ENHANCED RECOVERY PATHWAY IN COLORECTAL SURGERY
The Activities on these Portfolio Pages correspond with the learning objectives
of the Guided Learning unit published in Nursing Times 105: 28 (21 July, 2009)
and 105: 29 (28 July, 2009). The full reference list for this unit follows Activity 4.
Before starting to work through these Activities, save this document onto your
computer, then print the completed work for your professional portfolio.
Alternatively, simply print the pages if you prefer to work on paper, using extra
sheets as necessary.
Recording your continuing professional education
To make your work count as part of your five days’ CPD for each registration
period, make a note in the box below of the date and the total number of hours
you spent on reading the unit and any other relevant material, and working
through the Activities.
Hours:
Date:
ACTIVITY 1
Learning objective: Understand the
principles of an enhanced recovery
programme and the associated surgical
procedures.
Activity: Explain how an enhanced
recovery programme might benefit the
following patients and their families:
 A recently widowed 82 yearold with a history of ischaemic
heart disease;
 A 15 year-old who is a county
cross country runner.
RESPONSE
Begin your response here.
Nursing Times Portfolio Pages: Enhanced recovery pathway in colorectal surgery
11
1
ENHANCED RECOVERY PATHWAY IN COLORECTAL SURGERY
ACTIVITY 2
Learning objective: Understand the
post-operative care for patients on the
enhanced recovery programme.
enhanced recovery and traditional care in
the pre- and post-operative period.
RESPONSE
Begin your response here.
Activity: Explain the variations between
Nursing Times Portfolio Pages: Enhanced recovery pathway in colorectal surgery
22
2
ENHANCED RECOVERY PATHWAY IN COLORECTAL SURGERY
ACTIVITY 3
Learning objective: Know the signs and
symptoms that might occur indicating a
post-operative complication.
Activity: Outline the signs and symptoms
of different post-operative complications
in colorectal surgery.
RESPONSE
Begin your response here.
Nursing Times Portfolio Pages: Enhanced recovery pathway in colorectal surgery
3
3
ENHANCED RECOVERY PATHWAY IN COLORECTAL SURGERY
ACTIVITY 4
Learning objective: Identify the cause
and treatment of post-operative
complications related to colorectal
surgery.
colorectal surgery?
If a patient had abdominal distension and
felt nauseous, what nursing care would
be necessary?
RESPONSE
Activity: What considerations would be
important when caring for a postoperative patient who has undergone
Begin your response here.
Nursing Times Portfolio Pages: Enhanced recovery pathway in colorectal surgery
4
4
ENHANCED RECOVERY PATHWAY IN COLORECTAL SURGERY
FULL REFERENCE LIST
Billyard, J. et al (2007) Implementing an
enhanced recovery programme in a district
general hospital. Gastrointestinal Nursing;
5: 9, 32–39.
Bisanz, A. et al (2008) Characterizing
postoperative paralytic ileus as evidence
for future research and clinical practice.
Gastroenterology Nursing; 31: 5, 336–344.
British National Formulary (2009) BNF
57. London: BMJ Group and RPS
Publishing. www.bnf.org/bnf
Chan, M.K.Y., Law, W.L. (2007) Use of
chewing gum in reducing postoperative
ileus after elective colorectal resection: a
systematic review. Diseases of the Colon
and Rectum; 50: 2149–2157.
de Castro, S.M.M. et al (2008) A
systematic review of the efficacy of gum
chewing for the amelioration of
postoperative ileus. Digestive Surgery; 25:
39–45.
Faiz, O. et al (2009) A cohort study of
results following elective colonic and rectal
resection within an enhanced recovery
programme. Colorectal Disease; 11: 4,
366–372.
Fearon, K.C.H. et al (2005) Enhanced
recovery after surgery: a consensus review
of clinical care for patients undergoing
colonic resection. Clinical Nutrition; 24:
466–477.
Fearon, K.C.H., Luff, R. (2003) The
nutritional management of surgical patients:
enhanced recovery after surgery.
Proceedings of the Nutritional Society; 62:
807–811.
Francis, N.K. (2008) The enhanced
recovery programme and laparoscopic
surgery: a new era for colorectal cancer
management. Gastrointestinal Nursing
Journal; 6: 5, 24–28.
