Pre-operative information for patients awaiting surgery Patient information Leaflet November 2017
Introduction This booklet contains information which will help you prepare for your forthcoming surgery. Please ensure that you read the information carefully. Day Case Patients If you are having your procedure under General Anaesthetic you Must: Be collected from the Day Surgery Endoscopy Unit by a responsible adult. Go home by taxi or car if possible. We discourage you from travelling by public transport home because you will still be recovering from the effects of your operation and anaesthetic. Arrange for a responsible adult to remain at home with you for the first 24 hours after your operation. Take the day after your operation off work. Ensure you have a responsible adult to care for your dependents for 24hours. If I am a Day Case patient will I need to stay in hospital overnight? Most day-case procedures are done and you will be discharged home the same day, There are some day-case patients who need to stay overnight and are discharged the following day. Your length of stay will depend on the procedure you have had and also how your recovery progresses. An overnight stay within the day-case unit may be required if: If it is too late in the evening for you to go home. If you require assessment and input from the physiotherapy services outside of normal working hours. If extra pain relief is needed after surgery as further monitoring is required to ensure that the pain medication is working. If you are having a General Anaesthetic and have no one to take you home or stay with you overnight. You will be informed if it is expected you will require an overnight stay. Where it is decided that you will be kept in overnight, your relatives are welcome to visit from 6.30pm. If your surgery is prolonged, complicated or there are unexpected problems you may need to stay overnight on a hospital ward. This would result in you being transferred to a more appropriate setting for patients requiring a longer stay in hospital. When will I next hear from you? If you have not already received an appointment to come in for your procedure, you will receive a letter in the post. Your letter will inform you of the date and time of your admission. On the day of your operation you should book in at the Reception of the Day Surgery Unit located on the 1 st floor of the Hartshead South building. If you become unwell, develop a cough or cold or cannot attend for any reason, please inform us as soon as possible so that another patient can benefit from your cancellation. The number to call will be printed on your appointment letter. Page 2 of 12
Things to bring in with you: You will need to bring the following belongings into hospital with you: Day-case patients A dressing gown and slippers. A book/magazine/something to help to pass the time A list of your medication and any inhalers, GTN spray or Insulin. Overnight stay/in patients Night clothes A change of clothes to cover the length of time you are expected to be in hospital Toiletries All your regular medication (please bring with you enough medication to cover the length of time you are expected to be in hospital) and your most recent prescription from your doctor. Puzzle/ reading books to help you pass the time Due to a lack of storage on the Day Surgery Unit, where possible patients being admitted as in-patients are advised to bring in minimal belongings on admission i.e. those outlined in the day-case list above. Following your surgery and transfer to the ward we ask that your visitors bring the remainder of your belongings with them when they visit you in the evening. Please do not bring any valuables with you, as we have no lockable storage. Please remove all nail varnish, make up, and any body piercings/jewellery. Fasting Instructions Before Admission please follow the fasting instructions set out below: The Day Before Your Procedure You should eat normally, but avoid large fatty meals No alcohol is allowed for 24 hours before your procedure Fasting on the Day of your Procedure Early Morning Admission for Morning Procedure List: You MUST NOT have any food after 2.30am (this includes chewing gum and boiled sweets) No smoking on the day of your admission Unless you have been reviewed by an anaesthetist and given different instructions. You may have clear non-fizzy drinks up to 6:30am on the morning of your operation/ procedure. This includes water, squash or clear fluid without bits, black tea/coffee NO milk or milk products are allowed. Please ensure you take your medications before 6.30am. DO NOT take any medication you have been advised to stop by the Pre-op Team or Anaesthetist. You should have nothing by mouth after 6.30am on the day of procedure. Lunchtime Admission for the Afternoon Procedure List: You may have a light breakfast (such as toast or continental breakfast, or a small bowl of cereal). You MUST NOT have any food after 7.30am (includes chewing gum and boiled sweets). Page 3 of 12
No smoking on the day of admission Unless you have been reviewed by an anaesthetist and given different instructions. You may have clear non-fizzy drinks up to TWO HOURS prior to the time your letter advised you come in on the morning of your operation/ procedure. This includes water, squash or clear fluid without bits, black tea/coffee NO milk or milk products are allowed. Please ensure you take any medications due at lunchtime before 11.30am. Do not take any medication you have been advised to stop by the Pre-op Team or Anaesthetist. You should have nothing by mouth after 11.30am on the day of procedure. Medication Instructions Prior to Surgery. Please do NOT take the following medications on morning of surgery.... Other Advice. Please note: If you require simple painkillers following your surgery (Paracetamol, Ibuprofen, CoCodamol8/500), the hospital will not supply these. These medications can be purchased over the counter and you must ensure you have a supply of painkillers at home before coming in for your surgery. Do I need to do anything in preparation for my surgery? Orthopaedic Patients Only Rashes, scratches, wounds and scabs Due to the increase risk of infection it is important that you inform us immediately if you develop a rash, scab, wound or scratch on any part of your body, as your surgery may need to be postponed. Please inform the booking team on: Page 4 of 12
