1 Enhanced Recovery After Surgery Care Plan
- 1.1 Key Objectives
- 1.2 Outcome measures
- 1.3 Current Baselines
2 Workflow
- 2.1 Patient pathway
- 2.2 Enhance Recovery After Surgery Care Plan (day 1-2 and days 8-10)

Enhanced Recovery After Surgery Care Plan

Key Objectives

Provide a tool for the remote management of kidney transplant patients

Outcome measures

Equip patients with the tools they need to support self-management post-operatively, as well as providing the tools they need to interact digitally rather than relying on a face to face consultations.

Current Baselines

All activity is face to face, patients are traveling large distances, and their follow-ups aren’t being efficiently, or effectively managed.

Workflow

The whole workflow is from pre op> transplant> post-op but the care plan is introduced in the transplant phase.

Patient pathway

Patients register with their PKB record before surgery or on the ward post-operatively when the nurse caring for them adds the Enhance Recovery care plan to the patient's PKB record on day one.

The care plan is completed by the nurse each day while the patient is in the hospital, which is normally for six days post-operatively, before being discharged home, where they will complete the care plan themselves. The team then reviews the care plan daily over the phone with the patient.

Enhance Recovery After Surgery Care Plan (day 1-2 and days 8-10)

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<p>Quick links: <a href="#cp_day1anchor">Day 1</a> / <a href="#cp_day2anchor">Day 2</a> / <a href="#cp_day3anchor">Day 3</a> / <a href="#cp_day4anchor">Day 4</a> /

<a href="#cp_day5anchor">Day 5</a> / <a href="#cp_day6anchor">Day 6</a> / <a href="#cp_day7anchor">Day 7</a> / <a href="#cp_day8anchor">Day 8</a> /

<h2>Introduction to our enhanced recovery programme</h2>

<p>Enhanced recovery after surgery (ERAS) helps patients to recover more quickly from their transplant. Reaching certain targets can reduce the likelihood of complications and can help improve the experience of patients as they recover.</p>

<p>We hope this journal will help you to understand what to expect and feel more involved in what happens during your transplant inpatient journey. The journal is yours to keep and complete to help you record your progress. Relatives, friends and members of the transplant team can help you to fill it in if you find this difficult. By completing this journal as you go along, it will help us to support you and ensure your recovery is as efficient as possible.</p>

<p><b>All elements of the programme may not be suitable for everyone. Do not worry if you don't meet all of your targets. Every patient is different and everyone will achieve targets at their own pace. The transplant team will make any changes where needed to make sure that you receive high quality care specific to your needs.</b></p>

<h2>On admission for your transplant</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px;">The nurses will ask you some questions to help plan for your needs when you go home.</li>

<li style="list-style:inherit; margin-left: 15px;">If you have a relative or friend who can be a support person during your recovery, please arrange for them to be available in the afternoon on days 3 and 4 following your transplant. This is an important part of your recovery where the nurses will provide you with education on how to look after your transplant as well as the details of your medications.</li>

<li style="list-style:inherit; margin-left: 15px;">Please record the details of your support person below.</li>

</ul>

<label class="cp_label" for="cp_namedSupportPerson">Named support person:</label>

</div>

</div>

<label class="cp_label" for="cp_supportRelationship">Relationship:</label>

</div>

</div>

<label class="cp_label" for="cp_admissionDate">Date of admission:</label>

</div>

</div>

<label class="cp_label" for="cp_transplantDate">Date of transplant:</label>

</div>

</div>

<label class="cp_label" for="cp_estDischargeDate">Estimated Date of discharge:</label>

</div>

</div>

</div>

<h3>After surgery</h3>

</div>

</div>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Eat & drink as soon as you feel able. You have a drip to keep you hydrated.</p>

</div>

<p>Your drip stops today. Try to drink to your fluid target.</p>

</div>

<p>Try to drink to your fluid target. The nurses will help you to record your fluid intake.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>The nurses will help you to sit out in your chair.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for two walks.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Your weight will not routinely be measured today.</p>

</div>

<p>The nurses will help to weigh you before breakfast.</p>

</div>

<p>The nurses will help you to weigh yourself. Please record it in your journal.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Use your PCA button as much as you need. Your pain catheter will keep you comfortable.</p>

</div>

<p>Your PCA stops today. Your pain catheter is still there and you will be given pain relief.</p>

