NORTHALLERTON
HEALTH
SERV1CES
SURGICAL WARD
MULTI-DISCIPLINARY
CO-ORDINATED CARE PLAN
Trans-Urethral Resection of Prostate
Patient's Name ___________________
Hospital Number ________________ DOB ___________
Named Consultant _______________
Named Nurse ____________
Abbreviations used in this document:
TPR
Temperature, Pulse & Respiration
WTU Ward Test Urine
CBI
Continuous Bladder Irrigation
IVI
Intravenous Infusion
RGN Registered General Nurse
BP
Blood pressure
MSU Midstream Specimen of Urine
CXR Chest x-ray
OPA
Out patient appointment
HCA Care Assistant
NORTHALLERTON HEALTH SERVICES TRUST
CO-ORDINATED CARE PROGRAMME
SURGICAL WARD
INFORMATION SHEET FOR PATIENTS
This sheet has been produced in order to provide you with some additional information regarding
your stay within the Surgical Ward at the Friarage Hospital.
We are currently looking at ways of making sure that the care we offer is:
EFFICIENT
THE RIGHT CARE FOR YOU
THE HIGHEST QUALITY
One way of achieving these objectives is by clearly agreeing and documenting patient care
therefore, the doctors, nurses and physiotherapists in the Ward have met together to discuss and
decide what tests and treatments need to be done whilst you are here, and when is the best time to
do them.
This is then put onto paper and called a "Co-ordinated Care Plan" or a "Patient Focused Plan"
because it lists all the really important events and the best time for them to happen.
The nurses will show you this documentation and answer any questions you may have. Your
treatment and care continues to be kept in confidence at all times.
Of course, there may be very good reasons for some of these events not happening at the stated
time, and the doctors and nurses will use their experience and professional judgement to decide the
best care for you. When each event has happened they will sign by it, so that it is easy to see what
care has been given and what still needs to be done.
The programme is still in its infancy, and although the care given to patients will be consistent, the
paperwork for the staff will be different when they are using the "Co- Care Plan" system.
If you have any questions of comments about your plan of care the nursing staff will be happy to
discuss it with you.
Multi-disciplinary Care Protocol
Trans-Urethral Resection of Prostate
SPACE FOR ID LABEL
ACTIVITY
STAFF
SIGNATURES
MORNING
AFTERNOON
DATE OF ADMISSION . . . . . . . . . . . . . . . . ..
PRE-OPERATION
Complete admission assessment / social services forms RGN
ID band fitted
RGN/HCA
Record baseline TPR, BP, Weight
RGN
Obtain WTU and MSU
RGN
Give patient 2 x suppositories
HCA
Give and discuss pre and post-op information about
catheter and CBI
RGN
.........................
Obtain medical history
Take blood - GP save, X-match, HB & U+E's
Order ECG if >5O yrs
Order CXR
Answer any questions patient has
Perform rectal examination
Obtain consent
Prescribe pre-op antibiotic: ie Trimethoprim
Prescribe night sedation and post-op pain relief, if
necessary
)
)
)
)
)
)
)
)
)
) Medical
.........................
Order non-stock drugs from pharmacy
RGN
Teach deep breathing + leg exercises
Physio
Examine by anaesthetist
Prescribe pre-med if required
)
)Anaesthetist
.........................
Monitor sleeping pattern
Night RGN
....................
Specific Care Comments
Time
Comment
Signature
NIGHT
Hospital No
ACTIVITY
STAFF
............... .... Patient's Name .................
SIGNATURES
MORNING
AFTERNOON
NIGHT
OPERATION DAY - PRE OP DATE
Fast patient 4 hrs pre-op Time ..................................... RGN
Prepare patient for theatre
- bath
- change into gown
- change bed linen into theatre pack
HCA
.........................
Complete checklist and give pre-med (if prescribed)
RGN
.........................
Collect all notes, X-rays, bloods and MSU results
RGN
.........................