Mr Jamil: 0161 922 5808 Mr Alvi/ Mr Bari/ Mr Chirputkar/ Mr Ebizie: 0161 922 4259 Mr Naim/ Mr Obeid/ Mr Thalava: 0161 922 6351 Miss Crawford/ Mr Pervali/ Mr Prasad/ Mr Swaminathan Smoking and Alcohol Smoking prior to surgery delays wound healing and increases your risk of developing chest complications during and after surgery, not to mention increasing your risk of long term chest problems. Prior to hopital admission we advise that you stop smoking at least 2 weeks before and for at least 6 weeks after. If you require assistance with stopping smoking prior to surgery please visit your GP for advice. N.B. Your procedure may be cancelled if you have had alcohol or smoked on the day of your surgery. Tameside Hospital is a non smoking site. Alcohol intake should also be reduced prior to admission and for around 6-8 weeks after. If your intake is excessive please inform clinic staff or visit your GP. Keeping warm when in hospital It is important to keep warm prior to your operation as this will help you to lower your risk of complications. As the hospital may be cooler than your home, please pack additional clothing such as vests, cardigans, dressing gowns to help you to keep warm. It is also important to tell staff if you feel cold during your hospital stay. The Day of your Operation On arrival On arrival to the unit you should book in at the Reception, please tell staff of any changes to your personal details. Please be advised that whilst relatives/ friends will be able to stay with you in the waiting room, they will not be able to accompany you into the main ward area when you are called. If you are a day-case patient your escort will be given the units contact telephone number and an approximate discharge time from the nursing staff as to when to phone later for information. A restaurant and cafes are available please ask Receptionist for details. How will the day be organised? We allocate a nurse to each patient and they will introduce themselves when you arrive. You will be admitted by a member of the nursing staff either in an admission room or on the ward area. They will complete any relevant nursing documentation following on from your pre-operative assessment. Please inform the nurse if you require a fit for work (sick) note. The operating lists can be all day lists, morning or afternoon only. We will have asked you to come to hospital at a particular time in order to prepare you for your operation. Page 5 of 12
However, sometimes things change an emergency may take priority on the operating list or a piece of equipment may become unavailable until a certain time (e.g. specialist x-ray equipment) so we cannot guarantee the exact time of your operation. We will try to keep you informed if there are any changes or delays. If at any point you have any questions regarding your waiting time, please ask a member of the nursing team, who will find out the information for you. If you have not already done so, your surgeon or one of his team will explain the proposed procedure, and associated risks/ complications. You will then be asked to sign a consent form confirming that you are happy to proceed; your skin will be marked to highlight the operation site. You will also meet your anaesthetist who will discuss the type of anaesthetic, the drugs and pain relief they intend to use. After the operation You will be taken to the recovery room, following initial observation and if you are a day-case patient you will be transferred back to the Day Surgery Unit. In-patients will be transferred directly to the ward where you will remain until you are discharged. Discharge home can be as early as the following day. Patients who are having a total hip or knee replacement are usually discharged after two days. Day-case Patients The nurses will assess your progress regularly, ensuring that you have eaten and are drinking. When you are ready to go home, you will be given post-operative advice and information specific to your procedure along with contact telephone numbers in case you have any concerns once you get home. If you require a follow up appointment in Outpatients Clinic, this will be requested by the Nurse and you will receive an appointment letter in the post. If you have sutures (stitches) or skin clips that require removal or your Surgeon has requested a wound check, a referral to the District Nursing team will be completed. The nurse will explain all this to you before you go home. If necessary the nurse will give you painkillers to take home. Once you are at home For the first 24 hours at home, DO NOT: Drive, Operate machinery, Use a cooker, Ride a bicycle, Sign any legal documents Engage in any activity requiring skill or judgement. Take sleeping tablets Drink alcohol. In Patients Once on the ward the nursing staff will continue to monitor your recovery closely checking your observations, wound site and any drains or urinary catheters you may Page 6 of 12
have in situ. Mobilisation Following your surgery you will be encouraged to mobilise as soon as possible as this has been shown to promote a faster recovery and helps to prevent the complications associated with prolonged bedrest and reduced mobility. The staff on the Unit will assist you sit out of bed a few hours following your surgery if required. It is important that you set yourself your own personal goals to achieve each day, as this will encourage and motivate you and aid your recovery. Diet and Fluids It is important that you eat and drink as soon as you are able, we may monitor your food intake to ensure you are eating and drinking enough to help your recovery. Sickness Sometimes people experience feeling or being sick after an operation. If you do develop such symptoms please inform staff and they can give you some medication to help relieve this. Pain You will be given regular medication to control the pain, which