</div>

<p>Your pain catheter may be removed. The nurses will help you to take pain relief.</p>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">no title</h3>

</div>

<p>The nurses will monitor your drain output.</p>

</div>

<p>The nurses will help you to record the drain output in your journal.</p>

</div>

<p>Record the drain output in your journal. If the volume is low, it may be removed.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>The nurses will monitor your urine output.</p>

</div>

<p>The nurses will help you to record your urine output.</p>

</div>

<p>The nurses will help you to record your urine output.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>The nurses will give you all the medicine you need.</p>

</div>

<p>You will be given your medicine card today.</p>

</div>

<p>The nurses will help you to start taking your own medicines using your card.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Let the nurses know if anything has changed with your needs on discharge.</p>

</div>

<p>Let the nurses know if anything has changed with your needs on discharge.</p>

</div>

<p>Let the nurses know if anything has changed with your needs on discharge.</p>

</div>

</div>

</div>

</div>

</div>

</div>

<p>Try to drink to your fluid target and record your fluid intake. The nurses will help you.</p>

</div>

<p>Try to drink to your fluid target. Please record your fluid intake.</p>

</div>

<p>Try to drink to your fluid target. Please record your fluid intake.</p>

</div>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

</div>

<p>Please weigh yourself and record it in your journal.</p>

</div>

<p>Please weigh yourself and record it in your journal.</p>

</div>

<p>Please weigh yourself and record it in your journal.</p>

</div>

</div>

<p>Continue to take pain relief as needed to keep you comfortable and mobile.</p>

</div>

<p>Continue to take pain relief as needed to keep you comfortable and mobile.</p>

</div>

<p>Continue to take pain relief as needed to keep you comfortable and mobile.</p>

</div>

</div>

<p>If you still have a drain, record the output in your journal. It may be removed today.</p>

</div>

<p>If you still have a drain, record the output in your journal. It may be removed today.</p>

</div>

<p>You may go home with the drain. The nurses will show you how to look after it.</p>

</div>

</div>

<p>Your catheter may be removed today. The nurses will help to record your output.</p>

</div>

<p>Please continue to record your urine output.</p>

</div>

<p>Please continue to record your urine output.</p>

</div>

</div>

<p>Use your card to identify your medicines. The nurses will check them.</p>

</div>

<p>Use your card to identify your medicines. The nurses will check them.</p>

</div>

<p>Use your card to identify your medicines. The nurses will check them.</p>

</div>

</div>

<p>The nurses will teach you and your support person about caring for your transplant.</p>

</div>

<p>You will have a second education session today. We are preparing for you going home. Let us know if you don't feel ready.</p>

</div>

<p>You may be discharged home today if you are ready.</p>

</div>

<h2>After Surgery</h2>

</div>

<h3>Drinking</h3>

<p>You can start to eat and drink as you feel able. If you are struggling, let the nurses know.</p>

</div>

</div>

<h3>Mobility</h3>

<p>The nurses will help you to sit out in your chair if possible. Tomorrow, the physiotherapist will provide you with breathing exercises and a mobility programme to help you recover.</p>

</div>

</div>

<h3>Weight</h3>

<p>The nurses will help you to weigh yourself before breakfast. Please record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Your PCA and pain catheter will help to keep you comfortable. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will monitor and record your drain output.</p>

</div>

</div>

<h3>Catheter</h3>

<p>The nurses will monitor and record your urine output.</p>

</div>

</div>

<h3>Medicines</h3>

<p>The nurses will give you all your medications.</p>

</div>

</div>

<h3>Care planning</h3>

<p>Let the nurses know if anything has changed with your home circumstances or other needs for when you go home. Do you have someone to take you home and bring you to clinic appointments?</p>

</div>

<h2 id="cp_day1anchor">Day 1 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>If the team is happy with your fluids, your drip will stop today. You will be asked to drink and the team will give you a target to aim for. If you are struggling, let the nurses know. Record your fluid target and how much you drink below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>The physiotherapist will show you some breathing exercises and give you a mobility programme (A, B or C). This will include two walks today. Try to follow this as much as possible. Aim to sit in your chair for every meal. Record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>The nurses will help you to weigh yourself before breakfast. Please record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Your pain catheter may be removed today. The nurses will help you to take your oral painkillers. Heat packs are also available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will help you to monitor your drain output. Please record this below. Your drain may be removed today if the volume is less than 100ml.</p>

