Royal Gwent Hospital Day Surgery Unit

1. Royal Gwent Hospital Day Surgery Unit Student Nurse Handbook

2. Day Surgery’s Philosophy • We recognise the right of each student to be treated with respect and given the necessary support to benefit from his or her placement within the unit • We will provide an environment that geared to learning in a supportive and positive way

3. Philosophy • The unit is English speaking but we will make every effort to accommodate Welsh speaking students and other students of other nationalities. • The care we provide in this unit reflects inclusion, dignity, diversity, respect and support for the patients religious and cultural beliefs as well as practices.

4. DSU Philosophy • We recognise that it is an on going process and will endeavour to ensure that though reflective practice, all activities and procedures are seen as learning opportunities.

5. Introduction • The Day Surgery Unit cares for patients coming into hospital for the day to undergo planned, routine operations and investigations. The Unit is open Monday to Friday from 07.00hrs until 22.00hrs. It is a nurse led service and includes the specialities of Gynaecology, General surgery, Orthopaedic, Ear Nose and Throat, Chronic Pain Management and Dermatology, performed under general and local anaesthetics. • Our role as Registered Nurses, is to admit patients into the Unit giving support, advice and as much information as possible prior to surgery, in order to reduce stress and promote a speedy recovery.

6. Allocation • Pre-registration nurses can be allocated to DSU for their surgical placement from 1 week, - 12, weeks • You will be allocated to the ward, anaesthetics, theatre and recovery areas.

7. Learning Opportunities • Ward – Admission, Pre-op Check List, Post Operative Care and Discharge • Anaesthetics – Airway, Breathing Circulation, Medication and Maintenance • Theatre, Infection Control, Health and Safety, Management of Waste, Management of Swabs Needles and Instruments and Equipment • Recovery, Care of the Unconscious Patient, Monitoring of Observations, Pain and Nausea Requirements, Medicines Management, Care of Patients following Spinal Anaesthetics

8. DSU Ward • On the day of surgery the majority of patients will have been pre-assessed. If not, the patient will be assessed on admission prior to their operation. • On admission the named nurse identifies any problems or needs (physical, social or psychological) and informs the relevant surgeon or anaesthetist. • The named nurse completes an assessment. Correct patient identification is essential to ensure that the right person has the right operation. Name bracelets are used to identify individual patients and these are verified with the patient prior to them being secured to the patients’ wrist/ankle together with any allergy bands. • The nurse needs to complete a pre-operative checklist, an example of which will be seen during your placement. The patient needs to be dressed appropriately in a theatre gown, removing underwear, taping any jewellery and removing any nail varnish and make-up. • The patients are then seen by both the surgeon and anaesthetist, who explain again what will happen to the patient and take the patients written consent for the procedure. Depending on the surgery the patient is to undergo there may be other procedures to be followed i.e. shaving the operative area, pregnancy tests, pre-medication to be administered.

9. Pre-Operative Checks • The correct patient is consented for the right operation • He/she is fit enough for surgery/general anaesthetic • The patient has been fasted for an appropriate time • Operation site marked • Had correct investigations, tests and preparation • Has signed the consent form • He/she is dressed in a theatre gown and all make-up removed • All jewellery removed or secured • Blood pressure/pulse, temperature, oxygen saturation weight/body mass index have been recorded individual health needs of the patient has been highlighted i.e. coughs and colds • The patients are prepared emotionally as wellas physically

10. Anaesthetics • Understand the importance of communication for relieving anxiety, and the process of patient preparation for anaesthesia • Recognise essential anaesthetic equipment • Identify different methods of anaesthesia • Understand the principles and practice of airway management • Observe patient’s airway and insert pharyngeal airway Demonstrate the use of patient monitoring equipment to include: ECG/NIBP/Spo2/temperature • Understand different methods of anaesthetic medication administration • Recognise the importance of anaesthetic documentation

11. Operating Theatre • Understand the design, layout and traffic patterns of the operating theatre department, and the roles of the theatre personnel • Understand the importance of effective communication and liaising with the multi-disciplinary team • Understand the importance of maintaining patient safety including the principles of: Infection control, Universal Precautions, Sterilisation methods • Planning holistic care • Operating Theatre documentation including pre-operative check list Manual Handling/Patient positioning and moving • Patient advocacy and maintaining patient dignity • Demonstrate awareness of patients with special needs, which may include: Learning disabilities/ mental illness/ physical disability, partial or complete loss of hearing, vision or speech, little or no understanding of the impending surgical procedure (e.g. children)

12. Surgery • Demonstrate the principles of aseptic technique • Perform surgical scrub and donning of gown and gloves • Recognise the importance of theatre checking procedures and preparation prior to the commencement of an operating list, including: • Heating/lighting/humidity/packs/instruments • Discuss the roles of the circulating nurse and scrub nurse • Recognise and state the use of surgical diathermy • Discuss the importance of swab, needle and instrument checks • Demonstrate the correct disposal of sharps, swabs and instruments • Identify types of sutures, drains and wound dressings and apply wound dressings • Understand the process of wound healing • Understand the importance of correct sending of specimens • Understand the difference between various pain injections • Understand the importance of effective communication between the ward and recovery regarding continued care, to include operative notes, post operative instructions, what drugs may have be given intra/post operatively and ensuring the discharge letter has been signed

