The BAUS Enhanced Recovery Pathway (ERP)

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Transcript of The BAUS Enhanced Recovery Pathway (ERP)

  • The British Association of Urological Surgeons Date of publication: December 2015 Date of next review: December 2017

    THE BRITISH ASSOCIATION OF UROLOGICAL SURGEONS

    35-43 Lincolns Inn Fields

    London

    WC2A 3PE

    Telephone +44 (0)20 7869 6950

    Facsimile +44 (0)20 7404 5048

    Internet www.baus.org.uk

    Email admin@baus.org.uk

    BAUS Enhanced Recovery Pathway

    PREPARED BY THE BAUS ERP GROUP

    Jon Cartledge - Leeds Malcolm Crundwell Exeter

    Mark Daugherty - Exeter Kim Davenport - Cheltenham

    Anurag Golash Stoke on Trent

    David Gillatt - Bristol Gurminder Mann Nottingham John McGrath - Exeter Toby Page Newcastle upon Tyne Julian Smith - Southampton

    Document design by Nigel Bullock - Cambridge

  • BAUS Enhanced Recovery Pathway - Page 2

    CONTENTS

    FOREWORD by Mr Mark Speakman, President of BAUS ..................................................... 5

    1 INTRODUCTION ............................................................................................................................. 6

    2 OVERVIEW ....................................................................................................................................... 7

    2.1 What is enhanced recovery? .............................................................................................. 7

    2.2 The components of an enhanced recovery programme .......................................... 7

    2.2.1 Primary care .................................................................................................................................. 7

    2.2.2 Outpatients ..................................................................................................................................... 7

    2.2.3 Pre-admission ............................................................................................................................... 8

    2.2.4 Day of surgery ............................................................................................................................... 8

    2.2.5 Peri- and intra-operative .......................................................................................................... 8

    2.2.6 Post-operative ............................................................................................................................... 8

    2.2.7 Follow-up ........................................................................................................................................ 9

    2.2.8 Summary ......................................................................................................................................... 9

    3 PREPARATION FOR SURGERY ................................................................................................... 9

    3.1 Primary care......................................................................................................................... 10

    3.2 Outpatient clinic ................................................................................................................. 10

    3.3 Pre-admission clinic .......................................................................................................... 12

    3.4 Day of surgery admission ................................................................................................ 13

    4 ANALGESIA & ANAESTHESIA .................................................................................................. 14

    4.1 Pre-operative ....................................................................................................................... 14

    4.2 Operative ............................................................................................................................... 14

    4.2.1 Intraoperative neural blockade ........................................................................................... 14

    4.2.2 Fluid management .................................................................................................................... 15

    4.2.3 Anaesthetic agents ................................................................................................................... 15

    4.2.4 Antiemetics.................................................................................................................................. 15

  • BAUS Enhanced Recovery Pathway - Page 3

    4.2.5 Avoidance of hypothermia .................................................................................................... 15

    4.2.6 Antibiotic prophylaxis............................................................................................................. 15

    4.2.7 Extended VTE prophylaxis .................................................................................................... 16

    4.3 Post-operative ..................................................................................................................... 16

    4.3.1 Avoiding opiates ........................................................................................................................ 16

    4.3.2 Avoiding patient-controlled analgesia (PCA) ................................................................ 16

    4.3.3 Post-operative analgesic strategy ...................................................................................... 16

    5 DRAINS ........................................................................................................................................... 17

    5.1 Renal surgery ....................................................................................................................... 17

    5.2 Pelvic surgery ...................................................................................................................... 18

    5.3 Summary of recommendations ..................................................................................... 18

    5.3.1 Renal surgery ............................................................................................................................. 18

    5.3.2 Pelvic surgery ............................................................................................................................. 18

    6 URINARY CATHETERS ............................................................................................................... 18

    6.1 Renal surgery ....................................................................................................................... 18

    6.2 Pelvic surgery ...................................................................................................................... 19

    6.3 Summary of recommendations ..................................................................................... 19

    7 MOBILISATION ............................................................................................................................ 20

    8 NUTRITION ................................................................................................................................... 20

    8.1 Pre-operative ....................................................................................................................... 20

    8.1.1 Fasting ........................................................................................................................................... 20

    8.1.2 Carbohydrate supplementation .......................................................................................... 20

    8.1.3 Prevention of ileus .................................................................................................................... 21

    8.2 Post-operative ..................................................................................................................... 22

    9 DISCHARGE CRITERIA .............................................................................................................. 22

    10 IMPLEMENTATION .................................................................................................................. 23

    11 REFERENCES .............................................................................................................................. 23

    12 APPENDIX ................................................................................................................................... 29

  • BAUS Enhanced Recovery Pathway - Page 4

    12.1 Procedure-specific checklists ...................................................................................... 29

    12.1.1 Renal surgery checklist ........................................................................................................ 29

    12.1.2 Pelvic surgery checklist ....................................................................................................... 29

    12.2 Information for clinicians ............................................................................................. 30

    13 DISCLAIMER ............................................................................................................................... 30

  • BAUS Enhanced Recovery Pathway - Page 5

    FOREWORD by Mr Mark Speakman, President of BAUS

    This document has been designed as pragmatic guidance for urology

    units looking to implement enhanced recovery protocols (ERPs) across

    various types of major urological surgery.

    It is not intended to be proscriptive, because we recognise that many

    units achieve excellent clinical results despite variation in aspects of

    clinical care between indiv