Theatre and Surgical Nursing


The Christie NHS Foundation Trust: Dignifying surgery for a person with dementia and skin cancer

Patients with dementia and skin cancer were given an option of no treatment or treatment under general anaesthetic. Local anaesthetic was not considered in case they became distressed during surgery. Due to the increased, but avoidable, risk of a person with dementia developing delirium under general anaesthetic, a pilot was conducted in which a nurse accompanied the patient into theatre and delivered distraction therapy during surgery. The pilot was successful and this way of working has now become standard practice for the trust’s frailer patients. Financial savings have been significant, patient risk of delirium has been reduced and one patient even left theatre and told their carer “I’ve had a lovely day”.


King’s College Hospital NHS Foundation Trust: Nurse-led discharge pathways for elective surgery

Perioperative nursing teams developed discharge pathways for elective surgeries to address patients occupying inpatient beds due to delays in clinician review before discharge. Transforming the culture and working methods of the multidisciplinary teams, and appointing a surgical pathway coordinator to supervise and support frontline staff and patients, resulted in reduced demand for inpatient beds, and positive progress in elective recovery.

Leeds Teaching Hospitals NHS Trust: Enhanced care unit

This four-bed enhanced care unit was opened to ensure patient safety following more-complex procedures or procedures completed on patients with more-complex needs. Nurse training comprised a skills passport and criteria to follow. There was an 80% success rate in deliverance and completion of the nursing skills enhanced care passport, and feedback from both patients and staff was excellent.

Leeds Teaching Hospitals NHS Trust: Utilisation of National Emergency Laparotomy Audit coordinator and launch of nurse-led clinic

The National Emergency Laparotomy Audit (NELA) coordinator role was developed, and a NELA telephone helpline and a weekly face-to-face clinic launched to improve the patient experience. Patients were able to contact the coordinator for advice after discharge, which acted as a safetynetting programme for them. This initiative also resulted in hospital readmissions being avoided.

South Tees Hospitals NHS Foundation Trust: Personal perioperative pathway for adult patients with additional needs

Staff telephoned patients with additional needs, or their relatives, and asked pertinent questions so any necessary reasonable adjustments could be made for patients due to have surgery. Bespoke personal perioperative plans were created, which led to positive feedback from anaesthetists, who could better prepare for the surgery, and patients’ relatives, who felt reassured that care would be adapated as necessary.

Torbay and South Devon NHS Foundation Trust: Acuity based patient allocation

The volume of patients being operated on using the day-case pathway had increased, but estate capacity and staffing had not. Staff defined five categories of acuity and assessed individual patients to ascertain the nursing interventions required. By doing this, they moved from the traditional nursing model of one-to-one care to one based on acuity. No serious patient safety issues have occurred, patient handover has been faster and the number of late list finishes has reduced.