Theatre and Surgical Nursing

Nurses working in the perioperative environment care for patients at their most vulnerable. Surgery is a daunting prospect for most people, and nurses are the professionals they rely on not only for clinical skills but also to offer psychological support and to act as advocates to those under general anaesthesia. This award is open to individuals and teams working in the NHS or independent sector in any aspect of perioperative care. Entrants must demonstrate clear benefits of their initiative, for example, in better use of resources, reduced length of hospital stay or improved patient experience.

Bolton NHS Foundation Trust
Enhancing patient safety on a surgical assessment unit with the introduction of non-medical prescribing for senior nurses

Patients on our Surgical Assessment Unit (SAU) are typically admitted with acute painful conditions including bowel obstruction, pancreatitis, appendicitis, pyelonephritis, sickle cell and fractured ribs and all these patients require timely and effective pain medication. Due to the nature of the area, doctors are often on call in the Emergency department (ED) or theatres and patients are often transferred from a busy ED having received very little analgesia, to the SAU were they can wait for many hours for a review and medication to be prescribed often leading to patient deterioration. It was suggested by the Acute pain team (APT) that we could utilise our senior ward staff by encouraging them and supporting them through the Non Medical Prescribing Course enabling them to assess patients and prescribe timely and effective analgesia whilst being fully supported by the APT. With every new initiative comes challenges, but a strategy was agreed with management and put in place and results have been outstanding. including timely analgesia, improved patient and staff satisfaction and a huge impact on patient safety as patients at at much less risk of deterioration and admission to critical care areas. As a Trust we are looking at other assessment areas including orthopaedics and interest is high amongst team leaders in these areas. This is an initiative that could be successful in any acute hospital with limited costs but major benefits to the safety of surgical patients

Epsom and St Helier University Hospitals NHS Trust and South West London Elective Ortopaedic Centre
Prehabilitation of patients undergoing elective arthroplasty procedures

Prehabilitation include support provided to patients to be healthy and fit as possible before they go for any planned surgery by providing advice and information on lifestyle changes, exercises, nutrition information and emotional support during the pre-operative period (RCN, 2020) which would set realistic expectation and better compliance with the treatment plan (Flock et.al, 2014). South West London Elective Orthopaedic Centre (SWLEOC) had been providing information on preparing for surgery to all patients through preparing for surgery booklet, preparing for surgery class as well as the pre-theatre phone calls. Post-Covid years, SWLEOC embraced the introduction of Day case Arthroplasty pathway, and the team needed to look into ways whereby patient can be well prepared for their upcoming surgery, tackle preventable cancellations and provide positive patient experience. The changes were brought in including the development of an Artificial Intelligence Supported Video resource for patients undergoing Hip and Knee Arthroplasties as well as the introduction of an enablement phone call from the discharge nursing team, in addition to the already existing patient journey booklet as well as the Pre-theatre phone call, making it an extended prehabilitation service for the patients (Structure attached). The changes to the existing process were brought in after consultation with the patients on the Patient Forum and were well accepted by the patient group. The initial feedback indicate the acceptance that was received for the extended prehabilitation service and this has contributed not only to the patient experience, but also to the length of stay as well as better resource utilisation within the centre. With the success of this initiative, it was decided to extend this to patients undergoing shoulder replacement procedure – the team has already developed a patient journey booklet and are in the process of developing a video resource as of now.

