Surgical Directorate Booklet

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

Visiting times are currently restricted and visiting will be dependent on Infection Control and Senior Management approval if relatives are permitted to visit.

Please check with the ward if you are staying overnight.

Visitors are currently not permitted to Day Surgery, except in special circumstances requiring the above approval.

Wards

Family contacting the units

It would be helpful to ask one person from family/friends to ring the unit to find out news of your progress. This person can then pass this information onto other members of your family and friends. There may be a preferred time to call the ward so please ask. Please remember that staff are limited on the information they can give and will not disclose information about your procedure.

Pre-Operative Assessment Booking Office: Tel No: 01908 995 456

Pre-Operative Assessment provides a service to assess the medical fitness of all elective surgical patients for their proposed surgery. We provide health promotion and promote positive lifestyle changes. After a holistic assessment of the patient health care needs, we may conduct a wide range of interventions to meet those individual needs. As a team we will provide time to prepare, educate and support you and your family/carer so informed choices can be made about your individual journey from admission through to discharge.

The pre assessment nurse will inform you of the following:

If you are fit for the operation and anaesthetic.
Whether you will go through the Same Day Admissions (SDAU) or if you will report directly to the ward.
If you are suitable to come in on the day of your operation, or if necessary, a day or so before your operation because of medical reasons.
The starving guidelines that you need to follow.

Following your assessment if any change occurs please inform your pre- operative assessment nurse. such as:

If you change your mind.
If you visit your GP for a new problem.
If your GP starts, stops or changes your medication.
If you are taken into hospital for any reason.
If, when you have a date for surgery, you are unwell with a cold, high temperature, or chest infection.
Other infections

What if the pre assessment nurse finds something wrong?

Depending on the reason, it could be that your blood pressure is too high. The nurse may delay your surgery, or you may be asked to either visit your GP or an Anaesthetic assessment will be organised. We may have to remove you from the waiting list if you are not fit for surgery. Once the problem has been resolved you may then be recalled for another pre-assessment.

Preparing for surgery

If you smoke it is important that you do not smoke for 48 hours before your anaesthetic.
Do not drink alcohol or take any recreational drugs for at least 48 hours before your anaesthetic.
Please remove any body piercing, make up, acrylic nails, nail polish from fingers or toes before coming into the Treatment Centre for your operation/procedure.
On the morning of your surgery please have a full body and hair wash using your normal soap/shampoo. If you have been given a special wash at pre-operative assessment, please use as directed.
Please refrain from using body lotions unless they are prescribed.

On the day of surgery

If you are having a general anaesthetic, you will be either having your surgery in the morning, afternoon or evening. It is important that you follow the instructions carefully or it will not be possible to carry out your treatment and your operation will be cancelled.

You may be booked onto an all-day theatre list, which means you will arrive in the morning and may not go to theatre until the afternoon. Your anaesthetist will inform the nursing team if you are able to have a drink on the ward, due to the timing of your operation and a drink will be provided. It is essential that you are fully informed so if you have any questions please feel free to ask the nursing or medical teams.

Surgery in the morning

If you are having surgery in the morning you will be requested to attend the hospital at 07.15
Food and any other drink (tea, coffee, milk, juice etc.) can be taken until 02.30am
You may drink water only from 02.30am
At 06.00am please have a glass of water; please ensure you finish your glass of water by 06.30am.
You must not suck any sweets or chew gum.
If you have DIABETES: Some medication you may have to omit as you are fasting, if guidance is required please discuss with your Diabetic Nurse.
Please bring ALL YOUR REGULAR MEDICINES with you in the original containers. This includes all over-the-counter medicines, herbal preparations, ointments, creams and inhalers. You will be provided with a pharmacy bag to bring your medicines in.
If you take any medication, the Pre- Assessment Nurse will advise you of the medication that should be taken at home on the morning, of the day of your admission and operation.

Surgery in the afternoon

If you are having surgery in the afternoon, you will be requested to attend the hospital at 11.45am
You will be able to have a light, early breakfast before 7.30am at home on the day of your admission and operation.

