Annex A > Chapter 13 - Pre-operative Care > Pre-operative management of care > The management of pre-operative care at the BRI
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The management of pre-operative care at the BRI
20 Children were generally admitted to Ward 5A at the BRI for elective surgery two days prior to their operation, having been transferred from the BRHSC. If the case was an emergency, children were admitted to the ward more quickly, or in some cases directly to theatre, depending on their condition and availability of ICU beds. [22]
21 The usual routine once on the ward was for the children to be clerked on admission by the SHO, who would examine the child and take a full medical history, request tests such as X-rays and bloods. The surgeon and the anaesthetist saw the child and parents pre-operatively, usually a day before surgery, when they would assess the clinical state of the child. [23]
22 Sister Julia Thomas told the Inquiry:
`The admitting nurse was responsible for welcoming the child and family to the unit. The pre-operative screening for infection was carried out by the nurse on admission. This included nose/throat swabs, urine samples and observations of temperature.' [24]
Observations of blood pressure and heart rate were taken and the child was measured and weighed. [25]
23 Julia Thomas said that the parents of the child were always involved in the pre-operative care and encouraged to stay with the child at all times before the operation. The child was prepared for theatre by the parents, who gave them two baths using anti-bacterial soap, and a hair wash. [26]
24 She continued in her evidence to say that pre-operative talks were given to the parents and to the child. A book was produced by the nursery staff for the parents to read, with their child if appropriate, written in simple language with illustrative pictures. [27] The admission paperwork included a full discussion with the family about the child's likes, dislikes, fears, interests, etc. [28]
25 The parents were taken to see the ICU and the equipment was explained to them. They were encouraged to stay with their child at all times pre-operatively, and accompany them on their visits to other departments for electrocardiograms (ECGs) and X-rays, etc. [29] The family was always seen by a physiotherapist pre-operatively to explain treatment, and they were also seen by one of the nurse counsellors, Miss Helen Stratton or Mrs Helen Vegoda. [30]
26 An oral pre-medication was given to the child prior to surgery. The children painted their own operation gown with the play leader. [31] A nurse who knew the family accompanied the child to theatre. The parents were also able to accompany their child to theatre, although some consultant anaesthetists did not encourage the parents to go into the anaesthetic room. [32]
27 Mr Wisheart told the Inquiry:
`The nurses cared for the patients from the moment of their admission and made their own assessment in the period to surgery. If they found anything that they considered could be of importance to us they would always let the medical staff know. They had their own discussions with the parents and the families about the operation, about intensive care and other aspects of the patient's likely course.' [33]
`The physiotherapists play a very important role in the post-operative care of the patient. In order to do so they always saw the patients prior to surgery and made their own assessment at that time. They also undertook pre-operative physiotherapy and would have their own conversations with parents and families.' [34]
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Footnotes
[22] WIT 0114 0075 Fiona Thomas
[23] WIT 0114 0075 Fiona Thomas
[24] WIT 0213 0032 Julia Thomas
[25] WIT 0213 0033 Julia Thomas
[26] WIT 0213 0033 Julia Thomas
[27] WIT 0213 0033 Julia Thomas
[28] WIT 0213 0033 Julia Thomas
[29] WIT 0213 0033 Julia Thomas
[30] WIT 0213 0033 Julia Thomas
[31] WIT 0213 0033 Julia Thomas
[32] WIT 0213 0033 Julia Thomas
[33] WIT 0120 0150 Mr Wisheart
[34] WIT 0120 0150 Mr Wisheart