Coming for surgery - a guide for inpatients and day patients

Do not eat anything AFTER midnight, or have milk, on the day of your operation.

You can drink water up until 6am and then nothing to drink after this time. Prescribed drinks for enhanced recovery should be taken in accordance with the guidelines given to you by the Preassessment Clinic staff.

Please do NOT chew gum, eat sweets or drink anything other than water. ALL other fluids, including tea, coffee, carbonated drinks eg. coke, or milk of any sort, are NOT permitted during this time.

Failure to adhere to these guidelines could result in your operation being delayed or cancelled.

You may have a light meal such as tea and toast BEFORE 7am but no food or milk after this time. You may drink water up until 11am. Please do not drink anything after this time.

Take any regular medication that has been prescribed by your GP and is due on the morning of your operation with a sip of water, unless advised by Pre-assessment Clinic staff.

Prescribed drinks for enhanced recovery should be taken in accordance with the guidelines given to you by the Pre-assessment Clinic staff.

Please do NOT chew gum, eat sweets or drink anything other than water. ALL other fluids, including tea, coffee, carbonated drinks eg. coke, or milk of any sort, are NOT permitted during this time.

Failure to adhere to these guidelines could result in your operation being delayed or cancelled.

As far as can be assessed, you are fit for surgery, however you will be contacted if any of your test results are abnormal and need to be followed up. This may mean your operation or procedure needs to be postponed, but you will be advised on the way forward.

If you develop any illness or infection, or experience any changes in your health prior to your operation/procedure please contact the Pre-assessment Clinic on 01935 384863. They will be able to advise you whether your operation will be able to go ahead, after discussion with the anesthetist and/or surgeon.

Patients who are undergoing surgery will be screened for MRSA (Methicillin Resistant Staphylococcus Aureus). It is a type of bacteria that has become resistant to most antibiotics.

As there are some people in the community who have the MRSA bacteria without showing any symptoms, by screening we can find out who is an unknown carrier and provide treatment. The nurse will take a swab from your nose and/or groin. The swab is then sent to the laboratory for testing.

On the day of your surgery please refrain from:

• Chewing gum or eating boiled sweets
• Driving yourself in or using public transport - please arrange for someone to bring you or get a taxi
• Bringing any jewellery or valuables with you. Please remove your wedding band before surgery
• Smoking
• Wearing make-up and nail varnish - please remove before arrival
• You may bring iPods/mp3 players (all we ask is that you try not to disturb other patients while using it). However, please do not bring other portable electrical equipment, such as a hair dryer

Please note: Yeovil District Hospital NHS Foundation Trust accepts no responsibility for the loss of, or damage to, personal property of any kind, including money. You are responsible for the safekeeping of your property at all times.

Yeovil District Hospital is a smoke free site. Smoking is not permitted anywhere in the buildings or grounds. Smoking can increase the risk of complications, a longer length of stay and readmission.

Patients coming to the hospital are asked to consider giving up smoking to improve their health. Advice is also available for visitors, members of the public and hospital staff.

For your free local NHS Stop Smoking Service text ‘LOCAL’ and your postcode to 88088, telephone 0303 0339840 or speak to a member of staff.

Please have a bath or shower before your admission and please bring with you:

• Any drugs or inhalers you may take as prescribed by your GP
• Dressing gown and slippers (these are essential for your walk to theatre)
• Clothing that is comfortable and easy to put on for after your operation
• Toiletries

Please note: The time you have been instructed to arrive is an admission time and not the time of your operation. Your operation will be performed sometime during either the morning or afternoon.

Regardless of where you are admitted for your surgery, you may have to wait for your operation, so please bring something to keep you occupied. Yeovil Hospital has free Wi-Fi available on site.

Please check your letter carefully for where you need to arrive and check in.

Day Surgery Unit

Please check in with the receptionist of the Day Surgery Unit on level 3. Staff will admit you, answer any questions you have, and prepare you for surgery. Your surgeon and anaesthetist will visit you prior to your operation.

Theatre Admission Lounge (TAL)

Please check in at the reception desk in TAL situated on Ward 7A, Level 7. Staff will admit you, answer any questions you have, and prepare you for surgery. Your surgeon and anaesthetist will visit you prior to your operation. Please leave a telephone number for your named contact person with a member of the team and they will be called when you are ready to leave after your operation.

To preserve patients’ privacy and dignity, and to comply with the Department of Health standards, the Day Surgery Unit (DSU) and Theatre Admission Lounge (TAL) are unable to accommodate relatives and friends of patients attending the department unless in exceptional circumstances. This can be discussed and if it is considered to be in the patient’s best interest it will be arranged.

