Gynaecology Enhanced Recovery Programme

Enhanced Recovery Programme – Gynaecology

Enhanced Recovery Programme

Introduction
This information aims to increase your level of understanding of how you can play an active part in your recovery after your surgery. If there is anything that you are unsure about, please ask. It is important that you understand how you can help yourself recover, so that you, your family and friends can be involved. This is the programme offered by Worcestershire Acute Hospital NHS Trust for patients undergoing gynaecological surgery. There may be circumstances where the programme will not be appropriate for some patients and if this is the case, you will be fully informed. So we welcome you to be part of the team in ensuring you have a smooth recovery.

What is the Enhanced Recovery Programme?
The aim of the Enhanced Recovery Programme is to get you back to full health as quickly as possible after your operation. Research indicates that after surgery, the earlier you get out of bed, start exercising, eating and drinking, your recovery will be quicker and it will be less likely that complications will develop. This will hopefully allow you to return home earlier. Some of the benefits include:

• A quicker return to normal bowel function
• Reduced chest infection
• A quicker return to usual mobility
• Decreased fatigue
• Reduced risk of developing blood clot after surgery

In order to achieve this we need you to be partners with us so that we can work together to speed up your recovery.

What will happen?

Before you come into hospital
The consultant would have seen you in the outpatients department to explain your operation. Following this you will be given a card explaining how you can register for your pre-operative assessment on a system known as Synopsis. You can also access the pre-operative assessment via this link https://www.worcsacute.nhs.uk/pre-opquestionnaire. Do kindly complete this questionnaire so that we can help you prepare for surgery. If you are unable to access this electronically, we will arrange an alternative pre-operative assessment.

You may be sent a date to attend the pre-operative assessment clinic, where trained staff will carry out routine tests that are required to ensure you are fit and safely prepared for surgery. Please note all patients are routinely screened for potential infections at this time.

You will be provided with written or electronic information and given plenty of opportunity to ask questions.

You may be referred to the anaesthetist if necessary.

The nurse will discuss your arrangements at home so that together we can plan for any help you may need after your operation. The nurse also will discuss your diet. You may be given some pre-operative drinks to take home with you. This will help keep you well hydrated during surgery. You can choose from a variety of flavours. If you have concerns about your appetite or diet before coming in for your operation please refer to the eating and drinking section later in this leaflet.

What you eat is important, as good nutrition now will help you recover faster from your operation

The physiotherapist will provide written information on what exercise you should practice before and after surgery. In addition, there is a video which you can access introducing the various exercises that will help you recover faster. It is important to keep as active as you can before your operation.

Improving your fitness by exercising before and after surgery will help improve your muscle strength, helping you return to normal function quickly

If you are a smoker you should stop now

This helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice on products to help you stop smoking.

If you are diabetic, please see your GP to optimise your blood sugar control. If you are anaemic, please see your GP to optimise your iron levels.

This will help with reducing infections and improve wound healing.

If you are on HRT, please stop your HRT at least 4 weeks before surgery. This will reduce the risk of blood clots in your legs or lungs

Please bring a supply of your own medications into hospital with you. These will be stored safely on the ward and be returned to you on discharge.

Please also bring a supply of comfortable ‘day clothes’ as you will be encouraged to return to normality as quickly as possible after your operation, and this includes getting dressed.

Eating and drinking
Prior to your surgery you will be able to eat and drink as normal until 6 hours before you come into hospital. This includes chewing gum or sucking sweets. You can continue to have clear fluids until 2 hours before surgery.

A well balanced diet is important to help with wound healing, to reduce the risk of infection and aid with your overall recovery.

It is important that you also continue to have a variety of other non-fizzy drinks during your hospital stay. A few hours after your operation you will start to drink clear fluid if you wish. It is important that you eat and drink early after your surgery. Staff will help and advise you. Initially some patients may find a low fibre diet more tolerable.

Some patients will be advised to have bowel preparation in a form of laxatives as well as a low residual diet for 5 days as part of their pre-operative work-up.

You will be advised at pre-operative assessment if you require this.

You will be encouraged to sit in your chair to eat.

Recent studies show that chewing gum after an operation can be helpful towards improving your recovery by assisting the bowel to return to its normal function. On the day you come into hospital bring some chewing gum with you.

After your operation chew gum for 15 minutes, three times a day, until your bowel function returns to normal.

Preparing for theatre
In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.

It is important that you keep yourself warm before your operation and you are advised to dress accordingly. (Warm dressing gown, socks, slippers, blankets.) You will be asked to remove the warm clothing when it is time for your operation as you will be required to wear a hospital gown.