Frost, E.A.M. (2008) Strategies to prevent
postoperative ileus associated with opioid
administration. Topics in Pain
Management; 24: 4, 1–7.
Gatt, M. et al (2005) Randomized clinical
trial of multi-modal optimization of surgical
care in patients undergoing major colonic
resection. British Journal of Surgery; 92:
1354–1362.
Han-Geurts, I.J.M. et al (2007)
Randomized clinical trial of the impact of
early enteral feeding on postoperative ileus
and recovery. British Journal of Surgery;
94: 555–561.
Hendry, P.O. et al (2009) Determinants of
outcome after colorectal resection within an
enhanced recovery programme. British
Journal of Surgery; 96: 197–205.
Holte, K.H., Kehlet, H. (2005) Diverse
therapeutic solutions to a challenging
problem: a multi-modal approach to
postoperative ileus. Contemporary Surgery;
61: 8–11.
Kehlet, H., Wilmore, D.W. (2002)
Multimodal strategies to improve surgical
outcome. American Journal of Surgery;
183: 630–641.
King, P.M. et al (2006a) Randomized
clinical trial comparing laparoscopic and
open surgery for colorectal cancer within an
enhanced recovery programme. British
Journal of Surgery; 93: 300–308.
King, P.M. et al (2006b) The influence of
an enhanced recovery programme on
clinical outcomes, cost and quality of life
after surgery for colorectal cancer.
Colorectal Disease; 8: 506–513.
Leaper, D. (2003) Infectious complications
of surgery in general. In: Leaper, D.J., Peel,
A.L.G. (eds) Handbook of Postoperative
complications. Oxford: Oxford University
Press.
Leier, H. (2007) Does gum chewing help
prevent impaired gastric motility in the
postoperative period? Journal of the
American Academy of Nurse Practitioners;
19: 3, 133–136.
Mackay, M. et al (2005) Randomised
clinical trial of physiotherapy after open
abdominal surgery in high risk patients.
Australian Journal of Physiotherapy; 51:
151–159.
Nielsen, K.G. et al (2003) Effects of
posture on postoperative pulmonary
Nursing Times Portfolio Pages: Enhanced recovery pathway in colorectal surgery
5
5
ENHANCED RECOVERY PATHWAY IN COLORECTAL SURGERY
function. Acta Anaesthesiologica
Scandinavica; 47: 1270–1275.
Parnaby, C.N. et al (2009) Sham feed or
sham? A meta-analysis of randomized
clinical trials assessing the effect of gum
chewing on gut function after elective
colorectal surgery. International Journal of
Colorectal Disease; 24: 5, 585–592.
Schoetz, D.J. et al (1997) Ideal length of
stay after colectomy: whose ideal?
Diseases of the Colon and Rectum; 40:
806–810.
Schuster, R. et al (2006) Gum chewing
reduces ileus after elective open sigmoid
colectomy. Archives of Surgery; 141: 2,
174–176.
Schuster, T.G., Monte, J.E. (2002)
Postoperative ileus after abdominal
surgery. Urology; 59: 4, 465–471.
Soop, M. et al (2006) Optimizing
perioperative management of patients
undergoing colorectal surgery: what is
new? Current Opinion in Critical Care; 12:
166–170.
van Dam, R.M. et al (2008) Initial
experience with a multimodal enhanced
recovery programme in patients undergoing
liver resection. British Journal of Surgery;
95: 969–975.
Wald, H.L. et al (2008) Indwelling urinary
catheter use in the postoperative period:
analysis of the national surgical infection
prevention project data. Archives of
Surgery; 143: 6, 551–557.
Wind, J. et al (2006) Systematic review of
enhanced recovery programmes in colonic
surgery: results of a multicentre study.
British Journal of Surgery; 93: 800–809.
Wu, L., Griffiths, P. (2005) Early
postoperative feeding and abdominal
gynaecological surgery. British Journal of
Nursing; 14: 1, 42–46.
Zeitz, K. (2004) Post-operative
complications in the first 24 hours: a
general surgery audit. Journal of Advanced
Nursing; 46: 6, 633–640.
Nursing Times Portfolio Pages: Enhanced recovery pathway in colorectal surgery
6
6
ENHANCED RECOVERY PATHWAY IN COLORECTAL SURGERY
Nursing Times Portfolio Pages: Enhanced recovery pathway in colorectal surgery
7
7