Medical and Nursing Admission Splenectomy Clinical Path MR 97 by deafeningbuzz

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									                                                                                 AFFIX IDENTIFICATION LABEL



ROYAL CHILDREN'S HOSPITAL
MELBOURNE, AUSTRALIA

                                  This path is followed post operatively by either:

                                   Laparoscopic Splenectomy Path MR 97 I(I)
                                                             or
                                       Open Splenectomy Path MR 97 I(II)
                                              (To be decided post-operatively)



                                              MEDICAL CHECKLIST
                                          SPLENECTOMY CLINICAL PATH




                                                                                                                                         Medical and Nursing Admission Splenectomy Clinical Path MR 97 I
 On Admission
 Full medical assessment of child & document on pathway
 Notify haematology team of admission

 Ensure patient has had:
 • Pneumovax vaccine
 • Meningococcal vaccine
 • Hib vaccine

 Investigations pre operatively:
 Peripheral Bloods taken for FBE and XMATCH

 Post operatively:
 Ensure Intravenous Fluids reviewed and re written daily
 Ensure Intravenous Penicillin written
 Write request card for repeat FBE for day 1 post operative




 On Discharge
 Follow up appointment 1 – 2 weeks with General Surgical team
 Complete discharge script for prophylactic oral antibiotics (penicillin)


The path has been developed with input from Consultants, Registrars, Residents, Nursing Staff
and all Allied Health personnel involved and is based on best available evidence. Any queries
please speak to the Clinical Analysis Development Unit.

PLEASE NOTE
 All orders are to be documented on the MR56 -Treatment Order sheets
 All additional/ relevant information to be documented in the unit record.
 The Path is designed to assist clinicians by providing a framework of expected care. It is not intended to
 replace clinician judgement. If an individual patient does not fit the clinical care outlined, then the patient
 should be removed from the path.




spleenectomy2.doc                                                                            Refer to instructions for use on variance
Last updated Oct 2002                                         Page 1                                tracking record last page of path
                        MEDICAL ADMISSION NOTES




   Signature:
spleenectomy2.doc                                 Refer to instructions for use on variance
Last updated Oct 2002          Page 2                    tracking record last page of path
NURSING ADMISSION                                                           AFFIX IDENTIFICATION LABEL




Date: …………..Time: …….………..Ward/Unit: ……………….……..…………..Consultant:………………….…

WARD ADMISSION
Interpreter required? qYes qNo                                         Language:
Parents/guardians staying at:                                          Details on ID label correct?       qYes qNo
Contact numbers:                                                       Medical Certificate required? qYes qNo
Home circumstances: Primary caregivers / child to be discharged to


Does anyone in the family smoke?            Yes         No       Specify who:
Are they interested in obtaining help stopping smoking? qNot interested qInterested qVery interested
For those interested or very interested– Resources given? qYes qNo

ALLERGIES: Recorded on medication q Red band attached q
IMMUNISATIONS AND GP DETAILS: Record on Essential Particulars Record
Infant feeding: Breast q         Bottle q     Both q
Type of formula:                               Type of teat:                         Volume:
Diet:
Elimination: Nappies q            number and size of nappies:
                Toilet Trained q
Can a dummy be used to pacify the baby? qYes qNo
Relevant Past History:




Current Medications: Preferred time / method of administration




Nursing Assessment:




Signature & Designation:


spleenectomy2.doc                                                                   Refer to instructions for use on variance
Last updated Oct 2002                                     Page 3                           tracking record last page of path
  Splenectomy Clinical Path MR 97 I




                                                                                              Date:
                                                                                              Time:
                   On admission notify:
  Consultations    • Surgical RMO/ Registrar/ Consultant
                   • Haematology
                   • Children’s Pain Management Service (CPMS)
                   • Play therapy / Education Institute
   Assessment      Baseline vital signs including BP
   Medications     Administer pre op sedation (check MR52 if applicable)
    Nutrition      NBM as per fasting policy (unless otherwise ordered)
                   Orientate parent(s) to ward area
     Family /      Provide parent(s) with Splenectomy information handout
    Education      Explain plan of care using clinical path as a guide
                   Explain & reinforce treatment, procedures and equipment to parents


    Patient
 Specific needs



                   Reviewed and admitted by surgical team
                   Blood taken for FBE & X Match
                   Patient fasted for theatre
    Outcomes       Patient prepared for theatre
                   Parents understand unit layout, treatment plan & expected length of stay
                   Immunisation status documented on Essential Particulars Record
                   PROGRESS TO APPROPRIATE PATH POST SURGERY
 NURSE                                                                               Additional notes written in UR •
                   Date:        Time:          Print Name & Sign
 NURSE                                                                               Additional notes written in UR •
                   Date:        Time:          Print Name & Sign:
 NURSE                                                                               Additional notes written in UR •
                   Date:         Time:         Print Name & Sign:




spleenectomy2.doc                                                               Refer to instructions for use on variance
Last updated Oct 2002                                  Page 4                          tracking record last page of path
                                            Variance Tracking Record
                                                DATE      TIME             WHAT OCCURRED ?                           WHY ?                WHAT DID YOU DO ABOUT IT ?             OUTCOME               SIGNED
                                                          24 hr    eg: Orientation not given to parents   eg: Parents not in attendance    eg: Handed over to next shift   eg: Parents still require
                                                          clock                                                                                                                  orientation




spleenectomy2.doc
Last updated Oct 2002
Page 5
                                                INSTRUCTIONS for USE
                                            •     Record date and time as appropriate at the top of each column
                                            •     Each shift the nurse should complete the column & sign below in the space provided.
                                            •     TICK = item of care given as per path; “n/a” = care is not applicable to this patient at this time OR                           AFFIX IDENTIFICATION LABEL
                                            •     “VAR” = patient care or condition has varied from the path. The details are written on the Variance Tracking Record
                                            •     If you have any queries please contact the Care Coordination Manager in Clinical Support Servicesext / pager 6956




       tracking record last page of path
Refer to instructions for use on variance
                                            Variance Tracking Record
                                                DATE      TIME           WHAT OCCURRED ?                        WHY ?                WHAT DID YOU DO ABOUT IT ?             OUTCOME                      SIGNED
                                                          24 hr       eg: Orientation not given to   eg: Parents not in attendance    eg: Handed over to next shift   eg: Parents still require
                                                          clock                 parents                                                                                     orientation




spleenectomy2.doc
Last updated Oct 2002
Page 6
                                                INSTRUCTIONS for USE
                                            •     Record date and time as appropriate at the top of each column
                                            •     Each shift the nurse should complete the column & sign below in the space provided.
                                            •     TICK = item of care given as per path; “n/a” = care is not applicable to this patient at this time OR “VAR” = patient care or condition has varied from the path. The




       tracking record last page of path
Refer to instructions for use on variance
                                                  details are written on the Variance Tracking Record above
                                            •     If you have any queries please contact the Care Coordination Manager in Clinical Support Servicesext / pager 6956

								
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