After Your Operation
You may be given a small injection called ‘enoxaparin’ at approximately 6pm each day you are in hospital. Some patient will require the injection twice a day. This helps reduce the risk of blood clots by thinning the blood. Some patients who are at higher risk of experiencing blood clots may have to continue with the injection once home. This would only be for a few weeks after surgery and will be fully discussed with you when you are in hospital.

Most patients are able to administer the injection themselves or with the help of a relative or carer. The nurses on the ward will show you how to use the injection during your hospital stay. If you have any problems with administering the injection an appointment can be made with your practice nurse to carry this out each day, or we will arrange for a District Nurse to visit you if you are unable to leave the house.

Pain Control
It is important that your pain is controlled so that you can breathe deeply, walk about, eat and drink, feel relaxed and sleep well. Please let us know if your pain is not manageable so that we can help you. It is also important for us to know if you are either allergic or sensitive to certain pain killers.

You may be given one of, or a combination of the following methods of pain relief, to keep you comfortable after surgery:

• Oral analgesia. Paracetamol four times a day. You may also be given ibuprofen three times a day if it is appropriate for you.
• Spinal block. This is an injection given at the time of your operation that will temporarily numb you from the waist down and will help keep you comfortable afterwards.
• TAP block. This is an injection given at the time of your operation to temporarily numb the abdomen and help you keep comfortable immediately afterwards.
• Patient controlled analgesia (PCA). This is an intravenous pain killing medication, delivered by a machine, which is set up so that you can control it yourself. You will be given instructions on how to do this.

The anaesthetist will discuss these options with you and advise you on the best option when you are in hospital.

Sickness
You will be given anti-sickness medicine as part of your anaesthetic to help prevent nausea and vomiting. But if you feel sick following surgery please tell a member of staff who will be able to give you something for this. It is important to control your sickness so that you are able to drink, eat and sleep well.

Tubes and Drips
You may have a variety of drips, tubes and drains when you return from surgery. The nurses will explain what these are for. You will have an intravenous drip put into your arm to ensure you do not become dehydrated.

You may also be required to breathe extra oxygen for a short while after your operation. You will have a catheter to help us monitor your urine output after the operation. We will remove the drips, tubes and catheter as early as possible.

Monitoring
Many different things will be monitored during your treatment including:

• Observations (blood pressure, pulse, temperature).
• How much you drink.
• Food eaten.
• How much urine you pass.
• Pain and sickness assessment.
• When your bowel first start working.
• Mobility which includes sitting out in a chair and walking.

You may be asked to tell us about what you eat and drink and what you pass so that we can record it.

Please remember playing an active part in your recovery will help you get better soon.
If you have any questions regarding your recovery, please do not be afraid to ask a member of staff.

Mobilising and exercising
Our physiotherapists have developed a patient information booklet as well as a video showing you the appropriate activities and exercises that will help you recover well. The nurse at pre-operative assessment clinic will show you where this information can be found on our Trust website. If required we can give you a copy of the booklet.

Deep breathing exercise
Following your operation when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour. To do these you will need to:

• Be in an upright position.
• Take a deep slow breath in (feel your stomach gently rise).
• Hold the breath for 3 seconds.
• Breathe out slowly.
• Repeat 5 times.

You should cough regularly to make sure your lungs are clear of secretions. To do this, place a towel or pillow over your abdomen and incision site. Support it with your hands and cough.

When you are sitting in the chair or lying in bed, you should also do frequent leg exercises, (as prevention against blood clots); pointing your feet up and down and moving your ankles as if making circles can achieve this.

Getting out of bed
The staff will help you out of bed after your operation. This may be on the same day. The time spent out of bed will be increased daily. You will start with short walks, gradually increasing up to 60 metres 4 times per day after your surgery. The aim is to return you to your usual level of activity.

By being out of bed in a more upright position and by walking regularly, lung function is improved and there is less chance of a chest infection after surgery. Circulation is also improved, reducing the risk of a blood clot and helping bowel function return to normal.

We will discharge you when:

• Your pain is well controlled
• You are eating and drinking
• You are passing urine normally
• You are up and moving around the ward comfortably

Please kindly purchase your own supply of simple analgesia such as paracetamol and ibuprofen in preparation for discharge.

We will give you further information before you go home regarding what will happen once you go home and what to do if you think there is something wrong along with contact numbers for the ward and the gynae assessment unit (GAU) at Worcestershire Royal Hospital.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Thursday from 8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible

If you are unable to understand this leaflet, please communicate with a member of staff.

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