enhanced recovery programme
Post on 24-Feb-2016
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Enhanced Recovery Programme
K J DrabuConsultant Orthopaedic Surgeon
AimImprove patient care and experience
Good analgesiaMinimal GI problems
Minimal complications (Surgical & General)Early dischargeGood mobility
Where does it start and where does it go?
PatientGPPre-assessment – Physio and nurseSurgeon/AnaesthetistWard staffPatient
PhilosophyPositive approach from the startPatient and home support team pre-preparedClear understanding of the whole processEmphasis on early and safe mobilityEncourage the patient to “lead”
Patient
Aware and requesting the procedureWord of mouth and mediaDefined admission date and defined discharge
dateHome support in place when needed
GP
Aware of the processPre-prepares patient for process – Co-
morbidities, smoking, bowels etcPre-prepares home supportNOT RAPID DISCHARGE
Pre-assessment – Physio and Nurse input
Positive approach Point of contact for patientDeal with any issues – Pain, smoking, bowels etcPrepare for appropriate mobilityPre-op exercise programme
AnaestheticSingle shot spinalPropofolTranexamic acid and intra-operative re-
transfusionIV AbxOndansetronIV Fluids to 1 Lit intra-op
Operative TechniqueStandard procedure
A/lat approach, supine
Mini-incision
Preservation of Glut Medius
Obese patients
Posterior approach
TO DRAIN OR NOT TO DRAIN??
Mini Incision
2 cms greater than cup10 cms or lessMinimal disturbance to soft tissuesBerger – Chicago (Dual incision)AMIS
Mini- Incision THRsAdvantages
Less soft tissue disruptionQuicker rehabilitationLess blood loss
DisadvantagesLess visualisationRisk of complications
Indications for Mini Incision THRs
Not overweight patientGood bone“Normal” arthritic hip jointNot bilaterals?95%
Antero-lateral approach
Preserve Glut MediusLeg lengthCup orientationStability
Post-operative (Ward)Early mobilitySelf management – exercise programme and
mobilityCatheter – In/OutAvoid bed pans
THERE IS NO BETTER FEELING THAN FEELING NORMAL
Ward (Physio & Nurse Lead)
Self mobilityPositive feedbackAct quickly where neededRe-assure re point of contactInform Consultant of any problems after
dischargeContact telephone for follow up
Enhanced Recovery
Thanks toJackie Stayton
For leading this project
THANK YOU
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