Epsom and St Helier University Hospitals NHS Trust and South West London Elective Orthopaedic Centre
Remote monitoring of post-operative patients post discharge following hip and knee arthroplasty

The South West London Elective Orthopaedic Centre (SWLEOC) has experienced a notable surge in referrals, attributed to both the backlog from the COVID-19 pandemic and ongoing industrial disputes. This influx has strained outpatient department capacity significantly. Traditionally, post-operative follow-up appointments for elective orthopaedic surgery patients were scheduled around 6 weeks post-op; however, due to these challenges, appointments were delayed to 16-18 weeks post-op. Prior to this, there was no structured oversight of patients' recovery, hindering individualized follow-up and leaving hospital teams reliant on patient-initiated contact for issue resolution. Recognizing the need to distinguish between varying patient recovery trajectories, SWLEOC sought a safer, more personalized post-op pathway to optimize patient care. To address these concerns, SWLEOC adopted Definition Health’s Definition Recovery application. This web-based tool enables remote monitoring of patients' recovery during the initial 6 weeks post-op, facilitating personalized discharge planning based on their progress. Upon discharge, patients utilise an online diary to self-report pain levels, function, and wound status, supplemented with visual uploads for remote clinical assessment. Entries are color-coded (Red, Amber, Green), with validation ensuring accuracy. Amber and Red cases prompt telephone follow-up to address concerns or complications, while Green entries proceed without immediate intervention. At the 6-week mark, patients undergo a telephone final assessment by an advanced nurse practitioner. This assessment, combined with recovery trends and shared decision-making, dictates the subsequent follow-up plan. Options include patient-initiated follow-up, face-to-face review by a nurse or physiotherapist, or expedited Consultant consultation within a week. Performance metrics such as patient experience, re-admission rates, complications, and outcomes are meticulously tracked to evaluate the effectiveness of this pathway. SWLEOC's adoption of Definition Recovery represents a strategic approach to post-operative care, ensuring patient safety, individualized attention, and efficient resource utilization.

HCA Healthcare
Reducing colorectal surgical site infection through data innovations

Our initiative aimed to address the rates in colorectal surgical site infections (SSIs) observed in 2022 within our healthcare facility. Despite colorectal surgeries not being covered under our standard Surgical Site Infection Surveillance Protocol, there was a perceived increase in colorectal SSIs demanded urgent attention. The primary issue was the lack of specific data (denominator data) for colorectal surgeries, hindering our ability to accurately monitor and quantify this perceived rise in infections. To tackle this challenge, we utilised the ICnet system, an advanced infection surveillance and reporting tool, to generate detailed reports on colorectal surgeries. This approach allowed us to obtain the crucial denominator data, enabling an accurate assessment of the situation. Through data analysis, we identified a correlation between the increased SSIs and the practices of a specific surgical team. By comparing their protocols with those of other teams, we pinpointed discrepancies in practice that may have contributed to the higher infection rates. The main challenge we faced was the absence of specific data for colorectal surgeries; essential for our understanding of the scale of the issue and to effectively communicate and empower clinicians. We achieved this by leveraging technology and demonstrating the evidence based association of targeted interventions for high-risk patients such as the use of Triclosan-coated sutures and negative pressure wound therapy. These recommendations were well-received, leading to positive changes in practice and a notable decrease in SSIs. Moving forward, we are using this positive experience to expand our surveillance and intervention strategies to include other surgical categories not currently covered under our protocol. Our aim is to continuously leverage data and technology to identify risk factors, enhance patient safety, and educate others to improve surgical outcomes across a broader spectrum of procedures, thus reinforcing our commitment to excellence in patient care and infection prevention.

NHS England - GIRFT
The national non-medical preoperative assessment network

Preoperative assessment (POA) is a vital part of a patients perioperative pathway when contemplating surgery. Post pandemic and with the increase in waiting times for surgical intervention, POA services everywhere felt a struggle to meet demand and ensure that patients were seen in an appropriate timeframe to reduce the risk of cancellation close to the date of admission. I started to work for the getting it right first time team (GIRFT) in October 2022 as a POA nurse advisor and a leader of a well established POA unit. I quickly realised that there was no national network for POA leaders to meet with each other The non-medical POA network is a support network for non-medical multi-disciplinary leaders who work in POA services. Every month, our 90-minute online meeting creates a forum for learning and sharing best practice and an opportunity to link up POA leaders who previously often felt they worked in silo in this specialised area of practice. With POA transformation moving at pace to support elective recovery, the definitive objective of the network was always to provide peer support, yet it has achieved and created so much more.Since the first network meeting in November 2022, when we had 39 attendees, numbers have grown to an average of 70-80 attendees consistently for the last six months, and a membership of over 260 members. Representation is across all regions in England, with additional members from elsewhere in the UK. Once the network was established, the POA page on Future NHS was created to hold all of our presentations in one place. The network is growing and providing a key platform to feed into national objections for POA and the expertise of the group ensures that future policies and guidelines are based on current clinical practice.

