1 / 15

Assessment of obese patients to facilitate day case admission

Assessment of obese patients to facilitate day case admission. Sister Sue Roberts – Pre-op nurse practitioner Dr James Palmer – consultant anaesthetist Salford Royal Hospitals NHS Trust. Introduction. Why change practice? Audit What could be changed? Implementation Effects of new process.

enoch
Download Presentation

Assessment of obese patients to facilitate day case admission

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Assessment of obese patients to facilitate day case admission Sister Sue Roberts – Pre-op nurse practitioner Dr James Palmer – consultant anaesthetist Salford Royal Hospitals NHS Trust

  2. Introduction • Why change practice? • Audit • What could be changed? • Implementation • Effects of new process

  3. Why change? • Improve patient experience • Manage patients effectively • Meet day surgery targets • Meet 18 week pathway targets

  4. Audit of Gynae Overnight stays • One year’s data (2004-5) • 27 ASA1 patients admitted with BMI >35 • 1 required additional analgesia, 1 had vaginal pack, 2 had no social support. • 5 went home same day (1 with BMI=46), • 22 NO nursing/medical intervention required overnight!

  5. Population Audit of Obesity • Health survey for England 2000-2002. • Proportion of population with BMI >30 • National 21.4% (quoted as 21.8% elsewhere from same source) • Greater Manchester 21.1% • Salford 22.1%

  6. Audit figures at Salford Royal Hospital • 5.5% of daycases done have BMI ≥37. • 6% of non daycase elective surgical patients BMI>37 • Anaesthetic audit showed vast majority feared: • postoperative hypoxia in the obese • OSA • Some patients might benefit from referral for sleep studies and possible home CPAP.

  7. What are other NW trusts doing? • 2007 telephone/email audit of all NW day case units • Questions: • Do you have an upper limit for BMI for day surgery? • What is it? • Why has this figure been chosen?

  8. Results

  9. Discussion points • Choice of max BMI not evidence based • Pennine acute • Follow up for high BMI cases • None declared • Planned development • None declared • Active preassessment • None declared

  10. How to assess • Consulted respiratory team in trust • Developed process for pre-op nurses to follow

  11. Process ASA 1 with BMI >37 Baseline sitting SpO2 <95% not fit for DSU >3% desturation >95% do 2 minute step test <3% desaturation complete OSA questionnaire   Negative Refer for PSG ADMIT TO DSU Improvement with CPAP Positive PSG – referred for NCPAP training

  12. Pre-op assessment clinic • Generic clinic • Qualified nurse practitioners • Pre-op support workers • Equipment • In house sleep studies referral

  13. Implementation • Step test • Epworth score • Sleep studies how to refer? ?stop clock

  14. Outcome • Individualised patient process identified • Utilising day surgery more effectively • Increased patient satisfaction • No cancellations/AIRs • Day surgery staff report no problems

  15. Thank you Questions???

More Related