Orthopaedic Wards – Admissions

Firstly, let’s start with the patients who first get admitted to our ward. Patient’s will either get admitted straight from A&E, another ward (or hallway) or they will get admitted from the theatre after their operation.

The first thing you have to do, is your thorough assessments and observations. This is the first step in a successful and full evaluation of your patient’s; social, physiological, psychological, emotional, and spiritual needs (Toney-Butler TJ, Unison-Pace WJ. 2018)

The theory behind this is that it should concentrate on the patient’s response to health needs rather than the disease process (The Royal Marsden 2015). Not only will this enable the nurse to determine treatment options for the patient but the nurse needs to ensure they are aware of any health issues, skin issues (such as pressure sores), and know the patient’s baseline observations. This will enable the healthcare professional to monitor for any deterioration. For more information on the importance of nursing assessment, take a look at – The Royal Marsden NHS Foundation Trust 2015

The first things that must be done within 15 minutes of the patient being admitted are; observations such as AVCPU, blood pressure, temperature, pulse rate, respiratory rate, and Glasgow Coma Scale (in some cases). MRSA screening if this has not been completed already.

On surgical wards, the patients must be advised to wear ‘TED stockings’ which stands for Thrombo-embolic-deterrent which you can read more about here: NHS Compression Stockings

After surgery patients are put onto a strict 24 hour fluid balance chart and a stool chart to monitor input and output (depending on the type of surgery they have had). Here is some wider reading about what happens physiologically during surgery to the fluid balance within the body: Postoperative fluid management which might help to understand the rationale behind the strict fluid balance charts.

Within the trust I was working in we had risk assessment booklets, which were really easy to follow. These books had tick boxes and questions we had to ask the patient to assess their level of risk. Sections in the book included;

  • Tissue viability and risk of pressure sores
  • Body charts and skin integrity assessments
  • Manual handling and falls risks
  • Pain management and scoring
  • Urine and bowel continence
  • Visual and hearing impacts
  • Nutritional and malnutrition risks

Anyone that had a risk of the above were put onto a care plan / plan of action to prevent / reduce the risks. For example, if someone was high risk of a pressure sore, their skin would be assessed daily and documented, along with giving pressure relief regularly throughout the day either; hourly, 2 hourly, 4 hourly or 6 hourly (it depends on the individual’s needs).

If your patient has been admitted from A & E and are waiting for surgery, their observations will be completed every 4-8 hourly to twice a day, depending on the patient needs. If a patient has come straight from theatres after having their surgery, strict and regular observations must be done. The most frequent observations I completed were like so;

  • Every 30 minutes for 2 hours.
  • If patient is ok it moves to, every 1 hour for 4 hours
  • Again, if patient is ok then it changes to every 2 hours for 8 hours

Check your local trust guidelines and advice on observations. Each patient is individual and will have different timed observations depending on their surgical procedure or health condition.

If all observations are stable the patient will then be put onto 4-8 hourly and then twice a day until they are discharged.

The theory behind these thorough checks are due to being able to spot the signs of deterioration fast. There are many risks with many surgical procedures that could potentially be life threatening. As a nurse you want to be able to recognise these signs and prevent this from happening. You can read more here: Principles of Monitoring postoperative patients

Following all of this, the patient will be referred to other members of the team such as; physiotherapist and the occupational health team. These amazing people will assess the patient and ensure they are safe for their planned discharge. Physiotherapist like to get the patient as mobile as possible, as soon as possible. This helps build the strength in the muscle after the surgery and encourages good circulation around the wound site which in return reduces the length of hospital stays. You can read more about the role of the Physiotherapist here: The role of the physiotherapist

I hope you find this blog post useful for admitting patients to your ward. The links I’ve added are a really great read! Take a look at them if you haven’t already. And remember all areas / trusts are different so just familiarise yourself with that area and how it runs for your patients. The key points from this is patient safety and effective care planning for the patient always.

 

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34 years old and finally achieving my dream of becoming a nurse.

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