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 – Orthopaedics
Last updated 14th May 2021
Routine elective admissions for orthopaedics include total knee replacements (TKR), total hip replacements (THR) and shoulder replacements
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
- If FBC & U&Es taken during pre-op assessment in past 3/12 are normal and no new issues, no need for repeat
- INR – if on warfarin
- G&S needed on day of admission
ECG
- All patients
HEPMA
- Suspend any potential nephrotoxics prior to operation – including NSAIDs, ACEi. Prescribe all medications on HEPMA and then suspend these to reduce errors.
- Antiplatelets –
- Aspirin – look through last consultant letter regarding advice
- Clopidogrel should be stopped 7 days prior to operation
- Unless contraindicated (Hx of peripheral arterial disease), all patients should be prescribed TED stockings
Analgesia + Laxatives
Total Hip Replacement (THR)
- Regular Paracetamol QDS
- Oxycodone 10mg
- On morning of surgery – 7.00am if first on list, 10.30am otherwise
- 3 doses post- op every 12 hourly (8.00am and 8.00pm)
- Co-codamol 30/500 PRN after ± for discharge (ensure paracetamol is not prescribed concurrently)
- Oromorph 10mg PRN if only on paracetamol
Total Knee Replacement (TKR)
- Regular paracetamol QDS
- Oxycodone 15mg
- On morning of surgery – 7.00am if first on list, 10.30am otherwise
- 3 doses post-op every 12 hourly (8.00am and 8.00pm)
- Co-codamol 30/500 PRN after ± for discharge (ensure paracetamol is not prescribed concurrently)
- Oromorph 10mg PRN if only on paracetamol
Thromboprophylaxis
- Warfarin
- Patients on warfarin should have stopped their warfarin 5 days before surgery, interim LMWH might be prescribed if very high risk (eg metallic heart valve)
- 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
- If minor procedure/ low bleeding risk, just miss dose prior to surgery
Fasting
- Patients are allowed 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
Diabetes
- If Type 1 DM – patient should go on a VRII (pls refer to Diabetes & Endocrinology -> Variable Rate Insulin Infusion section on handbook for this)
- If Type 2 DM
- Oral medications – take their usual medications in the morning
- Insulin dependant – patient should go on a VRII (please refer to the page on Variable Rate Insulin Infusion)
- Diet control – regular blood glucose checks