Paediatric Pre Assessment Booklet

Please note, this page is printable by selecting the normal print options on your computer.

Contact details:
Play & prepare: 01908 997003
Ward 4 Tel No: 01908 996368
Ward 5 Tel No: 01908 996377
Children’s Community Team: 01908 996521

• Pre assessment
• Routine pregnancy testing before specific elective procedures: information for parents and young patients aged 12-16 years
• Play and Prepare
• Fasting Guidelines
• What to bring with you
• The Day Surgery Unit
• Overnight stay Ward 5
• Preventing infection
• On the day of surgery
• Going to the operating theatre
• In the anaesthetic room
• The recovery area
• After Surgery
• Discharge from the paediatric unit
• Patient, Advice and Liaison (PALS) Service

This booklet has been written to provide you the patient and also parents/carers of children/young people with information regarding your hospital stay in the paediatric unit.

Please note that when we are using the words ‘you’ or ‘patient’ throughout this booklet it is also encompassing whoever is responsible for the child/young person. It will explain about pre assessment, what to expect on the paediatric unit, going to theatre and essential discharge information.

If you no longer wish to proceed with your operation, please let the hospital know.

[email protected]
Telephone:01908 996798

If you are booked to ward 5 (overnight stay) then you have to phone the nursing staff to see if there is a bed available.

For admissions at 7:30am please ring at 6am 01908 996377
For admissions at 11:30am please ring at 9am 01908 996377

Pre assessment
All children/young people over the age of 12 months who are having elective (planned) surgery under a general anaesthetic will be pre assessed by one of the following methods:

• Pre assessed immediately at the time of being listed for surgery
• Pre assessed by an arranged telephone assessment
• Have a booked pre assessment appointment at the Treatment Centre.

On some occasions, we may complete MRSA screening as part of the pre-assessment. This is done by a nasal swab. The results will be checked and you will only be informed if the swab results are positive and treatment is required. If you know that you have been a carrier of MRSA please inform the pre assessment nurse.

Routine pregnancy testing before specific elective procedures: information for parents and young patients aged 12-16 years
It is very important to ensure that any female patient having this procedure is not pregnant. This is because a pregnant patient and her unborn baby may be harmed by the procedure. All female patients aged 12-16 years or their parents will be asked to give consent to providing a sample of urine for a pregnancy test. Although there may only be a very small/tiny number of pregnancies in this age group, we believe that testing all patients is the most effective way of avoiding the risk of harm. If a pregnancy test is refused we will discuss the safest way of proceeding but we hope you will recognise the reason for our decision. Your understanding will be greatly appreciated.

The pre assessment nurse will inform you of the following:
• If your child is fit for the operation and anaesthetic.
• The starving guidelines that your child needs to follow.
• Whether a blood test is required and a referral will be made.

It is important that we have the following information for the pre assessment:
• All home, work and mobile numbers.
• All prescribed medication and any herbal preparations.
• Any medical conditions
• A note of any allergies e.g. medication, latex, metal and food.
• Inform us of any special equipment services at home.

After your pre assessment it is important that you contact the clinical surgical unit or your pre assessment nurse if there are any changes to your health or circumstances after the pre assessment and prior to surgery, such as:
• If you change your mind.
• If you take your child to visit your GP for a new problem.
• If your GP starts, stops or changes your child’s medication.
• If your child is taken into hospital for any reason.
• If, when you have a date for surgery, your child is unwell with a cold, high temperature, or chest infection.

What if the pre assessment nurse finds something wrong?
The nurse may delay your surgery. If this is the case, you will be asked to either visit your GP or an Anaesthetist will either review your child’s notes or we may book an appointment for your child to see the Anaesthetist.

Play and Prepare Sessions

Would you like to help your child prepare for their procedure?

