Day Unit Information

STUDENT

DAY UNIT INFORMATION

PACK

DAY SURGERY

CONTENTS

PAGE

Student Information 1

Day Unit Staff Members 2

Profile of the Unit 3

Orientation to the Unit 4

Day Unit Philosophy of nursing care 5

Day Unit Telephone Numbers 6 -7

Concepts of Day Surgery 8-11

Student Objectives (ward based) 12-13

Meaning of ‘Orthopaedic’ 14

Menu of Learning 15-18

Day case procedures 19

Injection room procedures 20

Orthopaedic terminology 21-23

Further reading and reference list 24

Appendix 1 25

Incident Evacuation Plan for Day Unit

Additions:-Venous Thromboembolism Guidelines

Must Tool

Slips/Trips/Falls

Infection Control – Think Link

DAY UNIT STUDENT INFO PACK

STUDENT INFORMATION

The Royal Orthopaedic Hospital NHS Trust supports the viewpoint of the NMC that all students be allocated a mentor, who has the relevant qualifications. This includes both pre and post registration students. To ensure continuity of mentor ship it is suggested that each student be allocated two mentors, e.g. a primary and associate mentor; however it is the responsibility of all the ward staff to help you.

Effective mentorship of nursing students at the Royal Orthopaedic Hospital is essential to maintain high standards of nursing practice, promote learning and to develop a culture of dynamic practice.

Regulations state that the mentor must work with the student at least two shifts per week. If this is not possible due to annual leave or sickness, the ward manager must take responsibility for arranging an associate mentor to take over supervision and support of the student.

It is extremely important that those nurses acting as mentors to students liaise with the relevant course/module lecturer to facilitate integration of theory into practice.

Your allocated mentors are responsible for discussing your placement objectives and helping you to achieve them. They are also responsible for completing your CPA document at the agreed date for midway and final assessment. It is the student’s responsibility to bring the document with them and for its safe keeping.

It is important that any student having difficulties whilst on placement bring these difficulties to the notice of their mentors as soon as possible, likewise it is your mentor’s responsibility to bring to the student’s attention any concerns she/he has as early as possible. In order to discuss, take action, to enable the student to complete his or her objectives.

It is hospital policy that you do not travel to work in your uniform. There are changing facilities on the ward.

It is important that you contact the Unit and University if you are ill and unable to attend your placement.

Day Unit: 0121 685 4080/4207 BCU: 0121 331 7010

The staff on Day Unit wants you to find your placement enjoyable and interesting. We endeavor to provide an environment to facilitate your learning whether pre or post registration.

DAY UNIT STUDENT INFO PACK 1

WELCOME TO DAY UNIT

PROFILE OF UNIT STAFF

Senior Manager: Sr. Stacey Keagan

Unit Managers/ Sisters Sr. Suzanna Day

Sr. Jill Barr

Staff Nurses: Sn. Arlene Carr

Sn. Fiona Heames

Sn. Tina Lane

Sn. Sharon Gardner

Sn. Rebecca Preece

Sn.Vim Chakadini

Sn. Lisa Marshall

Orthopaedic Support Angela Vigus

Jane Jobbins

Worker: B

Nursing Auxiliary: Jayne Carter

Ann Ali

Ward Co-ordinators: Dawn Austin

Anne Stephens

Donna Mulholland

Ward Clerk: Amanda Hill

DAY UNIT STUDENT INFO PACK 2

DAY UNIT

ATTENTIVE…...WELCOMING……APPROACHABLE

Day Unit is a busy area of 11 beds, 7 trolleys and 4 reclining chairs. We deal with a wide variety of orthopaedic cases.

Please see your menu of learning experiences. We encourage your involvement and feedback.

Our method of nursing is ‘the named nurse’.

The shift patterns are: - 7:15am --- 7:00pm

7:15am --- 3:15pm

11:00am – 7.00pm

Patient hand over is between individual nurses

Coffee break ---15 minutes. Lunch break ---30minutes.

You will have the same shifts as your mentor except when you are visiting other wards. If you require different working times due to University or personal commitments, please let your mentor know. We will always try to accommodate your needs within reasonable requests.

We aim to assess, plan and implement and evaluate care based on ‘Ropers’ model of nursing. Involving patients/relatives and other disciplines as necessary.

You will be expected to adhere to the ROH NMC guidelines for record keeping. We will obviously provide you with information and opportunity to achieve this.

We see all members of the multi-disciplinary team on the Day Unit. All Consultants involved in the Trust have patients on the Day U nit at some stage. Therefore, you will probably see patients that are not day cases as well.

If you are unwell and unable to come on duty, contact the Unit and University.

Day Unit: 0121 685 4080/4207

UCE: 0121 331 7010

The Day Unit is locked at night. Access is by contacting the on-call Sister or the porters.

DAY UNIT STUDENT INFO PACK 3

ORIENTATION TO THE WARD

You will be introduced to your mentors who will:

1. Conduct a preliminary interview.

2. Introduce you to the geography of the Unit and the staff working here.

3. Ensure you are aware of the emergency procedures and can locate

fire equipment, bells and exits.

cardiac arrest equipment.