For example
 two slices of toast or
 a bowl of cereal
 along with a cup of tea or coffee or juice

Please make sure that once you have had your breakfast you do not eat anything.
You may drink water only from 07.30am.
At 11.00am please have a glass of water; please ensure you finish your glass of water by 11.30am.
You must not suck any sweets or chew gum.
Please bring all your regular medicines with you in the original containers. This includes all over-the-counter medicines, herbal preparations, ointments, creams and inhalers. You will be provided with a pharmacy bag to bring your medicines in.
If you have DIABETES: Please take your medication with your breakfast in the morning – if guidance is required please discuss with your Diabetic Nurse as you will be fasting at lunch time.

Please arrive at the stated time on your letter.

General Anaesthetic: ‘You & Your Anaesthetic’

Anaesthetic drugs remain in your body for 48 hours, and gradually wear off over this time. During those 48 hours you may be under the influence of general anaesthetic drugs, and it is important to obey the following instructions.
Do not drive a car, ride a bike, or any vehicle for 48 hours, or longer if advised by medical staff. It is always best to speak to your Insurance Company to make sure you are adequately covered as they may have their own guidelines about driving after an operation or procedure.
Do not operate machinery or appliances e.g., cookers or kettles.
Do not drink alcohol or use recreational drugs.
Do not lock the bathroom or toilet door or make yourself inaccessible to the person looking after you.
Drink plenty of fluids and eat a light diet, avoiding heavy or greasy foods.
Take things easy the day after your operation, and do not work with machinery or undertake strenuous exercise.
Do not make important decisions for 48 hours after your anaesthetic. If you experience any problems/pain after your discharge home, please contact your family Doctor (GP) or contact the ward for advice.

What to bring with you

Loose, comfortable night and day wear, we encourage patients to get dressed 1st day post operation – bring in underwear.
Dressing gown and socks.
For comfort health and safety reasons you should have a pair of flat supportive shoes. Slippers should also be fully enclosed. (Not open backed mules).
Toiletries: soap, shampoo, toothbrush/paste, 2 flannels, towels, hand wipes.
Comb/brush/shaving equipment
Books/ Magazine
Loose change -A newspaper trolley will visit the ward daily, selling magazines, snacks and other sundries.
It is important that you bring with you the following items if you normally use them at home.
All medication for an overnight stay in correct containers– please inform the nursing staff on the ward that you have brought them in.
All advice leaflets.
Inhalers/sprays
Glucometer (diabetic patients)
Anti-coagulant therapy yellow book
Hearing aid/spectacles
Denture pot/denture cleaner
Mobility aids (sticks etc.)
Other aids – (CPAP machine)
Female Menstruation: Internal protection not to be used on admission due to the risk of infection. Please use sanitary pads/towels only.

Please do not bring with you:

Valuables/ large amounts of money
Credit Cards
Pension Books
Jewellery
Electrical Equipment – this needs to be checked by the hospital prior to use.

The Trust cannot be held responsible for your valuables.

Information for Admission

Please arrive at the designated time on your letter to the Treatment Centre. Please report to reception, you will be asked to sit and wait until staff collect you from the reception area.
Staying overnight: Family /Friends can leave you at reception in the Treatment Centre. Visiting times will be dependent on circumstances – please check with the ward.
Parents/Guardians will be able to stay with their child on the unit. A parent may also accompany their child to the anaesthetic room if they wish.

Arrival on the Ward/Same Day Admission

The nursing staff will settle you into the ward environment and inform you of the ward routine.
The nursing staff will discuss with you any special equipment used normally at home and any extra help you may require on discharge.
The surgical team and anaesthetist will visit you before your operation. If you have any questions, please do not hesitate to ask.
All your details will be checked thoroughly, this may mean different people may ask you the same questions.
You may be measured for and given a pair of compression/anti-embolic stockings (AES), which are of benefit in reducing blood clot formation in your legs after surgery.
For your safety, the first time that you get out of bed after surgery you need to be accompanied, please call the nursing team by using your call bell.
During your stay in hospital, you will be encouraged to be as independent as possible. This means that you will be expected to do as much for yourself as you can e.g., washing, dressing and walking to the toilet.
You will be expected to sit out of bed when you are well enough rather than staying in bed.
You will be encouraged to get into your day clothes rather than spending all day in your nightwear. This usually makes you feel better in yourself and helps you stay independent.
If you have a concern during your stay in hospital, then please raise it with the nursing staff in your unit at the time or ask to speak to the Senior Sister or Matron covering the area.

