• Reference Number: HEY-441/2018
• Departments:
• Last Updated: 3 July 2018

Introduction

This leaflet has been produced to give you general information about your procedure, maximise your recovery, minimise any complications and assist you to be well prepared for your stay with us on the Colorectal Surgical Unit.

Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If, after reading it, you have any concerns or require further explanation, please discuss this with a member of the healthcare team who have been caring for you.

Enhanced Recovery After Surgery (ERAS)

As part of our ongoing commitment to the delivery of quality care we have developed a programme designed to enhance your recovery after your surgery and ensure that your stay in hospital is as short as possible. As part of this programme it is necessary to involve you in all aspects of your care from the moment we see you in our clinics through to your discharge from hospital.

We will aim to

• Ensure you are provided with appropriate nutritional support prior to and following your surgery. This is important in order to maintain adequate fluid intake, assist wound healing and promote recovery. You will therefore be encouraged to eat and drink as soon as possible after your operation.
• Ensure you have adequate pain relief throughout your stay and following discharge home.
• Support you through a programme of mobilisation, as soon as possible after your operation. This is important in order to prevent you from developing blood clots in your legs and to stop your muscles wasting. This will also help to prevent you developing a pressure sores. As part of your rehabilitation you will be provided with a chart to record your progress. We will also teach you how to breathe more effectively which reduces the risk of developing a chest infection.

THE ANTICIPATED LENGTH OF YOUR STAY IS 5 – 7 DAYS this is not to say that you will be in hospital for this amount of time, it may mean that you need to stay longer than this or you may recover quicker than this and require less time in hospital.  We will assess you every day to make sure that you will be safe when you go home.

Preparing for your hospital admission

Before You Come into Hospital

We encourage you to be involved with the planning of your care and recovery from the time you are seen in clinic until your discharge from hospital. You will have the opportunity to inform us about your individual needs and home circumstances.

It is important that you inform us if you feel that your circumstances have changed, or if you feel you may be unable to manage your daily activities when you are discharged from hospital, following your operation.

Please note you will be expected to bring into hospital the following items:- 

• Comfortable loose fitting clothing to wear during the day following surgery.
• Toiletries
• Wet wipes (these can be used to freshen your hands prior meal times).
• Any walking aids you normally use.  (Please attach a label with your name).
• Juice or preferred non carbonated drink.
• Music and/or reading material. Please note your bed space has an overhead television and telephone. If you would like to use this service a cost will be incurred and therefore you will need to bring with you a small amount of money.
• You may also require a small amount of money, if you wish to purchase a newspaper or buy from the shop.
• Please bring a pen with you as you will be encouraged to complete your daily menu, diary and exercise chart.
• Loose fitting nightwear, nightshirt/pyjamas, dressing gown and well fitting slippers, not mules.  Shorts and tee shirts can be used as an alternative to pyjamas.  You will be expected to wear your own nightwear 1 – 2 days after surgery.

Medication

You will need to bring with you all the medication that you are currently taking.

You will also need to arrange to have a 28 days supply of your usual medication together with a supply of paracetamol and ibuprofen, unless you have an allergy to either of these medications at home ready for your discharge. This is necessary as the hospital will not  provide you with these items. The hospital will arrange for you to have a supply of any new medication, which you will be required to continue to take, following your discharge form hospital.

If you are taking warfarin, Clopidogrel or any other medication that thins your blood it is important that you inform the pre-assessment nurse as  you may need to stop taking this medication prior to your operation.  This is to prevent you having problems with bleeding following your surgery.

Too help prevent the formation of blood clots you will be expected to give yourself an injection each evening called Fragmin.  The nursing staff will do this for you for the first few days, but they will then teach you how to give your own.  This is important as Fragmin needs to be administered for up to 28 days following your operation.  If you are physically unable to do this it may be possible to teach a family member or carer how to do this for you.  The pre assessment nurse will have given you a DVD, it is strongly advised that you watch this at home before your admission, if you are unable to do this please let the nursing staff know on your admission and they will arrange for you to watch it on the ward.  If you have any questions or concerns the ward team will be happy to answer any of these for you. 

Available Support

We have a large team of dedicated medical and nursing staff and other professionals who can help to organise any  support you might need. Please do not hesitate to ask for assistance or advice.

Stoma Care (if applicable)

You will be seen in the stoma care department by one of the dedicated stoma care specialist nurses. You will receive information to help you prepare for your stoma formation.  After your operation you will be instructed by the nursing staff on how to care for your stoma. The specialist stoma care nurse will also continue to visit you and monitor your progress. They will offer support and advice and ensure that you are prepared for your discharge. They will also arrange to see you after your discharge to ensure that you are managing your own stoma care.

The Day Before your Operation

This is the day you will be admitted to hospital.  Around 6pm you will be asked to drink 4 cartons of a carbohydrate drink. This is given to support your nutritional intake and prevent you from becoming dehydrated prior to your operation;. You will be allowed to eat normally for up to 6 hours and you may drink clear fluids up until 2 hours before your operation.  These are important to enhance your recovery after surgery.

The Day of your Operation 

You will be provided with a further 2 cartons of the carbohydrate drink which you need to finish 2 hours prior to your surgery. The nursing staff will arrange this with you. Some patients may require an enema to be administered. This will be given 1 hour before your operation in order to clear out a small part of the bowel.

