In this section : Admission
Hospital at Home (H@H)
Fracture Management Guidelines (Paediatric)
Fracture Management Guidelines (Adult)
Prescribing for CAU Patients Still in ED
Standard Operating Procedure for AMU
Prescribing Advice on Admission – Items Not Prescribed by GP
Prescribing Advice on Admission
Adults With Incapacity
Boarding
Obstetrics & Gynaecology/Medicine Admission Agreement
Urology Out of Hours
Urology Out of Hours
Transfer from Galloway Community Hospital
Repatriation of Patients from Tertiary Hospitals
‘Watershed’ Conditions
Ambulatory Care for Blood and/or Iron Infusion
Elective Admission – Colorectal Surgery
Trauma Admissions
Elective Admission – ERCP
Elective Admission – Orthopaedics
Acute Surgical Admissions
Emergency Laryngectomy Management
Emergency Tracheostomy Management
Elective Admission – Colorectal Surgery
Last updated 14th May 2021
All elective colorectal patients are automatically classed as Enhanced Recovery and treated according to pathway
Clerking in patients
- Ensure a complete clerk in is done including past medical history, social history (patients who scores >9 on FAST score would need to be on IV Pabrinex (3 ampules TDS for 3 days) + GMAWS protocol), any recent illness
- Bloods
- IV access (preferably at dorsum of hand)
- FBC, U&E, LFT (if has history of liver disease), INR (if on warfarin)/ clotting screen, Cross-match (1x 7.5ml tube)
- HEPMA
- 2 ERAS bundles on HEPMA – type ‘colorectal’ under protocol and 2 bundles will appear – medication and oral nutritional supplement. Medication includes LMWH, anti-embolic stockings.
- Suspend any potential nephrotoxics prior to operation – including NSAIDs, ACEi. Prescribe all medications on HEPMA and then suspend these to reduce errors.
- Antiplatelets
- Aspirin – suspend on day of surgery
- Clopidogrel should be stopped 7 days prior to operation
- Unless contraindicated (Hx of peripheral arterial disease), all patients should be prescribed TED stockings
- LMWH Dalteparin 5000 units prescribed at 1800 for post-op day till discharge
Analgesia + Laxatives
- Regular paracetamol (prescribe under Protocol for option of IV/oral)
- PRN Antiemetics – Ondansetron and cyclizine (prescribe under Protocol for option of IV/oral)
Thromboprophylaxis
- Warfarin
- Patients on warfarin should have stopped their warfarin 5 days before surgery and started on LMWH (Dalteparin 5000 units) during this period
- Check INR afternoon before surgery, if INR >1.4 give 1mg oral vitamin K and repeat INR
- Last dose of LMWH 12 hours prior to surgery
- DOAC
- These should be stopped 48-72 hours before surgery
ERAS Protocol
- Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery.This protocol is used for all elective colorectal resections.
- Please print out the ERAS pathway and fill this in – see attached link below
- Bowel preparation
Right hemicolectomy Mr Dreyer, Mr Ip, Mr Collins' patients - no bowel prep
Mr Whitelaw, Mr Darabnia - 2 sachets moviprepLeft hemicolectomy 2 sachets moviprep Sigmoid colectomy 2 sachets moviprep Abdomino-perineal (AP) Resection Mr Whitelaw, Mr Darabnia & Mr Dreyer - 2 sachets moviprep
Mr Collins & Mr Ip - phosphate enema 6am day of surgeryAnterior Resection/Total Mesorectal Resection (TME) 2 sachets moviprep Hartmanns No bowel prep Pan Proctocolectomy No bowel prep Total Colectomy No bowel prep Reversal of Ileostomy No bowel prep Reversal of Hartmanns 2 sachets of moviprep + phosphate enema PR 1800 day before surgery Reversal of loop colostomy Refer to Surgeons Formation of loop colostomy Mr Whitelaw, Mr Darabnia & Mr Dreyer - no bowel prep
Mr Collins & Mr Ip - phosphate enema 6am of day of surgery - Moviprep – given on day before surgery, 1st sachet at approx 1100, 2nd sachet at 1600
- ERAS Nurse – Fiona Black (Ext – 32412) will meet the patient on the day before surgery for stoma siting
- Pre-op drinks
- 6 bottles of Nutricia Pre-op drinks prescribed on HEPMA under colorectal ERAS bundle
- 4 bottles on the day before surgery at 1800
- 2 bottles on day of surgery – 2 ½ hours before procedure
- No pre op drinks if diabetic or known delayed gastric emptying issues
Fasting
- Patients are advised to drink clear fluids (this includes tea/ coffee without milk) till 2 hours before operation
- Last meal should be 6 hours before operation
- No indications for IV fluids unless prolonged periods of fasting
Links
- ERAS Colorectal Surgery Bundle (NHS DG computer only)