Jasmine Ward

Enter the Women’s Hospital main entrance, take the lift or stairs to Level 1. Ring the bell at the entrance to Jasmine Ward and a staff member will greet you there.

Please contact the DSU on 01935 384339, TAL on 01935 384778 and Gynaecology on 01935 384412 for further information.

Please check in at the reception desk in the Theatre Admission Lounge (TAL), situated on Ward 7A, Level 7. Staff will admit you , answer any questions you may have, and prepare you for surgery. Your surgeon and anaesthetist will visit you prior to your operation.

Please check in at the reception of the ward as stated in the admission confirmation letter. The Staff will admit you, answer any questions you have, and prepare you for surgery. Your surgeon and anaesthetist will visit you prior to your operation.

Eliminating mixed sex accommodation

Guidelines after general anaesthetic as day surgery:

After receiving a general anaesthetic, your co-ordination may be slightly muddled during the first 24-48 hours. Therefore, it is important to follow the instructions below for the first 48 hours following discharge from hospital.

• Rest for a day or two and refrain from strenuous activity
• When rising into a sitting or standing position, do so slowly
• Do not drive a car for 48 hours
• Do not use power tools or appliances that may cause harm or injury
• Do not make vital decisions or sign legal documents

You will only be allowed to go home once you have met the criteria for safe discharge. The staff will assess you and ensure that you are stable, comfortable, and have received full information about how to manage the next few days.

It is your responsibility to:

• Arrange for a responsible adult to stay with you for 24 hours
• Arrange for someone to accompany you home after your operation
• To stay locally. It is not recommended that you have a journey of more than one hour

After your operation

Once you have sufficiently recovered from your anaesthetic, and you have met the criteria for safe discharge from theatres, the Theatre Recovery team will escort you to the ward. They will hand your care over to the ward nursing team who will continue to monitor your progress by:

• Frequently observing your pulse, blood pressure and temperature
• Monitoring and assisting you in managing any pain you may have
• Checking your dressing (and drain if you have one)
• Assisting you to turn and move to get comfortable
• Do ask for help in getting up the first few times - you may not feel very steady
• You will be asked to do deep breathing and coughing exercises and to move your legs

The ward staff will assist in gradually re-introducing fluids and diet. Should you feel sick and vomit, advise the staff, lie down and take clear fluids only, starting with small sips and gradually increasing as you feel able.

Visiting times vary and are limited on the wards to allow routines to be carried out and give patients sufficient time to rest. Please check visiting times with the Sister/Charge Nurse on the ward.

Venous Thromboembolisms (blood clots) are more likely to form when the flow of blood is sluggish or virtually stagnant. Although most people are aware of the risks of blood clots occurring on long haul flights, it is much more likely to happen during a hospital stay, particularly following surgery when you are less active than normal.

Blood clots are preventable and as an inpatient at Yeovil District Hospital you will be assessed for your risk and preventative treatment given where appropriate. There is an information leaflet available ‘Reducing the risk of a blood clot’ which gives more detailed information. If you are not given one of these when you are assessed, please do ask.

After your operation it is important to keep the blood flowing to your feet to maintain your circulation and prevent blood clots forming. Do these every hour:

• Wiggle your toes up and down
• Bend your feet up and down at the ankles
• Move your legs in circles at your ankles
• Bend your feet up towards you and tighten your leg muscles, pressing the backs of your knees into the bed
• Tighten your seat muscles and feel your upper leg muscles tighten as well
• If you are allowed, bend your legs at the knees sliding your feet up along the bed towards you, then slide them down again

Remember:

• Do not cross your legs! This slows down the blood flow and could cause problems after an operation
• Do not remove your anti-embolism stockings without checking with the nurses. You may have flowtron boots or medication to reduce risk of blood clots
• Do your breathing and leg exercises together so you remember to do both

After your operation it is important to get moving as quickly as possible to get your lungs working and your blood circulating, which in turn will help you to recover from your surgery. Lying immobile in bed increases your risk of getting a blood clot, chest infection or pressure sore.

The following breathing exercise will help to:

• Improve your breathing
• Loosen any mucus
• Reduce the risk of a chest infection1. Place your hands on the sides of your chest
  2. Breathe in through your nose. You should feel your ribs move outwards pushing your hands apart
  3. Hold the breath for three seconds 4. Breathe out through your mouth

Do this three times every half hour.

