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The enhanced recovery programme aims to speed your recovery following your impending operation.
By involving you in your own care after the procedure,
we would aim to return you to normal activities as soon as possible.
This involves listening to professionals with regards to timing of eating,
mobilising after the operation and generally getting back to what you consider to be normal
for you.
By spending less time in hospital we would hope to reduce your risk of complications
normally associated with protracted hospital stays, such as chest infections,
wound infections, DVT's and other issues that would delay your recovery to normality.
John, my names Julie,
I'm one of the pre op assessment nurses and the purpose of your visit here today
is to make sure your fit for your anaesthetic.
Now that involves me asking questions about your general health,
listening to your heart and lungs, doing an ECG,
taking some swabs for MRSA and taking some bloods.
Ok. I'm also going to give you quite a lot of information and some pre-operative drinks
for you to take away with you today.
The actual assessment will take about an hour.
Ok, and if I do have any problems I'll be speaking to the anaesthetist about you. Is
that ok?
Yes that's fine thank you.
Can I ask if you have brought with you your letter for admission in with you today?
Yes I have, yes.
Have you brought any medication that you take?
Yes I've got some medication.
Right. Do you take any complementary medications at all?
No, none at all.
That's lovely.
Ok, so I'll ask the questions first of all about your heart and lungs etc,
then we will do the heart and chest examination and the other tests afterwards, Ok
Yes that's fine.
Stopping smoking before your operation can make the surgery safer.
If you are able to stop your likely to have fewer complications.
So, fewer infections, fewer heart or lung complications and hopefully a shorter stay
in hospital.
It's not easy to stop smoking, but we want to make sure you get the support you need,
that support is available through your GP or at any point you would visit the hospital.
The further in advance of the operation you can stop the greater the benefit.
Stop before your op and make that operation safer.
The job of the anaesthetist is to look after patients who are having operations.
There are various different stages to how we would go about this.
The first stage is pre operatively. Your anaesthetist will ask lots of questions,
or check through the questions you have already been asked,
mainly focusing on assessing other illnesses which you have.
These are quite important in terms of how they relate to
how you will cope with having the operation and the effects of the operation on patients.
So you will be asked as lot of questions about your heart,
breathing, about your exercise tolerance and your fitness.
Questions about whether you have acid coming up into your mouth when you lie flat,
all of these things have an impact on how your anaesthetic will be delivered.
Usually your anaesthetist will assess your airway as well
and see if you have any loose teeth or anything which might cause any problems during the
operation.
And the other thing we'll do is check on any allergies you might have,
whether you've had anaesthetics before and whether you've had any problems with them.
While you're having your operation your anaesthetist looks after you
and doesn't take any part in the operation. Their job is to just look after you.
We're quite interested in pain relief after your operation and we will talk to you about
that beforehand.
How you are given your pain relief after the operation will depend entirely on the surgery
that you're having.
But the anaesthetist will be experienced in the type of surgery you're having
and the various different pain relieving techniques that are available to you
during your operation and after.
But they will talk to you and decide on the best thing for you in conjunction with you.
Ok then John, we're ready for theatre now
When you are called through for theatre the admissions nurse will go through your details,
name, date of birth, check your wristband and a last temperature.
These are all to ensure your safety whist under our care.
Any paperwork will have been completed previously with yourself and checked over before you
go.
After changing into the theatre gown and your own dressing gown and slippers,
your property will be secured and labelled to be sent to the ward that you will go to
post operatively.
Any unnecessary jewellery should be removed and wedding rings taped.
Glasses and dentures may remain in situ until absolutely necessary.
It is advised to leave all valuables at home as much as possible.
We provide relatives a central telephone number to call for them to check on your progress
and we will keep them informed whilst you are gone.
A theatre porter will be sent to collect you and escort you down to the receiving room.
Relatives many accompany you if you wish.
We aim for a smooth transition, please feel free to express any anxieties at any point
of your journey.
We're going out the door on your right, then to your left.
Once you have had your operation the anaesthetist is the person
who is likely to have decided where you are looked after, after your operation as well.