Does your child have lots of questions?
Why don’t you come to one of our bookable play and prepare sessions, with our Play Team in the Milton Mouse Unit? The sessions are a preparation session, allowing the children to have a tour of the ward, meet the staff, and through play, talk through any questions. We encourage the children to bring in their Teddy or Dolls, if they wish. This can help with explaining procedures and talk through what will happen on the day. These sessions, run throughout the month on a Saturday morning from 11.00am – 12.00pm. These sessions can be booked at pre assessment or directly to Milton Mouse Unit on 01908 996516

Suggested reading for younger children:
• Going to the Hospital (Usborne First Experiences) by Anna Civardi
• Peppa Pig: Peppa Goes to Hospital: My First Storybook
• Topsy and Tim: Go to Hospital by Jean Adamson

Fasting Guidelines

Morning Operation/Procedure

If you are having surgery in the morning you will be requested to attend the hospital at 07:30.

Fasting advice
Clear fluids up to 07:30 in the morning. Breast milk up to 4 hours prior to admission. Solids/Formula/Cows milk up to 6 hours prior to admission.

Afternoon Operation/Procedure
If you are having surgery in the afternoon you will be requested to attend the hospital at 11.30

Fasting advice
Clear fluids up to 12:30pm in the afternoon. Breast milk up to 4 hours prior to admission. Solids/Formula/Cows milk up to 6 hours prior to admission.

Your child’s operation may be cancelled if they have eaten or drunk when they shouldn’t.

As a parent/carer it is important that your child’s nutritional needs are met. All children/young people are required to fast before an operation/procedure which may require a general anaesthetic or for the child/young person’s stomach to be empty.

Q. “What is fasting?
A. “To give nothing by mouth for a specified length of time.”

Reasons for Fasting
To ensure that your Child/Young Person’s stomach is empty and therefore avoid serious complications associated with vomiting (being sick) or regurgitation under General Anaesthetic or  sedation, or for specific tests.

Clear fluids
It is safe for a healthy child/young person to take clear fluids up to one hour before the general anaesthetic when the surgery is planned.

Q. “What is clear fluid?”
A. “Clear fluid is described as one through which newsprint can be read.”

Blackcurrant Juices
No blackcurrant juice must be consumed 6 hours or less prior to being fasted.

Breast Milk
Breast milk can be taken up to four hours before the general anaesthetic for planned surgery.

Formula Milk
Formula milk is counted as a “solid food” and may be given up to six hours before the General Anaesthetic.

Intake of Solid foods
No food must be taken six hours before a General Anaesthetic.

Chewing Gum and Sweets
Chewing gum should not be permitted on the day of the operation. Sweets including lollipops are counted as solid food and should not be allowed six hours before the General Anaesthetic.

Regular Medications
Regular medications should be continued before the operation unless you are told otherwise. Any medications required to be taken with water should be taken with no more than 30 mls (six teaspoons).

General Recommendations
Higher risk Children/Young People should follow the same guidance as healthy children unless you are advised by the doctor or nurse differently.

Q. “What does higher risk mean?”
A. “Children/Young people who are at risk of regurgitation, reflux, obesity or diabetes.”

What to bring with you
Favourite pyjamas or a nightie for going to theatre in. These should be cotton and not worn to the unit. (Do not bring in ‘onesies’ but two piece pyjamas without metal on.)
A dressing gown and/or slippers for the walk to theatre.
Something to play with, their favourite teddy/toy can accompany them to theatre.
You can bring in hand held computer games which are charged up or similarly DVD players or laptops as long as charged. You will be responsible for any valuables.
Hand/baby wipes
All medication in correct containers including inhalers
If your child is 5 years old or under please bring in your child’s red book
You could bring in a favourite snack and drink for your child for after surgery but please ensure you check with the nursing team that you child can eat.

Please also make sure that no jewellery is worn and that any nail polish or make up has been removed. Two adults can accompany your child to the paediatric unit; one of these must be a legal guardian who is able to sign the consent form for surgery. Two adults can walk your child to theatre but only one adult can accompany your child in the anaesthetic room if they wish to.

We do ask that other siblings or relatives are not brought to the unit.

The Day Surgery Unit Ward 4
In the Day Surgery Unit you will usually stay for part of the day or all day, this means you are a ‘day case’. Please note for security reasons to enter the paediatric unit you will need to be let in by the ward team. Once you are inside the paediatric unit you will be able to walk between ward 4 and 5. There is a Play Specialist who will help to prepare your child for theatre and will be able to provide play and distraction.