You may find there is some phlegm at the back of your throat, so you will need to cough to remove this. This is a normal effect of the anaesthetic. If pain interferes with your breathing and coughing see the pain information in the drop down below, but please inform the nurse about your pain.

Good pain control after surgery is of vital importance. It will mean that you can breathe, cough and move more easily.

The type of pain control you are given will vary depending on the type of surgery you are having but there are various types.

Oral medication: For minor procedures, pain relief taken in tablet or liquid form is usually sufficient. As it takes about 30 minutes to act, it is important to tell someone as soon as you get pain.

Injections: More major operations may require stronger pain relief which can be given as an injection into the leg or via an intravenous drip.

Peripheral nerve block: This is an injection of local anaesthetic around the nerves which go to the area of your operation, making the entire area feel numb.

There are different types of nerve block, each aimed at different nerves. A nerve block can give pain relief for 2-18 hours depending on the site and on the drug used.

Epidural, PCA or Intrathecal: If you are going to have major surgery, you may require more specialist pain control. This may be in the form of an epidural or patient controlled analgesia (PCA).

PCA: is a method of pain control that puts you in charge of your pain. It allows you to give yourself pain relieving drugs when you need them. You do not have to wait for a nurse to bring an injection. You will have PCA as long as you need it, usually about 48 hours. Better pain control will enable you to mobilise and participate with physiotherapy. When you feel pain, you press the button on the handset. A small measured dose of pain relief will be given to you via a drip in your arm. The pump is specially programmed so you cannot overdose.

Epidural: Local anaesthetics are injected into your back where the nerves to your lower body pass through, as a result the nerve messages are blocked. It can be a very effective method of pain relief. An epidural pump allows local anaesthetic to be given continuously through a tube into your back. Other pain relieving drugs can also be added in small quantities. When the epidural is stopped, full feeling will return.

Intrathecal: An intrathecal injection is an injection into the spinal canal (sub-arachnoid space). Effective pain relief can be achieved from smaller doses, thereby reducing the risk of possible side-effects.

It is important that you take regular pain medication, especially for the first 48 hours following your operation. It is advisable to take the medication, even if you have no pain at all, as pain is more difficult to control once you have it. It is very important that you read the instructions on the packet, and follow them carefully. Remember that it can be dangerous to exceed the stated dose. If you were given pain medication while in hospital, your nurse will tell you when you are able to take your next dose.

Any time after the day of discharge, if you are still taking regular pain medication but still experiencing pain, the best option is for you to contact your own GP, as your records will no longer be in the Unit. Your GP can then refer you back to the hospital if needed.

It is important to tell the nursing staff as soon as you come into hospital if you regularly take pain medication at home. It is quite likely to contain Paracetamol and/or Codeine, which are found in many pain relief medications. This could lead to accidental overdosing.

Your doctor or nurse will advise you prior to discharge if you can take more than one pain medication at the same time.

• Rest and try to relax in a warm and quiet place, for example on the sofa, or in bed
• You may find it helpful to read or watch television, to take your mind off the pain
• Try to keep your wound protected and gently supported
• Ask a friend or relative to look after you for a few days. This is particularly useful if you have children

Medical Certificate
If you require a medical certificate to give to your employer, please ask on admission or as early as possible.

Transport on discharge
Please be aware that the hospital is unable to provide transport. Therefore, it will be necessary for you to make your own arrangements for getting home.

The Patient Advice and Liaison Service (PALS)
The Patient Advice and Liaison Service (PALS) provides patients, relatives, carers and service users with confidential and impartial help if they have a problem or need more information while using NHS services.

If, at any point, while you are in the hospital you would like to speak to a member of the PALS team, please let a member of staff know and they can organise this for you.

The PALS office is located on level 3 by the main entrance to the hospital. Please ask at reception or you can call 01935 384706.

The Discharge Lounge
As part of your discharge plan you may be transferred to the discharge lounge; a comfortable waiting area situated within the hospital on level 2 in the Queensway Treatment and Rehabilitation Unit.

Relatives/carers can pick you up, without needing a parking ticket, by using the designated pick-up area just outside the lounge. Once you have the relevant documents and medication you need, staff will contact your relative/carer to let them know you are ready to leave.

Sandwiches and hot meals are provided free of charge, as well as hot and cold drinks, which will be available throughout your stay in the lounge. A packed lunch/supper can also be provided if your journey home coincides with a meal time.

The Discharge Lounge Co-ordinator will help you to make your stay in the lounge comfortable and will work with the following departments on your behalf while you wait in comfort:

• Ward
• Pharmacy
• Portering
• Transport

For any information regarding the Discharge Lounge, contact 01935 384876.