</div>

</div>

<h3>Catheter</h3>

<p>The nurses will help you to monitor your urine output. Please record this below.</p>

</div>

</div>

<h3>Medicines</h3>

<p>We will explain your medications to you today. We will help you to use your card to identify your medications.</p>

</div>

</div>

<p>Let the nurses know if anything has changed with your home circumstances or other needs for when you go home. Do you have someone to take you home and bring you to clinic appointments?</p>

</div>

<h2>Progress day 1</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink" id="cp_qtyDrink" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine" id="cp_qtyUrine" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain" id="cp_qtyDrain" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_day1FluidTarget">Today's fluid target is:</label>

</div>

<input type="text" name="cp_day1FluidTarget" id="cp_day1FluidTarget" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_day1MobilityProgramme">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_Day1targetComplete">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_Day1targetCompletea" id="cp_Day1targetCompletea" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_Day1targetCompleteb" id="cp_Day1targetCompleteb" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_Day1targetCompletec" id="cp_Day1targetCompletec" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_day1WalksManaged">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_day1TimesSat">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day1Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="cp_day2anchor">Day 2 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. The nurses will help you to record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme, which will include four walks today. Ask the nurses to help you with this. Please record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>The nurses will help you to weigh yourself before breakfast. Please record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Your pain catheter may be removed today. The nurses will help you to take your oral painkillers. Heat packs are also available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will help you to monitor your drain output. Please record this below. Your drain may be removed today if the volume is less than 100ml.</p>

</div>

</div>

<h3>Catheter</h3>

<p>The nurses will help you to monitor your urine output. Please record this below.</p>

</div>

</div>

<h3>Medicines</h3>

<p>We will explain your medications to you today. We will help you to use your card to identify your medications.</p>

</div>

</div>

<p>Let the nurses know if anything has changed with your home circumstances or other needs for when you go home. Do you have someone to take you home and bring you to clinic appointments?</p>

</div>

<h2>Progress day 2</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day2">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day2" id="cp_qtyDrink_day2" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day2">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day2" id="cp_qtyUrine_day2" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day2">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day2" id="cp_qtyDrain_day2" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day2">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day2" id="cp_FluidTarget_day2" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day2">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_targetComplete_day2">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day2a" id="cp_targetComplete_day2a" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day2b" id="cp_targetComplete_day2b" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day2c" id="cp_targetComplete_day2c" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_WalksManaged_day2">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_TimesSat_day2">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day2Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="day3anchor">Day 3 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. If you are struggling, let the nurses know. Please record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme which will include four walks today. Ask the nurses for assistance with this and record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>Please weigh yourself before breakfast and record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Continue to take oral painkillers as you need them. The nurses will help and will record what you are taking. Heat packs are available. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>If you still have a drain and the volume is less than 100ml in the last 24 hours, it may be removed today. If you still need it, the nurses will help you to monitor your drain output.</p>

</div>

</div>

<h3>Catheter</h3>

<p>Your urinary catheter may be removed today. Please record your urine output below. If your catheter needs to stay longer, we will reassess this each day and give you an expected date for removal. The nurses will change your urine bag to a leg bag to make it easier for you to move around.</p>

</div>

</div>

<h3>Medicines</h3>

<p>Please use your card to identify your medicines. The nurses will check they are correct before you take them.</p>

</div>

</div>

<p>If possible, your support person should attend the ward today or be available for video/phone call around 3pm. The nurses will provide you both with important education about your transplant and plans for going home.</p>

</div>

<h2>Progress day 3</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day3">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day3" id="cp_qtyDrink_day3" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day3">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day3" id="cp_qtyUrine_day3" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day3">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day3" id="cp_qtyDrain_day3" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day3">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day3" id="cp_FluidTarget_day3" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day3">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_targetComplete_day3">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day3a" id="cp_targetComplete_day3a" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day3b" id="cp_targetComplete_day3b" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day3c" id="cp_targetComplete_day3c" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_WalksManaged_day3">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_TimesSat_day3">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day3Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="cp_day4anchor">Day 4 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. If you are struggling, let the nurses know. Please record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme which will include four walks today. Ask the nurses for assistance with this and record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>Please weigh yourself before breakfast and record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Continue to take oral painkillers as you need them (the nurses will need to record what you are taking). Heat packs are available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will help you to monitor your drain output. Please record this below. Your drain may be removed today if the volume is less than 100ml.</p>

