Diary for Enhanced Recovery after Colorectal Surgery

What is the Enhanced Recovery Programme (ERAS).

At Blackpool Teaching Hospitals NHS Foundation Trust we aim to provide high standards of care based on current recommendations and protocols. The enhanced recovery programme is part of this and ensures that all members of the hospital and primary care staff work together to ensure patients;

• Are kept fully informed of what is happening at all times to enable you to make informed choices.

• Are as healthy / fit as possible before receiving treatment.

• Receive the best possible care during their operation.

• Receive the best possible care whilst recovering.

• Play an active role in your own recovery.

What the Enhanced Recovery Programme means to you

You will follow an ERAS programme which will provide you with daily goals to strive to achieve. Please remember that these goals are set to be worked towards, but everyone is an individual and will achieve these goals at different times. Please do not be disheartened if you don’t always meet your goals each day. This programme has input from all members of the team that will treat you and includes:

• Pre-admission screening and information

• Good pain relief • Improved sickness plan

• Early walking after surgery

• Early removal of catheters

• Less drips and drains

• Smaller wounds or keyhole surgery

• Early eating and drinking

• Reduced infection rates

• Shorter and more comfortable stay in hospital

• You feel involved in your care

This booklet will give you some information about the programme and how you can play an active part in your recovery.

Improve your fitness before your surgery

Moderate exercise before your operation will help strengthen your muscles and build up stamina which will benefit your recovery after surgery. This will allow you to mobilise earlier and reduce your risk of breathing problems such as chest infections which are common after major surgery. Depending upon your general fitness levels and the effects of any treatments you have already undergone, you may have a reduced ability, try going for a walk twice a day and increasing the distance over a period of time, to aid your personal fitness levels.

Walking, swimming, cycling and climbing stairs are all good ways of improving your fitness and strengthen your core muscles. You should choose an activity and an intensity that is appropriate for your current level of fitness. Ideally the exercise should raise your heart rate and make you feel breathless; however you should not be so breathless that you cannot hold a conversation. Please document on the next page the exercise that you do in the weeks leading up to your surgery – the more weeks you do the better!

Encouraging deep breathing and oral hygiene

Our aim both before and after your admission is to reduce the risk of you developing any complications such as a chest infection. As well as your increased activity level prior to surgery we would also like you to complete regular deep breathing exercises both before and after your operation. These are very important to reduce the risk of complications, we will be encouraging you to carry them out as soon as you return from the operating theatre.

In order to perform the breathing exercises firstly sit upright, as your lungs will expand better in this position. Place your hands on your tummy and breathe in deeply through your nose, pushing your tummy out into your hands as you do so. Try to hold your breath at the top for a count of 3 seconds and then slowly breathe out through your mouth. Repeat this for a maximum of 5 times at once, any more may cause you to experience dizziness or light headedness. Try to perform these exercises 3-4 times a day at home in preparation for your surgery which will help to improve your lung function. Good oral hygiene is also important to reduces the risk of lung complications after major surgery and improves your overall general health. Therefore brush your teeth for two minutes and use an antiseptic or chlorhexidine mouthwash twice.

7 days prior to surgery, walk or activity twice a day

Deep breathing exercises ..............Oral hygiene twice a day.............

6 days prior to surgery, walk or activity twice a day

Deep breathing exercises ..............Oral hygiene twice a day.............

5 days prior to surgery, walk or activity twice a day

Deep breathing exercises ..............Oral hygiene twice a day.............

4 days prior to surgery, walk or activity twice a day

Deep breathing exercises ..............Oral hygiene twice a day.............

3 days prior to surgery, walk or activity twice a day

Deep breathing exercises ..............Oral hygiene twice a day.............

2 days prior to surgery, walk or activity twice a day

Deep breathing exercises ..............Oral hygiene twice a day.............

The day before your surgery, walk or activity twice a day ............................................................................................................

Deep breathing exercises ..............Oral hygiene twice a day.............

Its important to remember moderate exercise before surgery will help strengthen your muscles and build up stamina which will benefit your recovery, the longer you give your body to build up stamina the better.