Most children will be admitted as a day case but some will need to stay overnight. This depends on what operation your child is having and how well they recover from the anaesthetic afterwards. If your child does need to stay overnight they will be transferred to ward 5.

Overnight stay Ward 5
If your child does stay in overnight then one parent/main carer is able to stay overnight and a reclining chair is available beside your child’s bed. If an overnight stay does occur please can you also think about any arrangements to be made for your other siblings, as they will be unable to stay in hospital overnight.

Visiting Times
For the parents/legal guardian there are no restrictions on visiting times, so ‘open’ visiting. For all other visitors who are not the parent or the main carer to the patient then visiting times are 2-8pm.

Preventing Infection
In Milton Keynes we do as much as we can to protect our patients – but we need your continuing support to stop avoidable infections starting. To achieve the objective of minimising infection and
safeguarding your health it is important that you observe the following personal care.

You can help by:
o Bathing or showering before being admitted to hospital;
o Wash your hands or request a hand wipe before eating
o Always wash your hands with soap and water after using the toilet;
o Do not share toiletries with other patients.

We also ask you to make use of the hand sanitiser that is provided, on entering and leaving the ward. This will assist in reducing infections but does not protect against the Flu virus, c difficile or the winter vomiting and diarrhoea bug. Please ask staff to wash their hands or use the hand sanitiser before attending to you. To keep our high standards of infection prevention and for
safety reasons, we do not allow flowers or potted plants on any of the wards.

On the Day
On arrival to day surgery you will be greeted by a nurse who will ask you lots of questions and complete a pre-op checklist. They will then carry out some ‘observations’ on your child which will include a temperature, Pulse, Blood pressure and Oxygen Saturations. They will use a hand held monitor to do this. Your child will also be weighed on admission. Once this is done the nurse will put some ‘magic cream’ on to the back of your child’s hands and this is to make the back of the hands numb for the cannula. They will go through all of this on the day with you. Routine pregnancy testing before specific elective procedures: information for parents and young patients aged 12-16 years. It is very important to ensure that any female patient having this procedure is not pregnant. This is because a pregnant patient and her unborn baby may be harmed by the procedure.

All female patients aged 12-16 years or their parents will be asked to give consent to providing a sample of urine for a pregnancy test. Although there may only be a very small/tiny number of pregnancies in this age group, we believe that testing all patients is the most effective way of avoiding the risk of harm. If a pregnancy test is refused we will discuss the safest way of proceeding but we hope you will recognise the reason for our decision. Your understanding will be greatly appreciated.

Your child will be seen by an anaesthetist. The anaesthetist needs to find out about your child’s general health, previous experiences of anaesthesia, any medicines your child is taking and any allergies he or she may have. If your child has been ill please let them know. You will also be seen by someone from the surgical team, who will answer any questions and get you to sign the consent form, if this hasn’t already been done.

Going to the operating theatre
The morning theatre list usually starts at approximately 9.00 and the afternoon lists at 13.30, it depends on where your child is on these lists as to what time they will go to theatre. The nurse will be able to give you an approximate time on the day. Your child will be able to wear their own cotton pyjamas or night dress to the operating theatre, but we do also provide gowns to wear if needed.
Depending on the operation your child may be able to keep their underwear on. Your child will walk to the anaesthetic room so please bring some slippers and a dressing gown for them to wear.

In the Anaesthetic Room
Two adults, (one of these must be a legal guardian) along with a nurse can accompany your child to theatre. One parent or guardian will be allowed to accompany your child into the anaesthetic room. The reason we have only one parent/guardian in the anaesthetic room is because of the size of the room and the number of people form theatre that have to be in this room. You stay in the
anaesthetic room until your child has have gone to sleep. The anaesthetist will either get you to sit with your child on your lap in the anaesthetic room or if your child is bigger you can stand by their trolley so that your child knows you are there.