The Day Surgery Unit

The Day Surgery Unit admits, treats and discharges patients within one working day. In the Day Surgery Unit (DSU) you will usually stay for part of the day or all day, this means you are a ‘day case’.

On the Day surgery unit, the nurses will look after you during your stay and will contact your relatives when you are fit enough to go home. We ask that relatives do not come to the hospital until contacted by a member of staff. When family arrive, there is a telephone at the reception desk to contact the ward.

The Same Day Admission Unit on the day of your operation

The Same Day Admission Unit admits patients who are staying in hospital for longer than a day. There are trolleys and chairs, along with a change and wait area. Family can accompany you to the Treatment centre reception. Please keep your property to a minimum. (Small Bag) Items can be brought in at a later time.

Whilst you are in theatre your property will be taken to the appropriate ward and stored in a secure facility. Once you have had your operation you will go to the ward that will look after you for the remainder of your stay.

Wards 20, 21A, 21b, 23 & 24

The length of stay for patients on both wards can vary depending on the type of surgery and the patient’s post-operative recovery. Your estimated discharge date should be discussed and agreed when you arrive on the ward.
If you stay for only one night and are well enough, you will be allowed to go home the following day.
Some procedures do require a longer stay in hospital and you should have been informed about this.
Visiting times are restricted and it will be dependent on Infection Control if relatives are permitted to visit.
If you have a concern during your stay in hospital, then please raise it with the nursing staff in your unit at the time or ask to speak to the Senior Sister or Matron covering the area.

Discharge

We operate a nurse discharge policy and depending on instruction from the surgical team you may not be seen before discharge. If you have a specific request, please inform your nurse.

When it is time for you to be discharged, the nursing staff will give you a copy of your discharge summary. A copy of this will also be sent to your GP.

You will need a responsible adult (aged 16 or over) to collect you by car or to accompany you in a taxi (not public transport).

All patients (whether adult or a child) need a responsible adult to look after them for the first 24 hours after returning home following a general anaesthetic. If you do not have a responsible adult to look after you during this time your operation will be cancelled.

When you are ready to be discharged home, you may be collected from the ward or taken to the ‘Patient Discharge Unit’. You will receive continued nursing care from the Patient Discharge Unit until you are collected to go home.

Please do not contact your next of kin regarding your discharge from hospital until the nurse informs you that your discharge documents are ready, and you have signed your discharge form.

Please ensure you have the following before leaving the building:

All your personal belongings
Your discharge paperwork and any relevant documentation.
The regular medicines you brought into hospital on admission and any post-operative medication for discharge.
If applicable any medication to take home.
If applicable, a follow-up appointment
You know who to contact with a concern.
Please inform the nursing staff/ward clerk on leaving the ward.

If you require to be taken home by hospital transport, please note the following:

A specific time cannot be given to pick you up or get you home by.
It is preferable that you have your own front door key available
You need to limit your luggage to one bag only.

Recommended pain relief following surgery are:

Ibuprofen 200mg or 400mg one or two tablets three times a day when required for pain relief. (Must be taken with or after food).
Paracetamol 500mg one or two tablets four times a day when required for pain relief.
Co-codamol 8/500 one or two tablets four times a day when required for pain relief. Must NOT be taken with Paracetamol.

When you go home

Before you go home you should make sure that you know what to do to reduce the risk of DVT developing.

If you develop any of the symptoms described, please seek immediate medical advice.

What is Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)?

(DVT) is a blood clot that develops within a deep vein in the body, usually in the leg. Blood clots that develop in a vein are also known as venous thrombosis. DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the calf and the thigh. It can also occur in the pelvis or abdomen.

It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism.

Pulmonary Embolism

This is a serious condition that occurs when a piece of blood clot breaks off into the bloodstream. This then blocks one of the blood vessels in the lungs, preventing blood from reaching them.

What are the signs of DVT and PE?

