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Nursing Management Plan Small or large bowel Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) Highlight the procedure/s and add other details: FF Open / Laparoscopic Assisted FF Hemicolectomy / Right / Left / Extended FF Sigmoid Colectomy / Transverse Colectomy FF Total Colectomy / Subtotal Colectomy FF Formation of Ileostomy / Loop / End FF Formation of Colostomy / Loop / End FF Reversal of Hartmanns FF Reversal of Ileostomy / Colostomy FF Other procedure or additional change to surgery: ______________________________________________________________________ This Nursing Management Plan is a guideline only for patients undergoing elective colorectal surgery within the ERAS pathway - use professional clinical judgement and decision making. Use Nursing Management Plan in conjunction with ERAS protocol: Capital Docs ID: 1.100959 CapitalDocs ID: 1.100995 | SUR NMP-01 | Issue date: January 2016 | Review date: January 2019 Page 1 of 11 Management Plan progression Laparoscopic procedures Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) Date of surgery: The / / Surgery: symbol indicates the expected patient progression along the care plan Date Post op day PACU / RTW Stage One Stage Two Stage Three Discharge 0 1 2 3 4 5 6 IV and Oral fluids IDC satis Pain score <5/10 Exercises Post-op wash and mouth cares Stop IV fluids/daily weigh Oral fluids and diet Oral analgesia IDC removed Assistance with mobilising and personal cares Commence stoma cares Initiate referrals Oral analgesia Tolerating most diet Oral fluids/daily weigh Continue stoma cares Minimal assistance with mobilising and personal cares Discharge planning Meeting most ERAS targets Tolerating diet Minimal pain Managing stoma cares Meeting ERAS targets Discharge planning complete Mobilising as pre-op Discharge criteria met Discharge plan in place Met ERAS targets Page 2 of 11 Management Plan progression Open procedures Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) Date of surgery: The / / Surgery: symbol indicates the expected patient progression along the care plan Date Post op day PACU / RTW Stage One Stage Two Stage Three Discharge 0 1 2 3 4 5 6 IV and Oral fluids IDC satis Pain score <5/10 Exercises Post-op wash and mouth cares Stop IV fluids/daily weigh Oral fluids and diet Oral analgesia IDC removed Assistance with mobilising and personal cares Commence stoma cares Initiate referrals Oral analgesia Tolerating most diet Oral fluids/daily weigh Continue stoma cares Minimal assistance with mobilising and personal cares Discharge planning Meeting most ERAS targets Tolerating diet Minimal pain Managing stoma cares Meeting ERAS targets Discharge planning complete Mobilising as pre-op Discharge criteria met Discharge plan in place Met ERAS targets Page 3 of 11 Discharge planning Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) Discussed length of stay: Support person on discharge: Relationship to patient: Barriers to discharge Action taken Discharge arrangements Date / / / / / / / / / / Details Date Transport on discharge / / District Nurse Referral / / CCC Home Help Referral / / Stoma Nurse Referral / / OT or PT equipment ordered / / / / / / Other: Other: ERAS discharge criteria met Discharge authorised by surgeon Discharge summary provided Prescription given to patient Discharge Checklist (to be completed on discharge) FF Yes FF N/A District Nurse referral faxed FF Yes FF N/A Stoma Nurse referral faxed FF Yes FF Yes FF N/A FF N/A Discharge advice / instructions FF Yes given to patient Dressing checked / changed FF Yes IVC removed FF Yes FF N/A FF N/A FF N/A CCC Home Help referral faxed Other convalescent care arranged Patients own medications returned Patients valuables returned Follow up appointment made FF Yes FF Yes FF N/A FF N/A FF Yes FF Yes FF N/A FF N/A FF Yes FF N/A FF Yes FF Yes FF N/A FF N/A Page 4 of 11 Management Plan Small & large bowel surgery Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) Date of surgery: / / Pre-admission Admission to Discharge Planner commenced Appropriate referrals initiated Length of stay discussed Pre-op education provided Patient booklet provided and explained Bowel preparation discussed Diet information given Nutricia preOp® drinks provided with administration instructions Stoma nurse input required Yes No Referred Day of Admission to Surgical Admissions Routine admission procedure completed Bowel preparation completed or administered if required Clear oral fluids up to 2 hours pre-op Time documented Nutricia preOp® drink was taken and finished Medication charted and given as per ERAS Anaesthetic Protocol TED stockings in situ unless contraindicated Patient prepared for theatre as per pre-op checklist Print Name Signature Initial Print Name FF FF FF FF FF FF FF FF FF Completed Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No FF FF FF FF FF FF FF Completed Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No Yes FF No Signature Initial Page 5 of 11 Management Plan