Eating Well

Good nutrition is always important but it becomes even more vital before and after surgery. After surgery you will have wounds that will heal better if you have been eating a healthy balanced diet before surgery.

Try and eat your recommended 5 portions of fruit and vegetables in the days / weeks leading up to your admission, and include some sort of protein in your meals (meat, chicken, fish, eggs, pulses). Continue to eat and drink as normal the day before surgery. After surgery we will give you supplement drinks to boost your vitamins, mineral and protein intake. These are all essential elements needed for wound healing and your post operative recovery.

Preload Drink

At the preadmission clinic you will be given a Preload drink that you should take before surgery. This drink provides you with extra carbohydrates that will help prepare your body for surgery. How and when you should take this drink will be explained to you at preadmission. This drink is an important part of your pre operative build-up and it is essential that you take it as requested.

Sachet one, mix with 400mls of water and drink at ____________

Sachet two, mix with 400mls of water and drink at ____________

If you are a diabetic who takes insulin you will not be given the pre-load drink. It is important that you continue to eat and drink normally the day before surgery. Please have supper before 10pm and follow the instructions given to you at pre-admission clinic.

Smoking and Alcohol

In order for you to be in the best possible health for your surgery we recommend that you ideally stop (or at least reduce) your alcohol and cigarette intake. Smoking significantly increases your risk of developing a chest infection and also slows down the healing process causing problems with your wounds. Alcohol can also suppress the immune system meaning a much higher risk of complications following surgery. If you do smoke or drink please use this as an opportunity to stop or cut down as smoking increases your risk of developing complications. Cutting back or stopping completely will help speed up the healing process, speed up your recovery and reduce the risk of complications occurring, reducing your stay in hospital.

For smoking cessation advice or drop in clinic times please call Stop Smoking Services on:

• Blackpool - 01253 957457

• North Lancashire - 08081964324

Likewise If you require support with reducing your alcohol consumption please contact your GP or ask the nurses to contact our Hospital Alcohol Liaison Team (HALS) – 01253 953943.

Planning Your Discharge

We will talk to you about your discharge before you come into hospital. Most people want to leave hospital as soon as possible and in order to make your discharge a smooth process we start to plan for this before you are admitted. It is helpful for you to talk to your relatives, carers or friends about what help and support you will need following your discharge home.

If you live alone it is essential that you consider what help you may need when you go home. It is unlikely that you will be able to do many everyday jobs such as lift shopping bags, push hoovers or mop floors when you first go home. You may need a relative to stay with you for a short time after your operation. Please tell us as early as possible if you have concerns about managing at home after your discharge from hospital. We can discuss support and the other options available to you and begin to organise your discharge.

Your estimated length of stay will vary according to your pre op fitness level.

We recognise that coming into hospital can be very daunting. Planning ahead for when you get home can help reduce stress. Below are some practical points to remember.

Check list

• I know my expected date for discharge (going home).

• I have informed the relevant people where I will be.

• I have all my medication ready to take with me.

• I have packed a small bag (e.g. loose day clothes, night clothes, non-paraffin based lip balm, toiletries, reading material, good fitting shoes and slippers).

• I have arranged my transport to and from hospital.

• I have checked I have the right equipment and support in place when I get home.

• I have taken any pre-operative bowel prep discussed at preadmission.

• Write a list of questions I want to ask so I do not forget.

Some of these questions may be:

• When can I have a shower or bath?

• When can I drive again? When can I go back to work?

• Who can I contact if I have any concerns or questions when I get home?

• I know where to go on my day of admission?

• I have the following details?

I am expecting to stay in hospital for _________________nights

I can eat and drink normally until: _______________________

I can have clear fluids until: ____________________________

I must be nil by mouth from:____________________________

Medication instructions: ______________________________

We aim to manage your care for your individual needs after your operation. Your daily goals are designed to help get you back to your normal level of activity as soon as possible. Getting fitter quicker and home sooner means returning to normal life sooner. This will be done by incorporating the following;

Performing Lower Risk Surgery

Wherever possible we aim to perform surgical techniques with smaller wounds or keyhole surgery. We aim to remove tubes, drains and drips as soon as it is safe to do so, this helps reduce the risk of infection and helps you to mobilise more freely and easily.

