Enhanced recovery after surgery

Transcription

1 Enhanced recovery after surgery Patient Information Author ID: DB Leaflet Number: Surg 038 Version: 4 Name of Leaflet: Enhanced recovery after surgery Date Produced: November 2015 Review Date: November 2017 Enhanced recovery after surgery Page 1 of 6

2 You have been chosen to take part in an Enhanced Recovery Programme (ERAS). The aim of the programme is to optimise your condition and help you recover from your operation as soon as possible. The programme has input from the whole team and includes the surgeon, specialist nurses, physiotherapists, pain team, dietitian etc. Benefits The intended benefits from this programme are that you are fitter sooner, which enables faster rehabilitation and return to everyday life and work. There is improved patient experience and also improved clinical outcomes and if you follow the elements of the pathway, it could help you get discharged from hospital quicker and the need for ongoing care interventions can be reduced. The enhanced recovery programme is now the standard of care in the UK after elective bowel surgery. About the programme This leaflet gives you some information about the programme and how you can play a key part in your recovery. There are three elements to the programme which are: Good pain control Early mobilisation, so you can be up and about as soon as possible Nutrition, early introduction of food and drinks which will contain supplement nutritional drinks Prior to admission Bowel preparation If it is necessary for you to have bowel preparation (laxatives). This will be discussed by the surgeon, colorectal specialist nurse and the ERAS nurse. This may mean you have an enema or a drink of fluid which contains the laxative. The enemas are given on the day of surgery and if the liquid laxative is needed, this is taken the day before surgery. Discharge planning It is helpful if you can discuss with your relatives, carers and friends whether you think you would need social services help on discharge, for example meals on wheels, home help. This will be discussed during your first meeting with the ERAS specialist nurse. Once we know what help may be needed on discharge, we are then able to start planning for your discharge, which makes the process as seamless as possible. This will also quicken the referral process and prevent a lengthened stay in hospital. This will also be discussed with you by the ward staff on admission. Enhanced recovery after surgery Page 2 of 6

3 Following early discharge, there is a 10% risk of readmission to hospital. This can be for reasons including pain control, infection or your bowel not functioning normally. Food and drink Before coming into hospital, please continue to eat and drink normally. You may be given supplement drinks (Ensure) if needed to optimise your nutrition, please take these as directed. You may also be given an energy drink to be taken the night before and the morning of surgery. These drinks give you the energy you will require during surgery and help you recover quicker from the operation. Directions and times will be given with the drinks. Admission Drips and Tubes (Catheters) During surgery it will be necessary to put a drip into your arm or hand to administer fluid which is needed during and after your surgery. It may also be necessary to put a drip into your neck if closer monitoring of fluid is needed. Whilst asleep, sometimes a tube is inserted into your bladder (catheter) to monitor urine production and the kidneys functions. This helps the staff to monitor how much fluid is needed. These drips and tubes will be removed as soon as possible after your operation once you are making good recovery. Pain control during and after your operation Before your operation you will be seen by an anaesthetist, who will discuss pain relief with you. This may be an epidural (pain relief given continuously through a tube inserted in your back). There may be a small additional tube put inside your wound, this is called wound infiltration and offers a local anaesthetic infusion that ensures additional pain relief, or a patient controlled analgesia pump which you control yourself. There are separate leaflets to explain these in more detail. After your surgery Pain control As mentioned earlier, good pain control is essential to your quicker recovery. If your pain is controlled well, then you will be able to mobilise quicker, even the day of surgery, and you will be breathing deeper and will be able to eat and drink better. You will also sleep better, therefore getting adequate rest. The ward staff will ask you frequently about your pain and if you feel that your pain control is not effective, tell the staff and they will be able to discuss this with the pain team. The Enhanced recovery after surgery Page 3 of 6

