Enhanced Recovery Programme

1
Enhanced Recovery Programme

• Lynn Shaw
• Colorectal CNS

2
What is ERAS?

• Holistic care pathway
• Returning the patient back to pre operative state
• Reduce post operative complications
• Shorter hospital stay

3
Changes in Traditional Post Op Care

• No bowel prep
• No fasting food given after surgery
• IV fluids discontinued earlier (less than 3
  litres)
• No drains no NG tube
• No premedication
• Early discharge

4
Which Patients?

• All ages
• Both sexes
• Elective surgical patients only
• Programme is being encouraged by National Cancer
  Peer review

5
Are There Any Exceptions?

• Emergency admissions
• Any other exceptions will be at the Consultants
  discretion
• Not all Consultants/hospitals participating

6
What Does it Mean for the Ward Staff?

• Ensuring the patient drinks on the evening post
  op. (can eat light diet if not nauseated)
• Stopping the PCA IVI 8am 1st day post op
• Giving the patient diet fluids (not waiting for
  the Doctors to give permission)
• Getting the patient up early morning and
  encouraging them to walk around the ward

7
Pre Operatively

• Patient given diagnosis by Consultant CNS
• Given information about operation ERAS
• Verbal consent
• Attends pre op assessment

8
On Admission

• Admitted day before surgery (may change)
• Infacol 30mls x 2 doses
• High carbohydrate drinks day before - up to 2
  hours before operation
• Eat drink normally
• No bowel prep (may require enema at Consultants
  discretion)

9
Why Carbohydrates?

• Reduces metabolic derangements insulin
  resistance
• Carbohydrates stimulate insulin
  production/secretion
• Hyperglycaemia increases complications i.e.
  Ileus, infection, kidney failure, muscle
  weakness, increased inflammatory response.

10
Day of Operation

• Morning op high carbohydrate drink at 07.00hrs
• Afternoon op high carbohydrate drink at 11.30hrs

11
Evening of Operation

• Fluids
• Light diet if not nauseated
• Sit out of bed if morning operation
• Oral analgesia (as well as PCA)
• IV fluids overnight
• Usual observations fluid balance

12
1st Day Post Op

• Discontinue IV fluids PCA at 08.00hrs (leave
  venflon in situ)
• Oral analgesia
• Breakfast
• Own hygiene cares
• Mobilise 3xlengths of the ward
• Oral Maxolon
• Lactulose
• Stoma cares

13
2nd 3rd Day Post Op

• Remove catheter
• Normal diet
• Mobilise

14

• Discharge home 4th day if ok
• 5th day if stoma where possible
• Histology at next MDT
• Patient contacted at home by CNS with results