Reducing Your Pain

Good effective pain control is an essential part of your recovery, if your pain is well controlled you will be able to breathe easily, walk about, eat, drink, sleep well and participate effectively in your physiotherapy regime. It may also reduce the chance of complications occurring.

• If you can breathe deeply and cough easily after your operation, you are less likely to develop a chest infection

• If you can move around freely, you are less likely to develop a blood clot (venous thromboembolism or VTE) in the legs or elsewhere.

After your surgery you may be given a number of different pain relieving therapies, in either tablet or liquid form, via a fentanyl patch stuck to your arm or directly into a cannula in your arm or the back of your hand. It may be appropriate for you to have more than one form of pain relief.

It is therefore essential that you let us know if your pain relief is not effective or starts to be less effective than it was. Staff will encourage you to play an active role by regularly asking you to record your pain out of 10 (you will see this scoring system in your daily progress record later on in this book).

Additional painkillers are available and the specialist pain team can see you if needed to help you achieve your daily targets and help make you more comfortable.

 Encouraging early movement and activity

Regular deep breathing exercises after your operation, carried out as soon as you return from the operating theatre, will reduce the risk of developing a chest infection.

Performing leg and ankle movements every hour can reduce your chances of developing a blood clot (VTE). Depending on your reasons for surgery you may be commenced on blood thinners such as Deltaparin via an injection to avoid VTE. If it is deemed appropriate this will be commenced in hospital and discussed along with your other medications prior to discharge.

Following your surgery if safe to do so you will be encouraged to get out of bed on the day of your operation and to sit out in a chair for at least two hours. You will then be seen by a Physiotherapist the day after your operation when all patients, if clinically fit, will get out of bed and aim to be out of bed for at least eight hours throughout the day. Short rests on the bed through out the day are allowed.

Early mobility will be encouraged by the staff and Physiotherapists, however it is important that you understand the importance of taking an active role in your own mobility. Mobilising around your bedspace or walking around the ward area 3-5 times a day starting on the day after your surgery is a vital part of your recovery plan.

Completing your Daily Progress Record will help you achieve these goals

Encouraging Early Eating and Drinking

Most of our patients are encouraged to eat and drink normally and as soon as they want after their operation. The nutrition helps your body to recover more quickly. Sometimes surgery and medication can make you feel nauseated (sick), please let us know if you feel sick as we can give you medication to settle this feeling. Staff will encourage you to play an active role by regularly asking you to record your score for nausea, in order for us to be able to treat your nausea with the appropriate medication. When you are allowed to drink we want you to aim for 2 litres of oral fluid a day.

We will also supplement your diet with high protein and calorie drinks for a few days after surgery. We also advise a low fibre diet for the first six weeks to avoid complications, opt for low fibre cereals when Page 11 choosing your meals such as cornflakes or rice crispies, trying to avoid branflakes or Weetabix. Choose white bread, pasta or rice instead of brown or whole- meal and avoid leafy green vegetables. Staff will be happy to advise you.

Its important you mobilise as much as possible. Before your ‘drips’ and ‘drains’ are removed you will be able to carry or push them around with you. Mobilisation is the key to your recovery. Below is a list of goals / targets you should be able to achieve prior to discharge, we acknowledge that every patient is an individual and everyone will achieve these goals at their own pace, so please document the post operative day on which the goal was achieved, for your own reference and to keep you motivated with the Enhanced Recovery Programme.

                               Goal / Target                                                                                                                       Days post surgery target achieved

I managed to get dressed into my own clothes

I managed to wash myself unaided

Get out of bed for a total of 8 hours with a 1-2 hour rest in between if needed

Have managed to walk a total of 80 metres

Walked a complete lap of the ward

Prior to coming into hospital please have a look at the next section of your booklet. This is your ‘Daily Progress Record.’ Please familiarise yourself with this before your admission. Please remember to bring your booklet with you on your admission day so you can complete your daily progress record.

