Your estimated discharge date
The Enhanced Recovery Nurses will discuss your estimated discharge date with you.
Ask three questions - preparation for your appointments
We want you to be active in your healthcare. By telling us what is important to you and asking questions you can help with this. The three questions below may be useful:
- What are my options?
- What are the possible benefits and risks of those options?
- What help do I need to make my decision?
This information aims to increase your level of understanding of how you can play an active part in your recovery after your surgery. If there is anything that you are unsure about, please ask. It is important that you understand how you can help yourself recover, so that you, your family and friends can be involved.
This is the programme offered by North Bristol NHS Trust for patients undergoing planned bowel surgery. There may be circumstances where the programme will not be appropriate for some patients and if this is the case, you will be fully informed.
What is the Enhanced Recovery Programme?
The aim of the Enhanced Recovery Programme is to get you back to full health as quickly as possible after your operation.
Research indicates that after surgery, the earlier we get you out of bed, exercising, eating and drinking, your recovery will be quicker and it will be less likely that complications will develop.
Some of the benefits include:
- A quicker return of normal bowel function.
- Reduced chest infections.
- A quicker return to usual mobility.
- Decreased fatigue.
- Reduced risk of developing blood clots after surgery.
In order to achieve this we need you to be partners with us so that we can work together to speed up your recovery.
What will happen?
Before you come into hospital the consultant will see you in the outpatients department to explain your operation.
Following this you will be sent a date to attend the pre-operative assessment clinic, where trained staff will carry out routine tests that are required to ensure you are fit and safely prepared for surgery. Please note all patients are routinely screened for potential infections at this time.
The specialist enhanced recovery nurse will see you when you attend the pre operative assessment clinic and will explain the programme to you and your family. You will be provided with written information and given plenty of opportunity to ask questions.
You may be referred to the anaesthetist, colorectal nurse specialist and stoma nurse specialist as necessary.
The nurse will discuss your arrangements at home so that together we can plan for any help you may need after your operation. The nurse will also discuss diet and exercise with you and if necessary you will be referred to the dietitian. (For example if you have lost a lot of weight or your appetite is poor). If you have concerns about your appetite or diet before coming in for your operation please speak to the nurses at your pre-assessment visit. What you eat is important, as good nutrition now will help you recover faster from your operation.
You will be given the opportunity to sample special nourishing supplement drinks: these are called ‘fortijuce’ and ‘fortisip’. You will be given some of the drinks to take home with you even if your weight and appetite are normal. You can choose from a variety of flavours.
It is important to keep as active as you can before your operation and if you are a smoker you should stop now. This helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice on products to help you stop smoking.
Please bring a supply of your own medications into hospital with you. These will be stored safely on the ward and will be returned to you on discharge.
Please also bring a supply of comfortable ‘day clothes’ as you will be encouraged to return to normality as quickly as possible after your operation, and this includes getting dressed.
Eating and drinking
Prior to your surgery you will be able to eat and drink as normal unless you are required to take medication to clear the contents of your bowel. If this applies to you it will be discussed with you at pre operative assessment.
In preparation for your operation and in addition to your normal diet, you should aim to take three of the “Fortisip/Fortijuce” supplement drinks per day, for each of the 2 days before admission. Each drink can be sipped over a few hours.
When you are admitted to the ward after your operation, the supplement drinks will continue to be available to you, and you will need to continue with three per day.
The supplement drinks are important to help with wound healing, to reduce the risk of infection and aid with your overall recovery. It is important that you also continue to have a variety of other non-fizzy drinks during your hospital stay.
As well as the supplement drinks mentioned, you will also be required to take special carbohydrate drinks called ‘Pre Op’. You will require two drinks the night before and two drinks on the morning of your operation.
You may continue to eat for up to six hours before your operation and drink clear fluids for up to three hours before.
A few hours after your operation you may start to drink and eat if you wish. It is important that you eat and drink early after your surgery. Staff will help and advise you. Initially some patients may find a low fibre diet more tolerable. You will be encouraged to help yourself to the supplement drinks from the fridge. You will be expected to recommence the supplement drinks to help build up your strength following surgery.
Recent studies show that chewing gum after an operation can be helpful towards improving your recovery by assisting the bowel to return to its normal function. On the day you come into hospital bring some chewing gum with you. After your operation chew gum for 15 minutes, three times a day, until your bowel function returns to normal.
Preparing for theatre
Before your operation you may need 1-2 enema(s) to empty your bowel contents. Some patients may be required to take medication the day before in order to achieve this. This will be fully explained if this applies to you.
In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.
There is also evidence to suggest that keeping warm, before surgery, helps prevent infection. Please ensure you bring a warm dressing gown, socks, slippers, blankets or similar item of clothing to wear immediately before your operation. (You will be asked to remove the warm clothing when it is time for your operation as you will be required to wear a hospital gown.