Pain or swelling in your leg.
The skin on your leg feels hot or discoloured (red, purple or blue), other than bruising around the area if you have had an operation.
The veins near the surface of your legs appear larger than normal or you notice them more.
You become short of breath.
You feel pain in your chest or upper back.
You cough up blood.

What we do to reduce the risk of DVT

If you are at risk, you may be given one of the following to reduce the risk of you developing a DVT:

Anti-embolism stockings. These are tight stockings which squeeze your feet and lower legs and thighs helping your blood to circulate around your legs more quickly. You may not be offered these if you have recently had a stroke, or if you have problems with the veins in your legs.
A medicine called an anti-coagulant which thins the blood and helps prevent clots from forming. This may be an injection just under the skin or a tablet.
We will encourage you to mobilise as soon as you are able and assist you in doing so.
The staff should discuss the benefits and any risks with these treatments, but please ask the staff looking after you if you have any questions.

Pressure Ulcer prevention

Pressure Ulcers are localised areas of damage to skin or underlying tissue and can occur to areas of the body subject to pressure. Bony areas are at greater risk and these include head, shoulder, elbows, base of spine, bottom, knees, heels and toes.

Whilst nurses will assess you, we ask that patients assist by:
Changing position regularly to allow adequate circulation of blood to your pressure areas.
Early mobilisation post operatively
Assist with effective skin care, e.g., keeping skin clean and dry.
Maintaining hydration and diet post operatively
Report any redness seen and discomfort felt to the nurse.

Nursing staff may assess areas on your body which are prone to pressure damage. You will be encouraged to change your position frequently. If you are unable to move independently assistance is always available. For patients who are at risk, staff may also implement aids/equipment to prevent damage. i.e., Cushions, special mattress.

Preventing Infection

In Milton Keynes we do as much as we can to protect our patients – but 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:

Bathing or showering before being admitted to hospital.
Bring a daily change of clean clothes.
Wash your hands or request a hand wipe before eating.
Always wash your hands with soap and water after using the toilet.
Do not share toiletries with other patients.

Some patients receive MRSA screening as part of their pre-assessment. This is via a nasal swab. The results will be checked, and patients will only be informed if the results are positive, and treatment is required. 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.

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 in the Treatment Centre as well as the main hospital.
Keeping warm before, during and after surgery is important, because it can reduce postoperative complications.

Please bring additional warm clothing, such as a dressing gown, a vest and slippers.

Do tell the staff that are caring for you, if you feel cold at any time during your hospital stay.

If you become cold during the operation, you may wake with a warming blanket in the recovery room.

Additional Information

Please note Milton Keynes Hospital (NHS) Foundation Trust operates a ‘Smoke Free Site’. Please visit our Trust intranet site for further information on this by accessing the ‘Smoke Free Site Policy’. As a Trust, we remain committed to helping staff and patients give up smoking. The Trust will not tolerate violence or aggression to staff from other members of staff, patients and visitors.
The hospital has a Chaplaincy Department that offers religious, spiritual and pastoral support. The Chaplaincy leaflet describes this in detail. If you have any specific needs, please ask the staff to contact the Chaplains for you.

Parking is free for up to 15 minutes. If you are intending to stay longer, then you will need to park in the Multi-storey Car Park. You will need to pay on foot before you return to your vehicle.

PALS (Patient, Advice and Liaison Service) Patients, relatives and their careers 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 careers.
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.

Contact: Tel No: (01908) 995 954 or (01908) 996 222 | E-mail: [email protected]
Or write to us at: PALS, Milton Keynes University Hospital NHS Foundation Trust, Oak House, Standing Way, Eaglestone, Milton Keynes, MK6 5LD

Please complete a Friends and Family feedback form which will help to improve patient experience at our Trust.

Preparation for care following your operation

To avoid cancellation, it is important to have organised care at home if required.
Please plan for someone to be with you.
This can either be a family member a friend or a relative.
If you do not like asking family due to work commitments, have you got friends from a support group or Church who may help.

Age Concern have a helpline: 01908 996 073 |www.ageukmiltonkeynes.org.uk | outside Milton Keynes, please check the number for your own area | Age UK Advice line: 0800 678 1602

or contact your GP if they can assist with care at home.

You may only require assistance for a short period this will be dependent on your recovery and your circumstances – it is always best to be prepared.