</div>

</div>

<h3>Catheter</h3>

<p>Please record your urine output below. Ask the nurses if you need help with this. If you still have a catheter, we will continue to assess how long you need it for.</p>

</div>

</div>

<h3>Medicines</h3>

<p>Please use your card to identify your medicines. The nurses will check they are correct before you take them.</p>

</div>

</div>

<p>The nurses will go over any education needed in preparation for going home and order your medications. We are preparing for your possible discharge home tomorrow. It is very important to tell us about any worries or any help you need at home as soon as possible.</p>

</div>

<h2>Progress day 4</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day4">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day4" id="cp_qtyDrink_day4" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day4">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day4" id="cp_qtyUrine_day4" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day4">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day4" id="cp_qtyDrain_day4" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day4">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day4" id="cp_FluidTarget_day4" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day4">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_targetComplete_day4">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day4a" id="cp_targetComplete_day4a" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day4b" id="cp_targetComplete_day4b" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day4c" id="cp_targetComplete_day4c" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_WalksManaged_day4">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_TimesSat_day4">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day4Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="cp_day5anchor">Day 5 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. If you are struggling, let the nurses know. Please record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme which will include four walks today. Ask the nurses for assistance with this and record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>Please weigh yourself before breakfast and record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Continue to take oral painkillers as you need them (the nurses will need to record what you are taking). Heat packs are available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>If the drain volume remains high you may need to go home with it. Please continue to measure and record the output. The nurses will show you how to care for it yourself.</p>

</div>

</div>

<h3>Catheter</h3>

<p>Please record your urine output below. If you need to go home with your catheter, the nurses will show you how to care for it yourself.</p>

</div>

</div>

<h3>Medicines</h3>

<p>Please use your card to identify your medicines. The nurses will check they are correct before you take them.</p>

</div>

</div>

<p>The nurses will go over any education needed in preparation for going home. Please check your medicine card is up to date. The team are preparing for your possible discharge home today. If you or your family are worried about going home, let us know.</p>

</div>

<h2>Progress day 5</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day5">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day5" id="cp_qtyDrink_day5" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day5">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day5" id="cp_qtyUrine_day5" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day5">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day5" id="cp_qtyDrain_day5" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day5">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day5" id="cp_FluidTarget_day5" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day5">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>Before you go home?</u></b></p>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5a" id="cp_targetComplete_day5a" value="I have everything you need at home?"> I have everything you need at home?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5b" id="cp_targetComplete_day5b" value="Transport has been arranged to take you home?"> Transport has been arranged to take you home?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5c" id="cp_targetComplete_day5c" value="My medicine card is up to date?"> My medicine card is up to date?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5d" id="cp_targetComplete_day5d" value="I have arranged my transport to & from clinic?"> I have arranged my transport to & from clinic?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5e" id="cp_targetComplete_day5e" value="I have a tunnelled dialysis line or PD catheter, and a removal date been arranged for me?"> I have a tunnelled dialysis line or PD catheter, and a removal date been arranged for me?</input>

</div>

<p>Your next follow up appointment is on <input type="date" name="cp_followupDate" id="cp_followupDate" class="form-control" placeholder="dd/mm/yyyy"></input> with <input type="text" name="cp_followupUnit" id="cp_followupUnit" class="form-control"></input> at <input type="text" name="cp_followUpUnit" id="cp_followUpUnit" class="form-control" placeholder="hh:mm" maxlength="5"></input></p>

<p>We will call you tomorrow at <input type="text" name="cp_followUpTime" id="cp_followUpTime" class="form-control" placeholder="hh:mm" maxlength="5"></input> to see how you are.</p>

<label class="cp_label" for="cp_day5Questions">Notes</label>

</div>

<p>When you get home, if you are worried about anything please call us on <a href="tel:+441912137538">0191 2137538</a></p>

</div>

<h2 id="day6anchor">Progress day 6</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day6">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day6" id="cp_qtyDrink_day6" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day6">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day6" id="cp_qtyUrine_day6" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day6">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day6" id="cp_qtyDrain_day6" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day6">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day6" id="cp_FluidTarget_day6" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day6">Notes</label>