West Hertfordshire Teaching Hospitals NHS Trust
Surgical virtual hospital for elective colorectal patients

Our clinical lead for surgery delivers one of the largest volumes of robotic surgery in the country and promotes regional and national robotics strategies. Our robotics and Enhanced Recovery After Surgery (ERAS) programmes have contributed to a successful colorectal service at WHTH. How could we improve the service and reduce our post-operative stay even further? Could we improve patient satisfaction and experience while challenging the status quo? To do this, we constructed a surgical virtual hospital model for elective colorectal patients. The Trust operates a pioneering medical Virtual Hospital (VH), so we collaborated with them to add elective surgical patients. We met weekly with VH service leads and a project management team. We held stakeholder focus groups and consulted a patient representative throughout. A retrospective audit revealed that in six months we could have saved 22 beds. We established robust guidelines, pathways and policies to ensure the safety and effectiveness of the project. Hub nurses, ERAS nurses, and a colorectal team clinically managed patients to deliver integrated care under ERAS nurse supervision. The ERAS nurse would identify suitable patients pre-operatively and reassess post-operatively to ascertain if they met the strict inclusion criteria. Engaging the colorectal team in decision-making and sharing our data and experiences helped us overcome our key barrier, which was engagement from the wider team. Patient buy-in was also initially challenging however our comprehensive patient information leaflet helped to remedy this and we quickly gained patients' trust. Our data shows that we have saved 30 beds since November 23, surpassing our original target. 100% of patients felt comfortable and 100% believed VH was a better option. Our long-term goal is to do same-day discharge colectomies, which may be achievable because of our VH. We also intend to expand our service into other surgical divisions, followed by emergency care.

West Suffolk NHS Foundation Trust
Peri-operative nutritional support for hip fracture patients

Aim was to investigate the potential benefit of targeted nutritional supplementation to support the recovery for elderly patients following hip fracture surgery and make recommendations for the inclusion of nutritional support as a standard for Best Practice Tariff (BPT), and a new Key Performance Indicator (KPI). Background: Malnutrition is common in hip fracture patients. It is closely linked to frailty, leading to an increased length of stay, post-operative complications, morbidity and mortality. There is evidence for improved surgical outcomes by providing nutritional supplementation for these patients before and after their surgery. There is also evidence that utilising nutritional support workers can further improve outcomes. Local departmental data demonstrated poor 1st-day-mobilisation following surgery and prolonged length of hospital stay in comparison to other institutions. A Quality Improvement (QI) project was initiated, to give all patients pre and post operative nutritional supplements (for 14 days after surgery) and see if there was improvement in these outcome measures, as well as mortality. The dietetics department was happy to support us with this QI, and financially with the funding for an nutritional support worker to help staff embed the project, and with feeding patients. Our baseline dataset showed that weighing patients was poorly done, as was measuring and recording their nutritional assessment (MUST scores). We received funding for a patient transfer weighing board for our ward and ED, which has improved the accurate weighing. MUST scores are better recorded since starting the project. Our initial dataset analysis since starting the intervention has shown a 2 day reduction in acute hospital stay (from 13 to 11 days), and an increase in 1st day mobilisation from 77.6% to 87.4%. Our plan is to reanalyse data, including mortality, after our nutritional support worker has been in post for at least 6 months.