13. Recovery • Following the operative procedure/investigation, the patients are taken to primary recovery. • This area is where they are woken from the general anaesthetic and monitored until they are deemed alert and recovered enough to be transferred to the secondary recovery area. • In primary recovery the patient’s blood pressure, heart rate, oxygen saturation, level of consciousness, respiration and temperature are recorded. Oxygen is administered until they are able to maintain their own airway and have achieved an acceptable oxygen saturation level. This figure is a saturation of at least 95%. • Once the patient is awake and stable and the recovery nurse is satisfied with the patients’ recovery, they are transferred back on to the ward area. Patients are offered refreshments prior to getting up: this is to assess whether or not they can tolerate fluids without causing nausea and vomiting, prior to discharge home. Once patients are fit enough they are assisted up from the trolleys and get dressed, prior to discharge home. • Patients who are having ‘local’ operative procedures (which does not involve general anaesthetic) are offered a hot drink before being discharged home.

14. Post-Operative back on the Ward • Patients are offered refreshments prior to getting up: this is to assess whether or not they can tolerate fluids without causing nausea and vomiting, prior to discharge home. Once patients are fit enough they are assisted up from the trolleys and get dressed, prior to discharge home. • Patients who are having ‘local’ operative procedures (which does not involve general anaesthetic) are offered a hot drink before being discharged home.

15. Discharge Ensuring that the patient is fit for discharge is vitally important, as they will be expected to continue their care at home without the assistance of nursing staff. With this in mind discharge planning should always commence at pre-assessment if possible and not later than admission. There are strict discharge criteria that the patient must achieve if they are to be allowed home. These criteria are mainly built around safety issues for the patient, nursing staff and the patients’ carer. The patients named nurse will re-assess the patients physical, social and psychological status, applying the criteria and not until the patient satisfies all criteria, will they be discharged.

16. Discharge • The patient must: * Be able to tolerate fluids without feeling nauseated or vomiting * Have a level of pain that is acceptable to them * Have an escort home in private transport * Have a carer for 24 hours following their surgery * Not have any problems with their wound i.e. bleeding * Be provided with contact numbers in the event of any problems following discharge * Be given information about recovery, their operation and aftercare * Be given guidance on any dressing changes or sutures to be removed * State that they feel confident and happy to go home and continue their care in their own home

17. Telephone Follow-Up The Day Surgery Unit promotes continuation of care following discharge and therefore operates a telephone follow-up service. Patients are contacted by phone the following day to ensure that a good recovery has continued. The patient is assessed regarding pain, sleep, wounds, blood loss and eating and drinking. They also reinforce the taking of pain relief medication and reinforce information given on discharge if the patient is still unsure. This service is beneficial for both staff and patients and their carers as it gives the opportunity to clarify any problems and it gives the patients a chance to ask questions.

18. Mentors • Mentors are allocated to Student Nurses and they have to work with them 40% of the time • If you have any problems the Practice Educator will be found in Main Theatre Ask for Jane Reece 01633 238325

19. Day Surgery StaffSisters • DSU Manager Claire Thacker • Deputy Sister Sophia Whitcombe • Deputy Sister Leanne Knapp

20. Uniforms and Lockers • You do not kneed to wear your Student Uniforms to work. You will be provided with ‘Scrub Suites’ • Shoes should be brought in, they must be wipe-able and only used for the time in DSU. • Lockers are small, so do not bring large bags and do not bring anything of value

21. Shift Pattern DAY ONE YOU WILL START AT 09.00HRS THERE WILL BE AN INDUCTION PROGRAM AND A TOUR OF THE THEATRES TYPICAL SHIFT IS 07.30hrs – 19.00hrs

22. BREAKS/MEALS • FOOD CAN BE PURCHASED FROM THE HOT TROLLEY LOCATED IN THE REST ROOM BETWEEN 12.00-14.00HRS • IF YOU WISH TO GO TO THE STAFF DINNING ROOM THAT IS ACCEPTABLE BUT YOU MUST CHANGE INTO YOUR OUTDOOR CLOTHES • VENDING MACHINES ARE ALSO LOCATED IN THE REST ROOM IN MAIN THEATRE THEY PROVIDE HOT & COLD BEVERAGES, SANDWICHES & SNACKS • COFFEE/MEAL BREAKS WILL BE ARRANGED WITH YOUR MENTOR

23. Contact Telephone Numbers for DSU • 01633 234196 • 01633 234199

24. Sickness and Absence • ABSENCE MUST BE REPORTED AS SOON AS POSSIBLE TO DAY SURGERY UNIT 01633 234199/4196 • STATE YOUR NAME, DESIGNATION, MENTOR AND WHICH THEATRE YOU HAVE BEEN ASSIGNED TO, ALONG WITH THE REASON FOR ABSENCE • CARDIFF UNIVERSITY STUDENTS PHONE THE UNIVERSITY 24 HR ANSWER PHONE 02920 687878 • UNIVERSITY OF SOUTH EAST WALES STUDENTS PHONE PRE-REGISTRATION OFFICE 01443 483068

25. FINALLY • WE HOPE YOU ENJOY YOUR TIME AT THE DAY SURGERY UNIT • WE HOPE THAT YOU WILL GAIN KNOWLEDGE AND TRANSFERABLE SKILLS THAT WILL HELP YOU IN YOUR CAREER WHERE EVER YOU WORK