Small & large bowel surgery Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) All columns must be completed with Yes or N/A not applicable AM V DAY OF SURGERY PM V N V Observations Vital signs recorded as per post-op protocol EWS recorded and acted on as per protocol Oxygen therapy as charted Input IV Plasmalyte 148 no more than 80 ml/hr Replacement as per protocol Free oral fluids commenced after surgery D37 diet started 1 Two fortisip drinks: 2 Oral fluid target met: >600ml Elimination Fluid Balance Chart maintained Urinary output target met: 0.3 - 0.5 ml/kg/hr Bowel function recorded If unexpected stoma refer to stoma CNS Stoma cares Colour and size of stoma documented Flatus, volume and consistency of stoma output documented Clear and drainable stoma bag in situ Pain management Epidural: PCA RSC Other Medication charted as per Anaesthetic Protocol Analgesia administered as per Anaesthetic Protocol Pain score recorded Physio & mobility Deep breathing and coughing exercises educated At minimum patient mobilised to bedside Out of bed for 2 hours: 1hr 2hrs Physio seen patient Post-op requirements Post-op wash and mouth cares attended to Wound checked each shift Drain output recorded on drain chart Patient diary completed each shift Risks Complete and action Braden Scale Assessment Complete and action Falls Risk Assessment TEDs in situ unless contraindicated Discharge planning Appropriate referrals initiated Page 6 of 11 Management Plan Small & large bowel surgery Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) All columns must be completed with Yes or N/A not applicable AM POST OPERATIVE DAY 1 V PM V N V Observations Vital signs recorded as per post-op protocol EWS recorded and acted on as per protocol Oxygen therapy as charted Daily morning weight before 1000hr Input Oral intake goals explained to patient Discontinue IVF at 0800hr Oral fluid target met:1500ml/24hr 500ml 1l 150ml 1 2 3 Three fortisip drinks: Rechart IVF if fluid intake <1L at 2000hrs D37 diet tolerated Dietician assessment required: yes no referred Antiemetics administered as charted Elimination Fluid Balance Chart maintained IDC removed by 0600 Urine output target met: 0.3 - 0.5 ml/kg/hr Bowel function recorded Stoma cares Colour and size of stoma documented Flatus and volume, colour and consistency of stoma output documented Patient watched stoma bag empty and bag change Pain management PCA RSC Other Epidural: PCA stopped if pain managed Analgesia administered as per Anaesthetic Protocol Pain score recorded Physio & mobility Deep breathing and coughing exercises encouraged 1 hr 2 hr Out of bed for 2 hours AM: Out of bed for 4 hours PM: 1 hr 2 hr 3 hr 4 hr 1 2 3 4 Walk 4x 10mins: yes no specify: Mobility aid required: Physio seen patient Post-op requirements Wound checked each shift Check patient diary completed each shift Patient assisted with shower/wash Discharge Planning yes no referred: Social Work required: yes no referred: OT required: Patient and support person informed of planned discharge date Risks and barriers to discharge identified Risks Pressure areas assessed TEDs unless contraindicated Page 7 of 11 Management Plan Small & large bowel surgery Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) All columns must be completed with Yes or N/A not applicable AM POST OPERATIVE DAY 2 V PM V N V Observations Vital signs recorded as per post-op protocol EWS recorded and acted on as per protocol Oxygen therapy as charted Daily morning weight before 1000hr Input Oral intake goals explained to patient Discontinue IVF at 0800hr if restarted yesterday Replacement as per protocol required Oral fluid target met:1500ml/24hr 500ml 1l 150ml 1 2 3 Three fortisip drinks: D37 diet tolerated Antiemetics administered as charted Elimination Fluid Balance Chart maintained IDC removed by 0600 Urine output target met: 0.3 - 0.5 ml/kg/hr Bowel function recorded Stoma cares Colour and size of stoma documented Flatus and volume, colour and consistency of stoma output documented Patient assisted to empty stoma bag Patient assisted to change stoma bag Patient educated in skin & hygiene cares Pain management PCA RSC Other Epidural: Epidural / PCA / RSC stopped & removed Analgesia administered as per Anaesthetic Protocol Pain score recorded Physio & mobility Deep breathing and coughing exercises encouraged 1 hr 2 hr 3 hr Out of bed for 3 hours AM: Out of bed for 4 hours PM: 1 hr 2 hr 3 hr 4 hr 1 2 3 4 Walk 4x 10mins: yes no specify: Mobility aid required: yes no specify: Physio input required: Post-op requirements Wound checked each shift Check patient diary completed each shift Patient showered / washed with minimal assistance Risks Pressure areas assessed TEDs unless contraindicated Discharge planning yes no seen Social work required: yes no seen OT required: Patient & support person informed of planned discharge date Risks & barriers to discharge identified Page 8 of 11 Management Plan Small & large bowel surgery Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) All columns