Why we would like you to fill in a Daily Progress Record

We ask all our Enhanced Recovery patients to complete a patient diary. Using the diary will help you:

• Achieve your goals and track your progress

• Help you recover more quickly, with fewer complications

• Help staff in helping you to recover

How to Use the Daily Progress Record

The diary covers all types of surgery and therefore covers 6 days. Once you are ready to go home there is no need to continue the diary. The nursing staff will explain the purpose of the diary to you but if you need further help with completing it please ask.

Please cross the box each time you do the task mentioned. For example, if you sat out in the chair twice.

Sat in the chair twice X X

If you didn’t then put the reason why (for example) If not, why? I felt dizzy

At the end of each day you are asked to mark on the line your overall pain score in the last 24hrs. The smiley face is no pain and the sad face is the worst pain. 

Day 0 - Day of Surgery

Today’s date: ………………………………… Ward: ………………

Plan - Your plan for today is to sit upright in bed, and achieve satisfactory pain control. If back from theatre before 6pm you may sit out of bed for up to 2 hours.

Please X the box for each time you have achieved that goal:

Sat out in the chair                                       Yes         No         

If not, why?

Marched on the spot                                     Yes        No 

If not, why?

Supplement drinks                                     1.              2.               3.

If not, why?

Carried out your deep breathing exercises (as discussed on page 5)       1.               2.                3.                   4.                   5

Have you passed wind today?                      Yes          No

Food

Did you eat Lunch?                                       Yes           No 

If not, why?

Did you eat Dinner?                                      Yes           No 

If not, why?

Pain Score

What is your overall pain score today?

At Rest …………………...…… On movement …….……………………

1        2         3          4          5        6          7            8            9            10

Nausea Score

What is your overall nausea (sickness) score today?

Please place a cross where you feel it should be. If you feel that it is stopping you from drinking and eating please let a member of staff know.

I do not feel sick 0 

I feel sick but have not vomited 1 

I feel sick and have vomited occasionally 2 

I feel sick and have vomited frequently 3

Today’s date: ………………………………… Ward: ………………

Plan - Your plan for today is to get washed and dressed with assistance, sit out of bed for 8 hours in total and walk for 60 metres in total (can be done in 1—3 increments.) Achieve satisfactory pain control and eat and drink a low fibre diet.

Please X the box for each time you have achieved that goal:

Sat out in the chair                   Yes                          No 

If not, why?

Walked 60 metres in 30 metre increments           1           2              3             4

If not, why?

Supplement drinks              1               2             3

If not, why?

Completed your breathing exercises          1          2           3           4        5         6          7        8          9          10

If not, why?

 Have you passed wind today?                 Yes                 No 

Have you opened your bowels?                Yes                No 

Have you passed urine?                            Yes               No 

 Food

Did you eat Breakfast?                              Yes               No 

If not, why?

Did you eat Lunch?                                   Yes               No 

If not, why?

Did you eat Dinner?                                 Yes               No 

If not, why?

Discontinued or removed

Urinary Catheter                                      Yes               No 

Drains Out                                               Yes               No 

Bowels / stoma functioned                      Yes               No 

Intravenous fluids (Drip)                          Yes              No 

Pain Score

What is your overall pain score today?

At Rest …………………...…… When walking …….……………………

1         2        3         4         5      6        7      8        9        10

Nausea Score

What is your overall nausea (sickness) score today? Please put a number in the box provided using the guide on page 15 for help.

Nausea Score .......................................................

Today’s date: ………………………………… Ward: ………………

Plan - Your plan for today is to sit out in a chair for most of the day but ideally at least 8 hours. To walk 60 metres at least four times. Eat and drink a low fibre diet and achieve satisfactory pain control. Try to become more independent with your hygiene needs today.

Please X the box for each time you have achieved that goal:

Sat out in the chair                      Yes                  No 

If not, why?

Walked 60 metres in 30 metre increments          1.             2.         3.          4.

