Surgical WR template

WR Cons / SpR Dr

Age & sex

Issues
1.
2.

Obs: NEWS

Investigations
Bloods (date):
CXR (date):
CTAP (date):

On review
DRAFT / PT NOT SEEN YET

O/E
Alert, oriented, answering questions appropriately
Abdo SNT

Plan

Surgical clerking proforma

SAU clerking

Age & sex
PC:

HPC:

PMH:

Past surgical Hx:

Reg meds:

Allergies: NKDA

FHx:

SHx:

O/E:
Alert, oriented, answering questions appropriately
Abdo

Obs: NEWS
Bloods:
Urine dip:
Other Ix:

Imp:

Plan

Surgical discharge

Summary:

Emergency admissions

Name is a blank-year-old lady who presented to the Emergency Department / Surgical Assessment Unit of Heartlands Hospital on DATE with (symptoms). On examination, … [Describe investigations and findings. Her blood tests showed –. Her urinalysis showed –.] As she is now clinically stable, we are now discharging her.

Name is a blank-year-old gentleman who presented to the Emergency Department / Surgical Assessment Unit of Heartlands Hospital on DATE with (symptoms). On examination, … [Describe investigations and findings. His blood tests showed –. His urinalysis showed –.] As he is now clinically stable, we are now discharging him.

Elective admissions for specific procedures

Name is a blank-year-old lady who underwent an elective [procedure] under general anaesthesia on DATE. There were no intra- or post-operative complications. As she is now clinically stable, we are now discharging her.

Name is a blank-year-old gentleman who underwent an elective [procedure] under general anaesthesia on DATE. There were no intra- or post-operative complications. As he is now clinically stable, we are now discharging him.

Information given to patients:

Please go to your nearest A&E should you become unwell after your operation (e.g. if you experience uncontrollable pain, if you develop a high fever, or if bleeding at your wound site does not stop after applying pressure for 10 minutes).

Please go to your nearest A&E should you become unwell after your discharge (e.g. if you experience uncontrollable pain, or if you develop a high fever).

Please do not drive for at least 2 weeks after your surgery, or until you are pain-free and able to perform an emergency stop without pain.

After your discharge please leave your dressings on for 48 hours and keep the area clean and dry. It is fine to shower starting around 48 hours after surgery but no baths, pools or hot tubs for at least 2 weeks.

Information given to GP:

Dear colleague, kindly note the recent admission of this patient.

Check operation note and select accordingly.

Post-op care in general

Please do not lift heavy weights (more than 5 kg) for 6 weeks after your operation.

For major abdominal procedures (including bariatric surgery, laparotomies, C-sections, etc)

Post-op care for wound closures

Your stitches are dissolvable and do not need to be removed.

For stitches such as Vicryl and Monocryl.

You will need to go to your GP or a treatment centre for your stitches/staples to be removed.

For stitches such as Prolene, Ethilon (aka nylon), and silk. Information from Geeky Medics.

Skin glue will fall away in 7 - 10 days. Do not pick or rub it off but allow it to come away naturally.

Steri strips will fall away in 7 - 10 days. Do not pick or rub it off but allow it to come away naturally.

Specific operations

Hernia repairs

  • Abdominal hernias: do not lift heavy weights for at least 10 weeks.

Bariatric surgery

  • UHB Trust has their own bariatric protocol, please follow their template for discharge letter.

  • Liquid diet and oral fluids until 14d post-op, then follow advice of dieticians.

  • Avoid heavy lifting for 6 weeks post-op.

  • Enoxaparin for 7d post-op, wear TED stockings for 10d post-op.

  • Diabetes: HbA1c test at 6w, 3mo, 6mo, 12mo as part of follow-up.

  • Continue CPAP if previously on.

  • Medications:

    • T2DM medications: restart metformin only if blood glucose ≥10 mmol/L on two consecutive readings (and no other contraindications). Pts on VRIII or with fasting glucose >10 mmol/L post-op will require basal insulin + refer to inpatient diabetic CNS. Stop all other drugs, restart only advice of diabetic team.

    • T1DM: restart 50% of original dose of basal insulin. Suspend bolus insulin until liquid diet restarted. Refer to inpatient diabetes team before discharge.

    • Continue lansoprazole for 3mo (first 28d should be in orodispersible form).

    • Forceval 1tab OD for 28d, Adcal D3 1tab BDS for 28d – both in soluble/effervescent form.

    • Pain relief – paracetamol and codeine as needed.

SAU clerking checklist (download link for .docx)

☐ Clerking
☐ D/w Reg
☐ Patient admin
☐ VTE prophylaxis
☐ Regular medications
☐ Chase bloods / urinalysis
☐ Add to Acute Gen Surg / Urology list
☐ Prep discharge   ☐ TTOs

PDF version in case the Word doc is wonky

Last updated: 26/11/2024

Jobs list (download link for .docx)

Sections for
• Discharge letters (+TTOs +controlled drugs)
• Requests / others (eg ordering CTs)
• Prescriptions
• Bloods or cannulas to do
• Bloods to chase
• Blood forms that need putting out

PDF version in case Word doc is wonky

(Constructive) suggestions are welcome – send me an email at joan.loo [at] doctors.org.uk and I will see what I can do :)