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Managing Diabetes in Patients having Day and Short Stay Surgery-4th Edition A booklet describing how to safely manage diabetic patients for day and short stay surgery. 4th Edit…

The Day Itself - Your Care Pathway

The care pathway covers the different stages of preparation, operation and recovery that you will go through. It is a systematic approach, designed to make the surgical procedure itself as safe as possible and the result as good as possible.

On Arrival

When you arrive at the Day Surgery Unit (DSU), you will be seen by administrative, nursing, anaesthetic and surgical staff to ensure that nothing has changed since your POAC visit.

A member of the surgical team will mark the operative site using a marker pen - i.e they will put a big arrow or cross on you, where the surgery is to be!

The anaesthetist will discuss the anaesthetic and also post-operative pain relief and anti-nausea measures with you.

There will be some final checks, and you will be told how to get ready, perhaps changing into a hospital gown or removing jewellery.

Timing

It is worth repeating that it is impossible to predict the timing of your surgery with any great precision. Usually, things take longer than you expect and it is not unheard of for things to change at a moment's notice - for example, the order of the list may change, some procedures make take more or less time than expected. The DSU staff will keep you informed as well as they are able to.

Your time of arrival does not give any indication of your time of surgery.

In The Anaesthetic Room

You will be asked for a final time if you are fully informed and happy to undergo anaesthesia and surgery. You may be asked to confirm your signature again on the consent form. The operative site will be checked to ensure it is marked. The anaesthetic team will apply the monitoring devices to you and insert an intravenous cannula. The anaesthetic will then be administered.

Some units do all this in the operating theatre itself rather than in the anaesthetic room.

The Immediate Post-operative Period

After your procedure is complete, you will be moved into the recovery area. How long you will spend in here will depend on the anaesthetic used, the type of surgery you have had, and any pain relief medication that you might be given. It is quite normal to feel a little disoriented at first, and you might find it hard to focus on what people are saying or doing. If you have received strong pain relief, this disorientation may be heightened.

Once you are awake enough, you are likely to be given something to eat and drink. The postoperative staff will monitor you until they are happy that your condition is stable.

Pain Relief

It is important that you understand what and how much pain relief you should take after your operation. It is also important that you take it regularly, as instructed by the nursing staff. It is far more effective to prevent post-operative pain than it is to deal with it only once it has developed.

You will be given pain relief throughout your surgery and probably in the recovery area too. It works best if you start taking your post-operative pain killers before the hospital medications wear off. The anaesthetic or nursing staff should give you a detailed schedule about what to take and when to take it.

Hospitals vary in the drugs they are able to provide to take home but over-the-counter pain killers are very effective if taken regularly and in adequate doses.

Post-operative Nausea and Vomiting

Post-operative Nausea and Vomiting is an unpleasant condition that some patients experience. You will be given appropriate anti-emetic medication during your surgery if required, but more will be available to you afterwards if necessary.

Observations and Examination

The anaesthetic and nursing staff will monitor you for pain, nausea and other after-effects such as drowsiness, headaches or a sore throat after a general anaesthetic. Any necessary treatment will be administered.

Special Instructions

If you require any equipment or appliances - dressings, crutches, splints, mobility aids - the DSU staff should be able to provide them (or tell you where to get them from and how to return them).

Discharge

When the nursing staff in the recovery area are satisfied that you are ready for discharge from the hospital, you will be allowed to go home. There is generally no need to see your surgeon or your anaesthetist post-operatively.

It is most unlikely that you would be allowed to drive yourself home and usually you are advised to have someone with you for 24 hours after a surgery. Your companion needs to be aware of their responsibilities: how long they should stay with you (including over-night if necessary), symptoms or signs that may require treatment, a telephone contact number for assistance.

These arrangements should already have been sorted out in the Pre-operative Assessment Clinic.