If not, why?

Supplement drinks                 1.              2.              3.

If not, why?

Completed your breathing exercises               1.           2.            3.            4.          5.           6.             7.            8.              9               10.

If not, why?

 Have you passed wind today?               Yes                No

Have you opened your bowels?              Yes                No 

Have you passed urine?                         Yes                No

Food

Did you eat Breakfast?                            Yes                No 

If not, why?

Did you eat Lunch?                                 Yes                No 

If not, why?

Did you eat Dinner?                               Yes                 No

If not, why?

Discontinued or removed

Drains                                                    Yes                No 

Urinary catheter                                     Yes               No 

Central line                                            Yes               No 

Removal of wound catheters                 Yes              No 

Pain Score

 What is your overall pain score today?

At Rest …………………...…… When walking …….……………………

1            2        3        4           5        6     7      8        9        10

Nausea Score

What is your overall nausea (sickness) score today?

Please put a number in the space provided below.

If your nausea / sickness level is stopping you from eating / drinking please let a member of staff know.

Nausea Score ...............................................

Today’s date: ………………………………… Ward: ………………

Plan - Get out of bed, meet your hygiene needs with as little help as possible, walk 6x 60 metres throughout the day. Eat and drink a low fibre diet and achieve satisfactory pain control.

Please X the box for each time you have achieved that goal:

Sat out in the chair                            Yes                        No 

If not, why?

Walked 60 metres in 30 metre increments         1.            2.             3.           4.

If not, why?

Supplement drinks                        1.                2.                3.

If not, why?

Completed your breathing exercises        1.            2.           3.            4.             5.           6.            7.           8.          9.          10.

If not, why? 

Have you passed wind today?               Yes                   No

Have you opened your bowels?            Yes                    No 

Have you passed urine?                        Yes                   No 

 Food

Did you eat Breakfast?                          Yes                   No 

If not, why?

Did you eat Lunch?                               Yes                  No 

If not, why?

Did you eat Dinner?                              Yes                  No 

If not, why?

Discontinued or removed

Removed Central Line                          Yes                 No 

Drains                                                    Yes                 No 

Urinary Catheter                                    Yes                 No

Pain Score

What is your overall pain score today?

At Rest …………………...…… When walking …….……………………

1          2         3           4           5          6         7         8         9         10

Nausea Score

What is your overall nausea (sickness) score today?

Please put a number in the space provided below. If your nausea / sickness level is stopping you from eating / drinking please let a member of staff know.

Nausea Score ...............................................

Today’s date: ………………………………… Ward: ………………

Plan - Sit out of bed for most of the day, walk 8x 60 metres throughout the day, eat and drink normally, aim for satisfactory pain control. We would like you to get dressed into your out-door clothes / daywear. Are you fit for discharge? Is your family aware?

Please X the box for each time you have achieved that goal:

Sat out in the chair                       Yes                    No 

If not, why?

Walked 60 metres in 30 metre increments     1.          2.       3.         4.

If not, why?

Supplement drinks    1.        2.         3.

If not, why?

Completed your breathing exercises   1.         2.         3.         4.          5.         6.        7.          8.         9.         10.

If not, why? 

Have you passed wind today?             Yes             No 

Have you opened your bowels?           Yes            No 

Have you passed urine?                      Yes            No 

 Food

Did you eat Breakfast?                        Yes             No 

If not, why?

Did you eat Lunch?                              Yes            No 

If not, why?

Did you eat Dinner?                             Yes            No 

If not, why?

Discontinued or removed

Remove Central Line                          Yes             No 

Drains                                                 Yes             No 

Urinary Catheter                                 Yes            No 

Pain Score

What is your overall pain score today?

At Rest …………………...…… When walking …….……………………

1       2         3         4        5        6        7       8       9       10

Nausea Score

What is your overall nausea (sickness) score today?

Please put a number in the space provided below. If your nausea / sickness level is stopping you from eating / drinking please let a member of staff know.