4. Ensure you are aware of the location of policy and procedure files.

5. Show you where and how the Unit keep the patient profiles.

6. Give you a report of the patients on the Unit.

7. Introduce you to other members of the multi-disciplinary team as required.

8. Explain to you the general running of the Unit and the admitting and discharging procedure.

Staff on the Unit are all experienced within the field of Day Surgery.

Please ensure you use their knowledge and help. Make the most of this allocation as you can. You will only get out of it what you are willing to put in, and we will endeavour to help you as much as we can.

ENJOY YOUR ALLOCATION WITH US.

Please remember the following:

IF YOU DO NOT KNOW ASK!

IF YOU WANT TO KNOW ASK!

IF YOU ARE NOT SURE ASK!

DAY UNIT STUDENT INFO PACK

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DAY UNIT USEFUL TELEPHONE NUMBERS

Useful and emergency information

To use bleep system:-

Dial 88 – listen for message follow instructions, you will be told to:

Dial bleep number

Dial the extension number you are ringing from

BLEEP NO’S

Doctor on call 2621

Sister on call 2627

Porters/Security 2641

EXTENSION NO’S

RECOVERY UNIT 55618/55619

HIGH DEPENDENCY UNIT (HDU) 55691

PORTERS 55297

CARDIAC ARREST 2222

FIRE/SECURITY 333

DAY UNIT STUDENT INFO PACK

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CONCEPTS OF DAY SURGERY.

DEFINITION.

"A SURGICAL DAY CASE IS A PATIENT ADMITTED FOR INVESTIGATION OR OPERATION ON A PLANNED NON-RESIDENT BASIS WHO NONETHELESS REQUIRES RECOVERY.

THE CONCEPT OF ADMISSION IS RETAINED HERE TO EMPHASISE THE NEED TO OBSERVE PROPER ADMISSION PROCEDURES AND RECORDS. THIS DEFINITION EXCLUDES MINOR OPERATIVE PROCEDURES UNDERTAKEN IN THE OUTPATIENT OR ACCIDENT AND EMERGENCY DEPARTMENT."

THE ROYAL COLLEGE OF SURGEONS "GUIDELINES FOR DAY CASE SURGERY" (MARCH 1992)

When patients are referred for day surgery it is essential to ensure that:

✦ the procedure is suitable

✦ the risk of complications (from surgery and anaesthetic) are minimised

✦ admission to an in-patient bed following day surgery is prevented

✦ patients are adequately supported after discharge home.(rcn.org)

THE IDEAL UNIT

* PURPOSE BUILT AND INCORPORATING

* FOR A UNIT OF 16 BEDS YOU NEED 2 THEATRES

* RECEPTION AREA

* MAIN WARD AREA

* KITCHEN

* OFFICE

* COMPUTER LINK

* EXTERNAL PHONE LINE

* DAY R0OM

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DAY UNIT STUDENT INFO PACK

NURSING STAFF: SHOULD BE

* DEDICATED STAFF

* EXPERIENCED IN DAY SURGERY

* SKILLED THEATRE AND ANAESTHETIC STAFF

* EXCELLENT COMMUNICATION SKILLS

* MANAGERIAL SKILLS

* VARIED EXPERIENCE

* FRIENDLY AND RELAXED NATURE

* A SENSE OF HUMOUR

EXAMPLES OF DAY CASES FOR ORTHOPAEDICS

* MANIPULATIONS OF HIPS, KNEES, FEET SHOULDERS etc.

* ARTHROSCOPY OF KNEES, WRIST, SHOULDERS, ANKLES.

* CARPAL TUNNEL DECOMPRESSION

* RELEASE OF TRIGGER FINGER

* EPIDURAL

* NERVE ROOT BLOCKS

* FACET JOINT INJECTIONS

TYPES OF ANAESTHETICS

* LOCAL

* LOCAL AND SEDATION

* GENERAL

* GENERAL AND LOCAL

* REGIONAL BLOCKS : BIERS

-BRACHIAL PLEXUS

* EPIDURAL

DAY UNIT STUDENT INFOPACK

9

PATIENTS SUITABLE FOR DAY CASE SURGERY:

PHYSICALLY

* MALE OR FEMALE

* NO UPPER AGE LIMIT

* AMBULANT

* A.S.A. LEVEL 1 & 2

* STABLE BLOOD PRESSURE

SYSTOLIC BELOW 160

DIASTOLIC BELOW 100

PATIENTS TAKING ANTI-HYPERTENSIVES ARE SUITABLE FOR DAY CASE SURGERY ON THE CONDITION THAT THEIR BLOOD PRESSURE IS WITHIN THE LIMITS AS ABOVE.

* DIABETIC PATIENTS MAY BE SUITABLE DEPENDANT ON THE MEDICATION BEING TAKEN AND PROCEDURE TO BE PERFORMED

* SEVERE ASTHMATICS ARE NOT SUITABLE FOR DAY CASE SURGERY.