Sometimes you'll need to go to higher level care areas for the day or two after the operation
if it's important for nursing staff to keep a close eye on how well your heart and lungs
are working and
to make sure your organs are all working properly, to make sure you recover quickly and well
from the operation.
I'm just going to start doing your blood pressures ok, they go every five minutes.
How's your tummy feeling?
Have you got any pain?
Yes.
Is it bearable at the moment?
Only just.
Only just, ok we will get you sorted with some painkillers ok.
Just going to take your temperature.
Just pop this in your ear and take your temperature.
That's absolutely fine.
Would you like to try a slip of water?
Yes.
Just take it steady.
Good pain management is important to enable you to move around,
deep breath and cough and will help you to perform your physio exercises.
This will help to prevent complications and mean you get better more quickly.
After any operation it is usual to experience some discomfort,
however you will be given regular pain relief for this.
If your pain is not bearable at any time or you feel sick
please let your nurse know as soon as possible,
so they can assess you and provide extra pain relief or anti sickness medication as necessary.
Ok, were just going down that way there John, alright.
The nursing staff on the ward will also assist you with walking around the ward area
to meet your enhanced recovery milestones, and motivate you to be as independent as soon
as possible.
Well done.
Hi ya John.
Hello Sarah.
I've just got your dinner for you ok.
Yes thank you.
You've got some soup, orange juice and rice pudding.
As soon as your surgery allows you can start to eat.
We suggest that you start with something light such as soup, ice cream or yogurt.
It is likely that you will be required to give yourself an injection,
once a day for up to four weeks after you go home.
This is to reduce your risk of getting a blood clot.
You will be able to practice this with your nurse before you go home.
So all we do, is we take it out of its wrapper.
Yes.
Take the grey end off.
Yes.
Pinch an inch, so you can pinch a bit of your tummy.
And then put it straight in between your fingers.
Right.
Push the white plunger all the way down.
Yes.
And then a plastic end comes over to cover the sharps,
so you don't get injured and then we drop it in the sharps box.
Ok.
So do you want to have a go at that for me?
So you just peel that back.
Peel that back.
Can be a bit tough sometimes. That's it.
Lift it out. Lovely. This can just go in your normal bin at home.
Yes.
That's fine.
Pull that grey end off for me.
Yes, be firm with it. Give it a good pull.
That can go in your normal bin as well.
So then hold it like that and just pinch.
So that's it.
Hold it like that. Pinch.
That's it and go in-between your finger and your thumb.
Straight in, yep. Lovely straight in and push your white plunger all the way down.
It clicks a little bit. That's it and then lift it away and the ends covered look.
Oh yes.
And then we just drop that in your sharps box.
Are you happy to do that do you think?
I am yes.
So when I come round doing the drug round tonight at 6' o clock.
Yes.
I'll get you to do your own in your tummy then.
Oh yes.
Is that alright?
For real.
For real and we'll see how you get on.
I'm sure I'll be ok with that.
Lovely.
You will be seen by a physiotherapist as part of your post-operative care.
Participation in physiotherapy will prevent you from getting a chest infection,
restore your mobility and prevent other complications associated with surgery
such as the development of pressure sores and circulatory problems.
Therefore reducing your length of stay in hospital and improving your overall hospital
experience.
The morning after your surgery you will be encouraged to get out of bed and sit in your
chair.
Your physiotherapist will emphasise and encourage you to achieve your enhanced recovery milestones,
as written in your pre-operative handbook.
Your milestones are your minimum daily goals, if able you should aim to walk further and
more frequent.
Hello, could I speak to Mr Denver please
We will call you after going home from hospital
to make sure you're not running into any problems or developing complications.
Please do not wait for our call if you are worried about anything.
There is a summary of what to do or whom to contact in different circumstances at the
end of your recovery booklet.
Your recovery is assisted by all of these steps and by members of our team.
We are all here to help you, but the speed of your recovery is up to you.
Keeping yourself motivated and following advice from doctors, physiotherapists,
nurses and other members of our team will mean you get to recover at home much sooner.