4 pain team are a specialist group of nurses and anaesthetist who deal with acute pain after surgery. Mobilisation / Physiotherapy Getting out of bed and walking around is a very important part of your recovery. Most patients will get up the day of or the day after their operation. You will be encouraged to sit out in the chair and mobilise short distances. Nursing staff will be able to assist you with this task and physiotherapists will be present on the ward making sure your chest is clear. Having an operation can have an effect on your breathing, so it is essential that you perform deep breathing exercises. The physiotherapist will see you and give you advice on how to perform these exercises. The following exercises will help to reduce complications and speed up your recovery. Deep Breathing Exercises Following your operation you tend to breathe more shallowly and not expand your lungs at the bottom. These exercises help to improve your lung movement and clear phlegm off your chest. Start these exercises as soon as you wake up, and continue hourly whilst awake, until you are up and about again. Sit upright in a comfortable position and place your hand on the upper part of your stomach, relax your shoulders Take a slow deep breath in through your nose, concentrating on expanding the lower part of your chest Hold the breath for the count of three, then slowly breathe out completely, repeat three or four times Huffing Coughing can be uncomfortable and tiring and you might find that huffing helps to move phlegm prior to coughing. Take a small breath in Open your mouth wide and squeeze the air forcefully out of your lungs as quickly as you can, as if steaming up a mirror Coughing Good pain relief and correct coughing technique are essential to clear phlegm comfortably and effectively from your chest. Once phlegm has been loosened by huffing, try and do a supported cough. Position yourself either sitting in a chair, on the edge of the bed, or lying in bed with both knees bent up to relieve the stretch on your tummy; place hands or pillow over your stomach Take a deep breath in and as you cough, squeeze your hands over your stomach in order to support it. Enhanced recovery after surgery Page 4 of 6

5 Circulatory advice Good circulation in your legs helps to prevent deep vein thrombosis (DVT) or blood clots. You will be given a pair of surgical stockings to wear the morning you go to theatre and are encouraged to wear them throughout your stay in hospital. These help push the blood back to your heart. You will also be given an injection into your stomach once a day to prevent any clots from forming. If your surgery has been because you have been diagnosed with a malignancy (a cancer), you will need to be discharged with a supply of fragmin injections (up to 28 days following discharge). Also remember not to cross your legs or ankles, as this can make the circulation sluggish. Also plenty of mobilisations will help your circulation and also benefit your chest. Food and drink You will be offered food and drink as directed by your surgeon; this may be as early as the same day as your operation. You will also be encouraged to take up to three supplement drinks Ensure/Enlives per day, as well as normal diet. By eating and taking these drinks your body will receive the extra nourishment it needs to help heal your wounds and help your body recover from the operation. Returning to Work and Driving You will be able to return to work within four to 12 weeks after your surgery depending on what operation you have had and what job you do. Please discuss this with the surgeon when you are discharged and a doctor s note can be arranged. Your surgeon will advise you on driving, but again it can be up to four weeks before you will be able to drive again. Always inform your insurance company after your surgery as there may be clauses in your policy. If you have any other questions please ask! Follow-up phone call after discharge After you have been discharged, you will receive a follow up phone call from the Enhanced Recovery Nurse or a member of staff from the ward to check on your progress following your discharge from hospital. You will be provided with a questionnaire; please complete this the day after discharge and your answers will be discussed during your follow-up phone call. Contact Details ERAS Nurse Specialist: and ask for bleep 5568 Colorectal Specialist Nurses: Swinley Ward for Female Patients: Langtree Ward for Male Patients: Enhanced recovery after surgery Page 5 of 6

6 Comments, Compliments or Complaints The Patient Relations/Patient Advice and Liaison Service (PALS) Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. Contact Us Tel: (Monday to Friday 9am to 4pm) The Patient Relations/PALS Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Ask 3 Questions Become more involved in decisions about your healthcare. You may be asked to make choices about your treatment. To begin with, try to make sure you get the answers to three key questions: 1. What are my options? 2. What are the pros and cons of each option for me? 3. How do I get support to help me make a decision that is right for me? This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner Enhanced recovery after surgery Page 6 of 6