will be prescribed according to your requirements. It is important that you inform staff if you are experiencing pain and is not relieved by the medication provided as adjustments can be made. Doctors review You will be seen by a doctor each day you are in hospital. They will be monitoring your progress and condition, ordering regular blood tests and any other investigations you may require. If you are worried about anything, contact your GP or call the Day Surgery Unit on 0161 922 4917. In the unlikely event of an emergency, go to your nearest Accident and Emergency (A&E) department. NHS 111 is available 24 hours a day for advice. Infection Prevention Information MRSA Staphylococcus Aureus is a very common germ that around 30% of the population carry on their skin or in their nose with no ill effects. This is called colonisation. In some people, the germ can cause simple skin infections such as boils or absesses that can be easily treated. MRSA (Methcillin Resistant Staphylococcus Aureus) is a type of Staphylococcus aureus that is resistant to the more common antibiotics that are used. MRSA, like Staphylococcus aureus, does not always cause infections, but can live on the skin without causing any ill effects. It was first identified in a hospital setting but is also present in Nursing and Residential homes and within the general community. How does MRSA spread? Page 7 of 12
MRSA is mainly spread on hands, so hand washing is the most important way to stop it spreading. It can also be spread by contaminated equipment or the environment. Hospital Patients MRSA can pose a problem to seriously ill patients who may be unable to fight infection. For this reason it is important to stop the germ spreading among hospital patients. What happens next? Now that the swabs have been collected it will take a few days before the results are available. If your result is positive, the Infection Prevention nurses will consult with your hospital doctor and will review your individual circumstances and needs. Some patients who have a positive MRSA test will be advised to follow a course of decolonisation. However, this is not required in all cases. If decolonisation is recommended for you we will contact you to arrange this. If your results are negative or if decolonisation is not required, at this time, then you will not be contacted. What will happen if decolonisation is required? You will be informed of this by a health care professional and will be provided with an antiseptic body wash solution and an antiseptic cream for your nose. Decolonisation is usually achieved after five days and helps to remove the MRSA. When this course of treatment has finished we may if necessary (depending on your individual needs and circumstances), arrange to repeat the screening test. If a second test is positive you may be asked to repeat the antiseptic treatment programme. What can I do to help the spread of the MRSA germ? The most important thing that helps stop the spread of MRSA bacteria is good hand hygiene. Before and after meals and after using the toilet or bedpan, wash your hands thoroughly (for 10 seconds) with hot water and soap, or use wet wipes. There are posters on the wards showing how to wash your hands really thoroughly. We expect all hospital staff to clean their hands before and after touching patients and if you do not see this happen, please ask the member of staff about this. Will I need to be in isolation? We try to separate patients who have a positive MRSA test whenever possible. This may be in a side room or in an area within a ward. By isolation we mean caring for you away from other patients who may be vulnerable. All staff wear aprons and gloves whilst attending to your needs. Cleaning of your room will still continue and cleaning staff will also wear gloves and aprons. Could I pass it onto others? Yes, MRSA can be passed on to other people. That is why we aim to segregate you and take extra care and precautions such as wearing gloves and aprons and practicing good hand hygiene. Page 8 of 12
Can I have visitors in hospital or when I go home? Yes. You can have visitors in hospital and at home. As the MRSA germ is passed on through touch, you and your visitors should simply make sure you use good hand hygiene which is proven to be effective. When your family and friends visit you in hospital, ask them to wash their hands when they arrive and before they leave. MRSA infections are unlikely to occur in healthy friends and family. How will I know if it has cleared? We will screen you again and after you have finished your treatment and once we have three sets of negative results and you will be considered clear. You may be admitted into a single room if you come back to hospital and screened again to check for MRSA. Will MRSA stop me going home? Once you are medically fit to leave, MRSA will not delay your discharge. If you live with vulnerable people any precautions that should be taken will be discussed with you and your carers. CARBAPENEMASE RESISTANT ENTEROBACTERIACEAE (CRE) What does carbapenemase Resistant Enterobacteriaceae mean? Enterobacteriaceae are bacteria that usually live harmlessly in the gut of humans. This is called colonisation (a person is said to be a carrier ). However, if the bacteria get into the wrong place, such as the bladder or bloodstream they can cause infection. Carbapenems are one of the most powerful types of antibiotics. Carbapenemases are enzymes (chemicals), made by some strains of these bacteria, which allow them to destroy carbapenem antibiotics and so the bacteria are said to be resistant to the antibiotics. Why does carbapenemase resistance matter? Carbapenem antibiotics can only be given in hospital directly into the bloodstream. Until now, doctors have relied on them to successfully treat certain difficult infections when other antibiotics have failed to do so. Therefore, in a hospital, where there are many vulnerable patients, spread of resistant bacteria can cause problems. Does carriage of carbapenemase Resistant Enterobacteriaceae need to be treated? If a person is a carrier of carbapenemase Resistant Enterobacteriaceae (sometimes called CRE), they do not need to be treated. As mentioned, these bacteria can live harmlessly in the gut. However, if the bacteria have caused an infection then antibiotics will be required. How will I know if I am at risk of being a carrier or having an infection? Your doctor or nurse may suspect that you are a carrier if you have been in a hospital abroad, or in a UK hospital that has had patients carrying these bacteria, or if you have been in contact with a carrier elsewhere. If any of these reasons apply to you and you are being admitted as an in patient, screening will be arranged for you as part of the pre operative procedure. How will I be screened for carbapenemase Resistant Enterobacteriaceae? If necessary you will be asked to either perform a rectal swab which you are required Page 9 of 12
