health and Human Services Department, Office of the Secretary may be made in writing to the following address:

• US Department of Health and Human Services
• Office of the Secretary
• 200 Independence Ave S.W.
• Washington, DC 20201

Additional information is available at www.cms.hhs.gav/center/ ambdsman.asp.

ADVANCED MEDICAL DIRECTIVES POLICY:

Connecticut Orthopaedic Specialists Surgical Center will accept but not honor Living Wills, Advanced Directives, and Durable Power of Attorney for Healthcare documents or Do Not Resuscitate (DNR) orders. For clarification purposes, these are
defined as "written instructions, recognized under state law, relating to the provision of healthcare when the individual is incapacitated." (Federal Register, Friday, March 6, 1992).

State statute allows all adult patients to make decisions concerning their medical care. While hospitals, skilled nursing facilities, home health agencies and hospice care programs are required to furnish information to each adult patient as to
their individual rights under state law to make such decisions, the ambulatory surgical center, as specified in OBRA 90, is not obliged to do so. The purpose of an ambulatory surgery center is to enhance the quality of a person's life. If necessary, the
facility will attempt to resuscitate a patient in distress.

For complete information and forms on Advanced Medical Directives for the State of Connecticut, go to: www.larcc.org/pamphlets/elderiy/living_wills.htm and www.ct.gov/ag/cwp/browse.asp