</div>

<h2 id="cp_day7anchor">Progress day 7</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day7">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day7" id="cp_qtyDrink_day7" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day7">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day7" id="cp_qtyUrine_day7" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day7">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day7" id="cp_qtyDrain_day7" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day7">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day7" id="cp_FluidTarget_day7" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day7">Notes</label>

</div>

<h2 id="cp_day8anchor">Progress day 8</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day8">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day8" id="cp_qtyDrink_day8" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day8">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day8" id="cp_qtyUrine_day8" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day8">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day8" id="cp_qtyDrain_day8" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day8">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day8" id="cp_FluidTarget_day8" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day8">Notes</label>

</div>

<h2 id="cp_day9anchor">Progress day 9</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day9">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day9" id="cp_qtyDrink_day9" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day9">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day9" id="cp_qtyUrine_day9" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day9">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day9" id="cp_qtyDrain_day9" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day9">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day9" id="cp_FluidTarget_day9" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day9">Notes</label>

</div>

<h2 id="cp_day10anchor">Progress day 10</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day10">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day10" id="cp_qtyDrink_day10" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day10">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day10" id="cp_qtyUrine_day10" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day10">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day10" id="cp_qtyDrain_day10" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day10">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day10" id="cp_FluidTarget_day10" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day10">Notes</label>

</div>

<h2>Explanation of terms</h2>

<h3>Drain</h3>

<p>A tube coming from the transplant wound to remove blood and fluid that collects from the operation. It is connected to a bag that can be emptied so that the fluid volumes can be measured.</p>

<h3>Education session</h3>

<p>This is delivered by the nurses to give you information and help you better understand how to care for your new kidney. This will include signs and symptoms of potential complications as well as things you should try to avoid. They can put you in touch with other professionals if you need help with finances, work or have other concerns.</p>

<h3>ERAS = Enhanced recovery after surgery</h3>

<p>The name of the programme we are following to better support you as you recover from your operation.</p>

<h3>Fluid target</h3>

<p>On the morning ward round each day, we will suggest a certain amount of fluid that we would like you to aim to drink over the course of the day. It is important to try to work towards this but don't worry if you don't reach the target. Talk to the transplant team if you are finding it difficult and they will help.</p>

<h3>Medication card</h3>

<p>You will be provided with a card that has a list of your medications. This includes the name of the medication, the dose you take, when to take it and what the medication is for. The nurses will guide you in how to use this card to identify your medications.</p>

<h3>Pain Catheter</h3>

<p>This is a tiny tube inserted during the operation and sits around the muscle layer surrounding your new kidney. It provides a continuous supply of local anaesthetic to numb the area. The anaesthetic is stored in a ball that is attached to you. It usually lasts between 48-72 hours then it can be removed. You may also hear people referring to this as a 'pain buster' or 'OnQ catheter'.</p>

<h3>PCA = Patient controlled analgesia</h3>

<p>This is a machine that provides you with a painkiller called Fentanyl. This attaches to a cannula and enters the body through your veins. A dose is given each time you press the button. There is a safety mechanism which means you will only receive a dose once every 5 mins regardless of how often you press it. This usually stops 24 hours after surgery.</p>

<h3>Physiotherapy mobility programme</h3>

<p>A programme designed to help restore, maintain and make the most of a patient's mobility, function and well-being.</p>

<p>After your transplant, the physiotherapists will assess you and provide you with a mobility programme (A, B or C) prescribing a distance for you to try to walk each day. This is an important part of your recovery. They will take into account your level of fitness before transplant as well as your ability after the operation to make sure that the programme is right for you.</p>

<h2>Fluid Volumes</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px;">Large glass (blue) 240ml</li>

<li style="list-style:inherit; margin-left: 15px;">Small glass 170ml</li>

<li style="list-style:inherit; margin-left: 15px;">Water Jug 1litre</li>

</ul>

</div>

<label class="cp_label" for="cp_additionalNotes">Additional Notes</label>

</div>

</div>

Deploy Patients Know Best

Enhanced Recovery Care Plan

Enhanced Recovery After Surgery Care Plan

Key Objectives

Outcome measures

Current Baselines

Workflow

Patient pathway

Enhance Recovery After Surgery Care Plan (day 1-2 and days 8-10)