After your operation
Mobilising and exercising
Following your operation when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour. To do these you will need to:
- Be in an upright position.
- Take a deep slow breath in (feel your stomach gently rise).
- Hold the breath for three seconds.
- Breathe out slowly.
- Repeat five times.
You should cough regularly to make sure your lungs are clear of secretions. To do this, place a towel or pillow over your abdomen and wound. Support it with your hands and cough.
When you are sitting in the chair or lying in bed, you should also do frequent leg exercises, (as prevention against blood clots); pointing your feet up and down and moving your ankles as if making circles can achieve this.
Depending on what time you come back to the ward, the staff will help you out of bed about six hours after your operation. You may sit out of bed for up to two hours on the day of surgery and then up to six-eight hours out of bed on each subsequent day after surgery if you can manage this.
You will be encouraged to walk at least 60 metres 4 – 6 times per day after your surgery if you can manage this.
By being out of bed in a more upright position and by walking regularly, lung function is improved and there is less chance of a chest infection after surgery. Circulation is also improved, reducing the risk of blood clots and helping bowel function return to normal.
You will also be given a small injection called ‘clexane’ at approximately 6pm each day you are in hospital. This helps reduce the risk of blood clots by thinning the blood. Some patients who are at higher risk of experiencing blood clots may have to continue with the injection once home. This would only be for a few weeks after surgery and will be fully discussed with you when you are in hospital.
Most patients are able to administer the injection themselves or with the help of a relative or carer. The nurses on the ward will show you how to use the injection during your hospital stay. If you have any problems with administering the injection an appointment can be made with your practice nurse to carry this out each day, or we will arrange for a District Nurse to visit you if you are unable to leave the house.
Try wearing your day clothes as soon as you feel able after your operation as this can help you feel positive about your recovery.
It is important that your pain is controlled so that you can walk about, breathe deeply, eat and drink, feel relaxed and sleep well. Please let us know if your pain is not manageable so that we can help you.
It is also important for us to know if you are either allergic or sensitive to certain pain killers.
You may be given one of, or a combination of the following methods of pain relief, to keep you comfortable after surgery:
- Patient controlled analgesia (PCA). This is an intravenous pain killing medication, delivered by a machine, which is set up so that you can control it yourself. You will be given instructions on how to do this.
- Tap block. This is an injection given at the time of your operation to temporarily numb the abdomen and keep you comfortable immediately afterwards.
- Spinal block. This is an injection given at the time of your operation that will temporarily numb you from the waist down and will keep you comfortable afterwards.
- Ketamine infusion. This is a continuous intravenous pain killing medication which will run up to 24 hours after surgery.
The anaesthetist may discuss these options with you and explain more about it when you are in hospital.
Alongside this, the doctors will prescribe other types of pain relieving medicines, which work in different ways. You will be given these regularly (three or four times per day) and you should feel more comfortable.
If the pain worsens at any time, please tell the nursing staff immediately and they will be able to help you.
Sometimes after an operation it is not uncommon to feel nauseated and occassionally vomit. You will be given medication during surgery to reduce this, but if you feel sick following surgery please tell a member of staff who will be able to help.
Tubes and drips
During your operation a tube (catheter) will be placed into your bladder so that we can check that your kidneys are working well and your urine output can be measured. This tube will be removed as soon as possible.
You will have an intravenous drip put into your arm to ensure you do not become dehydrated. The drip will normally be removed the day after surgery, but you may still have the intravenous port (venflon) in place for a couple of days in case we have to give other drugs through it. You may also be required to breathe extra oxygen for a short while after your operation.
Many different things will be monitored during your treatment including:
- Observations (blood pressure, pulse, temperature).
- Fluid out.
- Fluid in.
- Food eaten.
- When your bowel first starts working or you pass wind.
- Pain assessment.
- Number of walks achieved.
- Time spent out of bed.
You may be asked to tell us about what you eat and drink and what you pass so that we can record it.
While you are in hospital you will be asked to participate in maintaining a daily diary/log (provided by the ward) so that you can keep a record of how well you are managing. This will help us monitor your progress.
Please remember playing an active part in your recovery will help you get better sooner. If you have any questions regarding your recovery, please do not be afraid to ask a member of staff.
You will be seen, during your hospital stay, by the Enhanced Recovery Nurses (Monday – Friday) who will support you and advise you on your journey through the Enhanced Recovery Programme.
References and further information
For further information on the Enhanced Recovery Programme:
How to contact us
Enhanced Recovery Nurses
Stoma Care Nurses
© North Bristol NHS Trust. This edition published Dec 2021. Review due Dec 2023. NBT002214