Your child will either have an anaesthetic gas to breathe or an injection via a cannula. If the gas is used it will take a little longer for your child to be anaesthetised. They may become restless as the gas takes effect and this is normal. The anaesthetist will use a mask over your child’s face to give the gas or cup their hand over their mouth. You will usually be able to hold your child whilst this happens, or if they are older talking to them helps as a distraction. If an injection is used a cannula will be inserted into your child’s hand, where the ‘Magic Cream’ was put on the ward.

‘Magic Cream’ is a local anaesthetic cream that numbs the area so that insertion of the cannula will not hurt. This works well in 9 out of 10 children. If you talk to your child whilst they are going to sleep, this helps to distract them until they fall asleep. You will find that your child falls asleep very quickly and if you are holding them they will feel quite heavy and floppy. You can then give your child a quick kiss and leave the anaesthetic room with your nurse who will accompany you to the waiting room in the treatment centre. Here you will be given a bleep which will go off when your child is ready to be collected from recovery. Please feel free to go and get yourself a tea or coffee and then return to the waiting area once the bleep has gone off.

A member of the theatre team will come and get you from the waiting area and accompany you to the recovery room to see your child. You will then return to the ward with your child
accompanied by staff from theatres or the ward.

In the Recovery Area
After surgery your child will go to the recovery room, each child is cared for by a specialist nurse until they are awake and comfortable. Once your child is awake and ready to come back to the unit a nurse will accompany you to the recovery room to collect your child. Sometimes you may be able to go in to the recovery room, but this is not always possible, the nurse will let you know on the day.

After Surgery
We will keep your child for a minimum of 2 hours after surgery, but all recovery times vary. Your child will be given something to eat and drink after surgery, if they are fussy eaters then please
bring something in for them to eat. The nurse or doctor will advise you as to when your child may resume eating and drinking. Usually fluids can be offered by mouth to healthy children when they are fully awake after the operation/procedure has finished. If your child is vomiting and cannot tolerate water or food or they are in a lot of pain then they may need to stay overnight on the children’s ward.

It is an expectation that your child’s pain will be under control prior to discharge. In order to go home, your child needs to have achieved the following:

– Tolerated food and drink
– Passed urine
– Mobilised around the ward
– Pain is managed

Discharge from the Paediatric Unit
Occasionally children feel sick or vomit after they have left the ward and this can happen in the car on the way home. This is quite normal but if your child was to start vomiting persistently or could not tolerate any food or drink then you would need to seek medical advice. The anaesthetic stays in your child’s system for about 48hrs and your child will need constant adult supervision
in this time. It is also advisable that children remain indoors for 24hrs and sleep on the bottom of bunk beds if necessary.

A nurse will go through all aspects of your child’s care before discharge. You will also be given the contact number for the Children’s Community Nursing team who you can contact if you have concerns over your child following discharge. If your child needs follow up with the Community Children’s Nurses then they will contact you the day after surgery to arrange this. Your nurse on the day will let you know if you child will need to be followed up in this way.

Please note Community Children’s Nurses visits are only to Milton Keynes addresses.  Your child will need adult supervision at all times for at least 48hrs following discharge, sometimes longer
depending on the procedure. Unless requested by the surgeon we operate a nurse discharge policy and so you may not see the surgeon before discharge. If you want to see them then please let
us know on the day so we have plenty of time in order to contact them. Before you leave the unit please could you complete the exit questionnaire as we value your opinions?

PALS (Patient, Advice and Liaison Service)
Patients, relatives and their carers sometimes need to turn to someone for on-the-spot help, advice and support or give feedback on their experience whilst in the hospital.

PALS can help by:
• Advising and supporting patients, their families and carers;
• Listening to your feedback and ensuring it is used to improve services to our patients and the public
• Listening to your comments, compliments, concerns and complaints
• Helping to sort out problems quickly on your behalf.

Tel No: (01908) 995954 or (01908) 996222
E-mail [email protected]
Or write to us at:
Milton Keynes University Hospital
Oak House
Standing Way
Milton Keynes

The Clinical Surgical Units are responsible for allocating you the time and date for surgery.

Should anything change to your circumstances, or if you need to be removed from our waiting list please contact the relevant department.

Admissions: Telephone: 01908 996798, [email protected]
Pre assessment booking Co-ordinators: Tel number 01908 995456, Email [email protected]