Immediate Post Op Care Plan – Ward 3A
The majority of patients undergoing endoscopic cranial surgery for craniosynostosis will be nursed in Ward 3A post-operatively. However, some high risk patients with pre-existing airway or respiratory compromise, or other significant co-morbidity, will still require critical care support post-operatively. This will be agreed by the Consultant Surgeon and Anaesthetist in advance of the procedure and a critical care bed booked appropriately.
Ward Nurse Staffing Levels
Patients can be nursed in single room or four bed bay depending on clinical needs.
Handover
Recovery nurse will give a verbal handover to ward nurse with written instructions on the operation note.
Observations
Continuous Sp02 monitoring and a high level of observation for post-operative decline in Glasgow Coma Score or suggestion of intracranial bleeding.
Document HR, BP, Sp02, RR, Temp, CRT and GCS on PEWS chart
- On return from theatre
- ½ hourly for 2 hours
- Hourly for the next four hours
- Then reduce to 2-4 hourly if condition stable
PEWS Policy for MEDICAL REVIEW should be activated at any time if indicated by PEWS score or concern about airway compromise.
Analgesia
Regular IV Paracetamol and Ibuprofen when tolerating milk/diet with PRN Oramorph will be prescribed according to the RHC Acute Pain Protocol. After the first 12-24hrs post op transition to oral paracetamol can be implemented.
Antibiotics
A dose of antibiotics will be given at induction of anaesthesia. There is no routine requirement for post-operative antibiotics.
Fluids and Diet Intake
IV access must be maintained for at least 24 hrs
IV maintenance fluids (usually 70% maintenance plasmalyte in 5% dextrose) should be continued from theatre.
Encourage oral fluids and soft diet if weaned, and reduce IV fluids appropriately.
Medical Staff Review and Role of Hospital at Night (HaN)
- Clinical concerns should be discussed with Neurosurgical Registrar DECT 82164 or via switchboard or PICU (84727) +/- Anaesthesia (84342) immediately if significant airway concern or reduced level of consciousness.
- The craniofacial team will inform the HaN team of the presence of these patients on the ward and any particular concerns that the team has about them.
Usual procedure for OOH review should apply by utilising HaN request on Trak for non immediate concerns (IV access or clinical review) if immediate concerns contact via telephone on dect numbers below.
Hospital at Night Coordinator 85770
HaN Lead Medic 85735 (2100-0900)
- Craniofacial patients to be flagged up to PICU as “watchers” with a clear plan for escalation in the event of clinical deterioration.
The HaN team do not possess airway skills. They will respond to routine tasks such as requests for re-siting of cannulae, and will of course attend in acute deterioration or emergency situation but they will not be the “decision makers” for the cases overnight.
Guidance for nursing staff in the event of clinical concern regarding craniofacial patients on Ward 3A
Examples of who to contact in the following situations:
- Reduced level-of-consciousness or suggestion of intracranial bleeding (as indicated by high PEWS score)
- On-call Neurosurgical Registrar via switchboard (or ext 82164)
- Request medical review from HaN team DECT 85770 (OOH 85735)
- Anaesthetic Registrar DECT 84342
- Signs of airway compromise:
- Anaesthetic Registrar: DECT 84342
- PICU Registrar: DECT 84725
- Inform Neurosurgical Registrar: DECT 82164