Nausea score …………………...……

Today’s date: ………………………………… Ward: ………………

Plan - If you are still in hospital on day 5 don’t worry, this is not a problem. Just continue to build up your mobility, becoming more independent and eat and drink as normal. Its always good to ask when your discharge is likely to be.

Please X the box for each time you have achieved that goal:

Sat out in the chair                        Yes                  No 

If not, why?

Walked 60 metres in 30 metre increments          1.          2.         3.         4

If not, why?

Supplement drinks     1.        2.        3.

If not, why?

Completed 10 breathes on Inspiron   1.       2.       3.       4.       5.       6.       7.        8.        9        10.

If not, why? 

Have you passed wind today?             Yes             No 

Have you opened your bowels?           Yes            No 

Have you passed urine?                      Yes            No 

 Food

Did you eat Breakfast?                        Yes             No 

If not, why?

Did you eat Lunch?                            Yes              No 

If not, why?

Did you eat Dinner?                          Yes              No 

If not, why?

Discontinued or removed

Urinary catheter out                          Yes              No

Drains out                                         Yes              No 

Any remaining lines /tubes removed Yes            No

Pain Score

What is your overall pain score today?

At Rest …………………...…… When walking …….……………………

1        2       3       4         5        6        7       8       9       10

Nausea Score

What is your overall nausea (sickness) score today?

Please put a number in the space provided below. If your nausea / sickness level is stopping you from eating / drinking please let a member of staff know.

Nausea score …………………...…… 

Today’s date: ………………………………… Ward: ………………

Plan - If you are still in hospital on day 5 don’t worry, this is not a problem. Just continue to build up your mobility, becoming more independent and eat and drink as normal. Its always good to ask when your discharge is likely to be.

Please X the box for each time you have achieved that goal:

Sat out in the chair                        Yes                     No 

If not, why?

Walked 60 metres in 30 metre increments   1.         2.         3.         4.

If not, why?

Supplement drinks   1.         2.         3.

If not, why?

Completed 10 breathes on Inspiron     1.          2.          3.          4.          5.         6.          7.         8.          9.        10.

If not, why?

 Have you passed wind today?                  Yes                  No 

Have you opened your bowels?                 Yes                 No 

Have you passed urine?                             Yes                No 

 Food

Did you eat Breakfast?                               Yes                No 

If not, why?

Did you eat Lunch?                                    Yes                No 

If not, why?

Did you eat Dinner?                                   Yes                No 

If not, why?

Discontinued or removed

Urinary catheter out                                    Yes               No 

Drains out                                                    Yes               No

Any remaining lines / tubes removed           Yes              No 

Pain Score

What is your overall pain score today?

At Rest …………………...…… When walking …….……………………

1         2        3       4         5         6         7       8        9       10

Nausea Score

What is your overall nausea (sickness) score today?

Please put a number in the space provided below. If your nausea / sickness level is stopping you from eating / drinking please let a member of staff know.

Nausea Score ..........................................

Today’s date: ………………………………… Ward: ………………

Plan - If you are still in hospital on day 5 don’t worry, this is not a problem. Just continue to build up your mobility, becoming more independent and eat and drink as normal. Its always good to ask when your discharge is likely to be.

Please X the box for each time you have achieved that goal:

Sat out in the chair                       Yes                    No

If not, why?

Walked 60 metres in 30 metre increments       1.         2.         3.          4.

If not, why?

Supplement drinks     1.         2.        3.

If not, why?

Completed 10 breathes on Inspiron     1.       2.        3.         4.       5.       6.        7.       8.      9.        10

If not, why?

 Have you passed wind today?             Yes              No 

Have you opened your bowels?            Yes             No 

Have you passed urine?                       Yes             No 

 Food

Did you eat Breakfast?                         Yes              No 

If not, why?

Did you eat Lunch?                             Yes               No 

If not, why?

Did you eat Dinner?                            Yes               No 

If not, why?

Discontinued or removed

Urinary catheter out                            Yes              No 

Drains out                                           Yes              No

Any remaining lines / tubes removed Yes              No 

Pain Score

What is your overall pain score today?