Accompany patient to theatre
HCA
.........................
Collect patient from theatre
RGN
.........................
1 hourly P + BP until stable - then 4 hourly
RGN
Follow post-op anaesthetic instruction
RGN
OPERATION DAY - POST OP
Check CBI running appropriately according to colour
of drainage in catheter bag, empty and record amount
when necessary
RGN
Transfer info from anaesthetic sheet to fluid balance
chart
RGN
Check IVI running on time
RGN
Give fluid and diet as tolerated
HCA
Assist with personal hygiene
HCA
Perform catheter care 4 hourly
HCA
Monitor sleep pattern
Night RGN
............................ .........................
Specific Care Comments
Time
Comment
Signature
Hospital No
ACTIVITY
......................... Patient's Name ....................
STAFF
SIGNATURES
MORNING
AFTERNOON
DAY 1 POST OP - DATE ...................................
Assist patient from bed to chair, monitor response
HCA
.........................
Encourage deep breathing, mobility as condition allows Physio/RGN
Monitor colour of patients urine and reduce CBI as
urine becomes clearer
RGN
Discontinue IVI - leave venflon in situ depending on
fluid tolerance
HCA
Assist with personal hygiene
HCA
Encourage 21/2 litres throughout 24 hours
RGN
Check Hb
Medical
Record TDS, TPR + BP
RGN
Teach patient self catheter care AM 1 PM
RGN
Monitor sleep pattern
Night RGN
.....................
Specific Care Comments
Time
Comment
Signature
NIGHT
Hospital No
ACTIVITY
................. ...Patient's Name...............
STAFF
SIGNATURES
MORNING
AFTERNOON
NIGHT
DAY 2 - POST OP DATE . . . . . . . . . . . . . . . . . . . . .
Assist patient with personal hygiene
HCA
Encourage deep breathing and mobility
RGN
Remove venflon - if Hb stable
RGN/HCA
Monitor colour of urine - clamp CBI if clear/rose and
record fluid balance/bladder irrigation chart 4 hourly
RGN
Encourage to drink 2.5 litres throughout day reducing
volume in evening
HCA
Give 2 x supps and record effect
HCA
Assist patient with self catheter care
RGN/HCA
Monitor sleep pattern
Night RGN
........................
Specific care comments
Time
Comment
Signature
Hospital No ......................... Patient's Name ....................
ACTIVITY
STAFF
SIGNATURES
MORNING
AFTERNOON
NIGHT
DAY 3 - POST OP DATE
Remove catheter if urine amber and record
output/frequency/urgency. Instruct patient on urine
measurement
RGN/HCA
.........................
Encourage to reduce drinking to 1 1/2 litres till 6pm and
record fluid balance
HCA
Check bladder capacity
Medical
Prescribe discharge medication and complete discharge
letter.
Medical
Obtain patients discharge medication
RGN
Complete discharge checklist
Give discharge documentation, medication & OPA
(if patient for discharge today )
)
)
) RGN
If unable to pass urine after catheter removed recatheterise with long term catheter
Medical
Apply legbag and initiate teaching patient bag drill for
day and night + catheter hygiene
HCA
Monitor sleep pattern
Night RGN
............. ........................... ..................
Specific care comments
Time
Comment
Signature
Hospital No ......................... .. Patient's Name .................
ACTIVITY
STAFF
SIGNATURES
MORNING
AFTERNOON
NIGHT
DAY 4 - POST OP DATE
Check patients ability to disconnect nightbag from
legbag
RGN
Assist with general hygiene needs + catheter
HCA
Give 1 weeks supply of nightbags
RGN
Arrange District Nurse for weekly CSU
RGN
Complete discharge checklist
Give patient discharge documentation, medication and
prescription details for catheter bags for GP
RGN
Give patient readmission date to come in 6/52 for trial
removal of catheter
RGN
Specific Care Comments
Time
Comments
Signature