When you arrive back on the ward you will be transferred to the ward high observation bay . This is an area of the ward where all patients undergoing major bowel surgery are nursed, in order to provide close monitoring in the initial period following surgery.

You will be attached to an intravenous infusion, also known as a “drip” to maintain your hydration. The surgeon will have placed a catheter into your bladder in order to drain your urine and allow the nursing staff to monitor your urine output. These tubes are temporary and will be removed within 24 – 72 hours.

You will also receive medication for pain relief. This can be provided in one of two ways:-

An epidural

This will provide you with continuous pain relief into your back via a thin tube as explained to you during your pre-assessment visit.

Patient Controlled Analgesia (PCA)

This will provide you with pain relief via an intravenous infusion or “drip” into your arm or neck. You will have a handset with a button for you to press which slowly releases pain medication. You will also be given tablets to prevent pain and sickness following your operation once you are able to drink.

If you are thirsty after your operation you will be able to drink normally.  You will also be able to eat later in the day. The nursing staff will advise you on what type of food is available.

If you are scheduled to be first on the morning theatre list you will be expected to try and sit out in your chair for 2 hours after your surgery in the late afternoon or early evening as part of your enhanced recovery programme.  

The Day After your Operation

Your enhanced recovery programme will continue. The nurses will help you to sit out of bed and mobilise throughout the day.  You will also be able to eat and drink.

You will be encouraged to take at least 3 – 4 walks around the ward with the help of the nurses and the physiotherapists, if required.  You will find markers on the floor around the ward to assist you with monitoring your progress and then you can record this on your exercise chart.  You may feel tired initially but you will be given a chance to rest in between walks.  Your pain relief medication will continue as you may feel sore but this will help you to mobilise more comfortably.

The nursing staff will continue to monitor the level of pain you are experiencing to ensure that this is managed effectively.

The physiotherapist may also teach you some deep breathing exercises to practice every half an hour as well as some exercises for your ankles and feet to help prevent blood clots in your legs.

High protein drinks will be provided as ‘extra’ calories to help wound healing and give you more energy to move around the ward.

If you have had a stoma as part of your operation you will be seen by the stoma care nurse specialists who will provide teaching sessions with you.  It is important to practice daily so that you are able to manage the stoma confidently when you go home.  Therefore, you will be expected to participate in daily pouch changes and emptying, up until you are discharged home.

Do not forget to fill in your patient diary as this will help you to see your progress and set goals for the next day. 

The Second Post Operative Day

Your epidural or PCA may be removed today.  You may feel some pain but it will become easier. You will still need to take regular painkillers so that you are able to walk around the ward, sit out for meals and make your way to the bathroom for a wash.

Any of the remaining tubes will be removed and you will be encouraged with all of the above activities.

Most people are passing wind from their bowels by this point.  You may feel more comfortable when you have opened you bowels normally.  Please do not worry if you have not passed wind, everyone recovers at a different pace.

The nurse will discuss going home with you and plan for this to happen within the next few days.

Do not forget to fill in your patient diary. 

Day Three Onwards

If you still have your epidural or PCA this will be removed today along with any remaining tubes you may have.

We will encourage you to increase your physical activity by walking around the ward.  This will help your bowels recover and reduce any bloating in your tummy.

You will also be eating and drinking better and your confidence will increase.

The oral painkillers will continue once your epidural or PCA has been removed.  You may still feel sore from your operation so you will need to take these regularly each time the nursing staff offers them to you. These will also continue when you go home.

Complications following surgery are all reduced as a result of increasing your activity levels as well as a shorter hospital stay.

If at any point you become unwell or suffer any complication of surgery which may affect your recovery, we will take you off this programme until you are well enough to resume your recovery. 

Going Home

You will be seen by the surgical team on a daily basis and they will allow you to go home if:-

• You feel confident about managing at home or services have been arranged
• You are passing wind and/or opening your bowels/stoma
• You are eating and drinking as well as carrying out normal activities like getting dressed
• You do not have a temperature or signs of a wound or chest infection
• You are walking around the ward safely and independently, with or without a walking aid, or you have returned to your previous level of mobility
• You are passing urine without difficulty
• You are confident to manage your stoma, if this applies to you

When you are discharged you will be provided with 28 days supply of painkillers and any other medications such as antibiotics or medication that have been started in hospital.  The nursing staff will explain all of your take home medication and show you how and when to take these. You will be expected to have
1 month’s supply of your regular repeat prescription medication at home ready for discharge as well as paracetamol and ibuprofen (unless you have an allergy to either of these drugs) as we will not be providing these.  This will allow our pharmacy to deliver your take home drugs quicker so as not to delay you going home.

It is important to continue with the painkillers until you are comfortable.  This will allow you to continue with normal activities at home such as bathing, dressing, making a drink etc.  If you require more painkillers you will need to visit your registered GP, however most patients find that the pain gets easier day by day.  You will also be able to gradually increase your activity and exercise.

On your day of discharge you will be expected to vacate your bed by 10am.  If you are unable to be collected by this time we will ask that you sit in our day room where you can wait in comfort for your medication and transport.

You will be given a patient information leaflet that gives you specific advice about what to expect when you get home.

You will be seen routinely in the surgical clinic for follow up care, a letter will be sent to you in the post.

Further Advice

If you have any concerns/questions or you are feeling unwell please contact us on:-

Ward 10:  (01482) 623010

Ward 11:  (01482) 623011

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Colorectal Surgical Department on Tel No: (01482) 623011

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.