At Rest …………………...…… When walking …….……………………

1        2      3        4        5          6        7        8        9        10

Nausea Score

What is your overall nausea (sickness) score today?

Please put a number in the space provided below. If your nausea / sickness level is stopping you from eating / drinking please let a member of staff know.

Nausea score …………………...…

Who to Contact

We recognise that coming in for any surgery can be a very stressful and emotional time and you may be apprehensive about it but these feelings are normal. The staff will be able to help answer any questions you may have before, during or after your stay in hospital. Please ensure you have the relevant contact numbers you may need. The contact names and numbers will vary depending upon the type of surgery you have.

Contact details

Switchboard: 01253 300000

Enhanced Recovery Nurses: 01253 956549

Colorectal Nurse Specialists: 01253 956620

Clinical Area of discharge: .................................................................

Ward Number: ...................................................................................

When You Leave Hospital

We expect your recovery to progress well following your discharge but occasionally complications may occur following major surgery. It is important you know what to look out for. If you are worried about any of the following please contact us on the numbers above. If you are unable to contact any of the numbers above please contact your GP or phone 111 for out of hours emergency care.

Your Wound

It is not unusual for the wound to be uncomfortable for the first 2 weeks. Please let us or your GP know if your wound becomes progressively inflamed(very red), painful or swollen, or starts to discharge fluid or begins to open.

Blood Clots Surgery increases the risk of blood clots, which is why it is important to maintain your mobility after surgery. You will need urgent medical attention if your calf becomes progressively painful or swollen or if you develop shortness of breath.

Sexual activity

Resume sexual intercourse once you feel confident to do so. If you remain relaxed and possibly adopt a more passive role, you may return more easily to your normal routine. After some operations however this time may be extended. Please talk to your consultant or nurse specialist about this further.

Bowels

Following surgery on your bowel you may find your stools are looser and you may get increased wind or bloating. This is normal whilst the bowel recovers from surgery, make sure you eat regularly and drink plenty of fluids. For the first six weeks after surgery we advise a low fibre diet. This will be discussed with you prior to discharge and you will be given a diet information sheet. If you are constipated for more than 3 days please contact us or your GP for advice.

Exercise

You should take regular gentle exercise several times a day. Gradually increase your exercise during the 4 weeks following your operation until you are back to your normal level of activity. Do not attempt to lift anything heavy for 6-8 weeks after surgery.

Driving

There is no exact specified time or law that determines when it is safe to drive after surgery. Do not drive until you are confident you can drive safely and perform an emergency stop. This is usually at least 6 weeks after surgery. If you are still taking strong pain killers, which is unlikely, they will affect your ability to drive.

It is recommended that you check with your car insurance company before you start driving again.

Follow-up

You will receive a follow-up appointment via the post. The date will depend on your surgeon and the type of surgery you have had. The ward staff and surgical team will be able to advise you when it is likely to happen.

The discharge checklist enables the team to work with you to plan a safe return Home from Hospital

• I have a copy of my electronic discharge summary for my own information
• I have my own tablets and any new medicines. I am happy with the instructions for taking them
• My Wounds have been checked by the Nurse today and if required i have a letter for the practice / district nurse. I also have a contact number for them
• My Cannulas (plastic tubes) have been removed
• Today I am: able to pass urine freely, my bowels are working, I can mobilize around the ward independently, I am comfortable and my pain is well controlled, I am eating and drinking.
• I have my own transport home and can be collected before 12 midday if needed, as the hospital transport is restricted to those with mobility needs
• I have received all the equipment and information I need from the Nursing staff and other specialist nurses / professionals. I have a telephone number to contact them if required.
• I feel able to look after myself when i get home, or I know that i have carers that will be able to look after me.
• I have a supply of nutritional drinks to take home with me for seven days following the day of my operation.
• I have the telephone number for ward ............. if I need help or advice and the enhanced recovery nurse is ........................................
• I have been told if I need a follow - up outpatients appointment, and i am aware that this will be sent home to me in the post.

                                 I am fit enough to go home today 

                                      Date of Discharge ............................................................