to insert just inside your rectum (bottom) or provide a sample of faeces. The swab/sample will be sent to the laboratory and you will normally be informed of the result within two to three days. If the result is negative, a further two samples may be required.if all results are negative no further actions are required. Advice for patients who have a positive result What happens if the result is positive? If the result is positive, once on the ward you will be accommodated in a single room with your own toilet facilities. Should you develop an infection, you will need to have antibiotics. However, if there are no signs of infection and you are simply carrying the bacteria, no treatment is required. How can the spread of carbapenemase Resistant Enterobacteriaceae be prevented? Accommodating you in a single room if the result is positive helps to prevent spread of the bacteria. Healthcare workers should wash their hands regularly. They will use gloves and aprons when caring for you. The most important measure for you to take is to wash your hands well with soap and water, especially after going to the toilet. You should avoid touching medical devices (if you have any) such as your urinary catheter tube and your intravenous drip, particularly at the point where it is inserted into the body or skin. Visitors will be asked to wash their hands on entering and leaving the room and may be asked to wear an apron. What about when I go home? Whilst there is a chance that you may still be a carrier when you go home quite often this will go away with time. No special measures or treatment are required; any infection will have been treated prior to your discharge. You should carry on as normal, maintaining good hand hygiene. If you have any concerns you may wish to contact your GP for advice. A letter will be sent to your GP advising that you have been colonised with Carbapenemase Resistant Enterobacteriaceae. This will be useful for the future and it is also important that you make health care staff aware of it. Should you or a member of your household be admitted to hospital, you should let the hospital staff know that you are, or have been a carrier. Surgical Wound Infections What are surgical wound infections? Germs naturally live in our bodies and our environment, most are harmless and can be useful. The skin normally prevents germs from entering the body, but in areas where there is a break in the skin this can allow harmful germs to enter and cause infection, but most surgical wounds heal up rapidly without any complications. When can these infections develop? An infection can develop at any time until the wound has healed, length of time for healing depends on the type of surgery you have had. Very occasionally an infection can occur several months after the operation. Most surgical wound infections are limited to the skin, but can occasionally spread to deep tissues. Infections are more likely to occur after surgery on parts of the body that harbour lots of germs, such as the gut. Page 10 of 12
How the wound will be monitored whilst in hospital During your stay in hospital, the nurse who changes your wound dressings will check for any signs of infection. If you are concerned about your wound, inform the nurse or doctor who is looking after you. Surgical wound dressings should be left dry and untouched for a minimum of 48 hours post-operatively to allow the first stage of wound healing to occur, unless otherwise clinically indicated. Please do not remove your dressings, or touch the wound or wound drain. You could accidentally transfer germs from your hands to your wound. Hand washing is the simplest and easiest way of preventing the spread of infection and disease. It s ok to ask staff if they have cleaned their hands before they examine you. Wound advice after your operation bathing and showering You may shower safely 48 hours after surgery. Showering is preferable to bathing. You are only to take a bath if you are sure you can keep the wound dry. Some waterproof dressings can be left in place whilst taking your bath or shower, however other dressings may need to be removed. Try to avoid putting any soap, shower gel, body lotion, talcum powder or other bathing products directly onto the healing wound. Make sure you take care and pat the wound gently with a clean towel after bathing and showering. Signs of infection, what to look for An infection can develop after you leave hospital, please be aware redness and swelling is expected after surgery, as this can be part of the normal healing process. If you however develop any of the following symptoms, you may have an infection. Increased swelling Heat/increased redness Increased pain or discharge of fluid or pus If you genuinely feel unwell or develop a temperature If you develop a problem with your wound, please contact your GP, practice nurse or district nurse, unless you have been advised to contact the hospital, as treatment may be required. If you have any questions you want to ask, you can use this space below to remind you If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Patient Information Centre on 0161 922 5332 Page 11 of 12
Document Control Information Author: Jayne Grant Division/Department: Date Created: February 2017 Reference Number: Version: 1 Page 12 of 12