SOCIAL CIRCUMSTANCES:

* ALL PATIENTS HAVING A GENERAL/ REGIONAL ANAESTHETIC OR SEDATION MUST HAVE A RESPONSIBLE ADULT TO COLLECT THEM FROM HOSPITAL.

* ALL PATIENTS SHOULD HAVE SOMEONE AT HOME WITH THEM

* FOR THE 24 HOURS FOLLOWING THEIR PROCEDURE.

* ALL PATIENTS SHOULD REFRAIN FROM DRIVING AND OPERATING MACHINERY FOR 24 HOURS FOLLOWING THEIR PROCEDURE.

* ALL PATIENTS SHOULD HAVE A REGISTERED G.P.

* ALL PATIENTS SHOULD HAVE ACCESS TO A TELEPHONE.

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DAY UNIT STUDENT INFO PACK

DAY SURGERY SHOULD BE :-

* CONSULTANT LEAD BY BOTH SURGEON AND ANAESTHETIST

.

* PATIENT SHOULD HAVE A LIMITED AMOUNT OF ANAESTHETIC

.

* ONLY THOSE PATIENTS SUITABLE SHOULD BE TREATED BY

THOSE CAPABLE.

THE PATIENTS FEARS: ARE

* ANXIETY DUE TO ADMISSION

* FEAR OF PAIN AT HOME.

* CAN I WALK?

* WHAT CAN I EAT?

* WHEN CAN I RETURN TO WORK?

* DOES THE HOSPITAL WANT TO SEE ME AGAIN?

* DOES MY GP KNOW THAT I HAVE BEEN TREATED IN HOSPITAL?

* DO I NEED TO TAKE ANY TABLETS?

* CAN I TAKE MY USUAL MEDICATION?

THE ADVANTAGES OF DAY SURGERY TO THE N.H.S

* FASTER THROUGH PUT OF PATIENTS.

* EASING PRESSURE ON ACUTE SPECIALITIES.

* HELPS IN KEEPING WAITING LISTS DOWN.

* MAKES EFFECTIVE USE OF OPERATING THEATRE.

* SAVE ON HOSPITAL HOTEL COSTS.

* EASE OF RECRUITMENT.

* COST EFFECTIVE STAFF.

ADVANTAGES TO THE PATIENTS:

* REDUCES WAITING TIME FOR OPERATION.

* CONSULTANT LEAD SERVICE.

* REDUCED ANXIETY CAUSED BY LONG HOSPITAL STAY.

* REDUCED RISK OF HOSPITAL ACQUIRED INFECTION.

* REDUCED INTERFERENCE WITH HOME LIFE.

* OWN BED TO SLEEP IN.

DAY UNIT STUDENT INFO PACK 11

DAY SURGERY OBJECTIVES

STUDENTS

GENERAL OBJECTIVES

Within the first week the student should be able to:

1. Identify:

(a) Fire exits and alarms

(b) Emergency equipment

(c) Relevant telephone numbers

2. Discuss the procedure in the event of a fire or an emergency e.g. cardiac arrest.

3. State where relevant files are kept for policies and procedures.

4. Discuss the action to be taken when dealing with telephone enquiries.

5. Describe the lifting and handling procedure to be used.

6. State the action to be taken in the event of an accident;

(a) To a patient.

(b) To a visitor.

(c) To another member of staff.

(d) To yourself.

SPECIFIC OBJECTIVES.

1. To explain the admission procedure, to include

(a) Previous medical history

(b) Contact numbers for next of kin.

(c) Allergies

(d) Drug treatment.

2. To identify parameters of pulse, blood pressure, temperature and respiration

3. To discuss the relevance of base line observations.

4. With trained staff supervision assess and plan the pre-operative care.

5. With trained nurse supervision discuss the information you need before taking a patient to theatre.

6. To discuss the relevance of the pre-operative period.

7. Observe hand over of a patient from recovery staff

.

8. Identify and discuss the relevance of post-operative observations.

9. Discuss the potential problems following surgery and the appropriate action that should be taken10. With trained staff supervision assess and plan the post-operative care.

11. Explain the relevance of identifying and assessing size and site of a wound.

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DAY UNIT STUDENT INFO PACK 13

ORTHOPAEDICS WHAT DOES

IT MEAN?

The word orthopaedic is derived from two Greek words orthos meaning straight, correct or right(e.g. orthodox) and arpaedia meaning childhood.

The English spelling is paedic the American is pedic.

The Greek word paideia is also used generally for discipline and training.

ORTHOPAEDIC = “straight child”

Nowadays the field of orthopaedics encompasses disorders of bone, joints, muscles, nerves and tendons in both children and adults.

DAY UNIT STUDENT INFO PACK 14

Tina Lane

MENU OF LEARNING EXPERIENCES FOR THE DAY UNIT

Listed are some of the learning experiences that are available on the day unit or in related areas i.e. theatres and the recovery unit. We hope they will help you to see how the competencies can be achieved during your placement. If you feel that you have no opportunity to achieve a particular competence then please speak to your mentor who will help you identify an area of work that will enable you to achieve it or, if necessary, arrange for you to spend some time in another area.