must be completed with Yes or N/A not applicable AM POST OPERATIVE DAY 3 V PM V N V Observations Vital signs recorded as per post-op protocol EWS recorded and acted on as per protocol Daily morning weight before 1000hr Input Oral intake goals explained to patient Replacement as per protocol required Oral fluid target met:1500ml/24hr 500ml 1l 150ml 1 2 3 Three fortisip drinks: D37 diet tolerated Antiemetics administered as charted Elimination Fluid Balance Chart maintained Bowel function recorded Stoma cares Colour and size of stoma documented Flatus and volume, colour and consistency of stoma output documented Patient assisted to empty stoma bag Patient assisted to change stoma bag Patient demonstrates skin & hygiene cares Pain management Analgesia administered as per Anaesthetic Protocol Pain score recorded Physio & mobility Deep breathing and coughing exercises encouraged 1 hr 2 hr 3 hr Out of bed for 3 hours AM: Out of bed for 4 hours PM: 1 hr 2 hr 3 hr 4 hr 1 2 3 4 Walk 4x 10mins: yes no specify: Mobility aid required: yes no specify: Physio input required: Post-op requirements Wound checked each shift Check patient diary completed each shift Patient showered / washed with minimal assistance Discharge planning Patient & support person informed of planned discharge date Risks & barriers to discharge being addressed Discharge criteria No IVF required and patient tolerating diet and oral fluids Pain is managed with oral analgesia Patient has passed flatus not necessary to have a bowel motion Returning to normal level of function Satisfactory home support Vitals signs within normal range Page 9 of 11 Management Plan Small & large bowel surgery Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) All columns must be completed with Yes or N/A not applicable AM POST OPERATIVE DAY 4 V PM V N V Observations Vital signs recorded as per post-op protocol EWS recorded and acted on as per protocol Daily morning weight before 1000hr Input Oral fluid target met:1500ml/24hr 500ml 1l 150ml 1 2 3 Three fortisip drinks: D37 diet tolerated Antiemetics administered as charted Elimination Fluid Balance Chart maintained Bowel function recorded Stoma cares Colour and size of stoma documented Patient independently empties stoma appliance Patient independently changes stoma appliance Patient demonstrates skin & hygiene cares Pain management Analgesia administered as per Anaesthetic Protocol Pain score recorded Physio & mobility Deep breathing and coughing exercises encouraged 1 hr 2 hr 3 hr Out of bed for 3 hours AM: Out of bed for 4 hours PM: 1 hr 2 hr 3 hr 4 hr 1 2 3 4 Walk 4x 10mins: yes no specify: Mobility aid required: Post-op requirements Wound checked each shift Check patient diary completed each shift Patient showered / washed with minimal assistance Discharge planning Discharge issues addressed Discharge criteria No IVF required and patient tolerating diet and oral fluids Pain is managed with oral analgesia Patient has passed flatus and/or bowels opened Returning to normal level of function Satisfactory home support Vitals signs within normal range Stoma CNS seen and discharged patient Page 10 of 11 Management Plan Small & large bowel surgery Surname: .................................. NHI: .................... First Names: . . .......................................................... D ate of Bir th: ......... / . . ...... / . . ....... Sex: . . .................... PL ACE PATIENT ID HERE ENHANCED RECOVERY AFTER SURGERY (ERAS) All columns must be completed with Yes or N/A not applicable AM POST OPERATIVE DAY 5 V PM V N V Observations Vital signs recorded as per post-op protocol EWS recorded and acted on as per protocol Daily morning weight before 1000hr Input Oral fluid target met:1500ml/24hr 500ml 1l 150ml 1 2 3 Three fortisip drinks: D37 diet tolerated Antiemetics administered as charted Elimination Fluid Balance Chart maintained Bowel function recorded Stoma cares Colour and size of stoma documented Patient independently empties stoma appliance Patient independently changes stoma appliance Patient demonstrates skin & hygiene cares Pain management Analgesia administered as per Anaesthetic Protocol Pain score recorded Physio & mobility Deep breathing and coughing exercises encouraged 1 hr 2 hr 3 hr Out of bed for 3 hours AM: Out of bed for 4 hours PM: 1 hr 2 hr 3 hr 4 hr 1 2 3 4 Walk 4x 10mins: yes no specify: Mobility aid required: Post-op requirements Wound checked each shift Check patient diary completed each shift Patient showered / washed with minimal assistance Discharge planning Discharge issues addressed Discharge criteria No IVF required and patient tolerating diet and oral fluids Pain is managed with oral analgesia Patient has passed flatus and/or bowels opened Returning to normal level of function Satisfactory home support Vitals signs within normal range Stoma CNS seen and discharged patient CapitalDocs ID: 1.100995 | SUR NMP-01 | Issue date: January 2016 | Review date: January 2019 Page 11 of 11 This page has been intentionally left blank.
