UPPER GI SURGERY SURVIVAL GUIDE Royal Surrey County Hospital

Frensham Ward Book using referral forms with relevant departments

TEAM STURCTURE:
Consultants: Professor Piers Gatenby, Mr Shaun Preston, Mr Javed
Sultan. (Secretaries sit in Frensham Ward in office behind Bay 10)
3 x SpRs
1 x SHOs
2 x F1s
Specialist team: Dieticians,
Rotates with HPB and Colorectal Surgery to do on-take weeks
ROUTINE DAY
7AM: Update and print List: Patient locations, bloods and imaging
results from previous day
 Add patients from the previous day’s theatre lists that have
been admitted (Note ITU patients stepped down overnight)
G Drive > Shared > Surgery > Upper GI Surgery
If Upper GI Team is on-take, print on-call lists and update patient
locations
G Drive > Shared > Surgery > SAU > SAU On-call lists
Write blood forms for any new patients –include clotting & INR for
anyone who may be going to theatre or for an interventional
procedure (ie. drain). Target INR < 1.4
Details of how to prescribe bowel prep can be found on the back of
the endoscopy request forms. If you have any concerns or
questions, please consult the ward pharmacist, your SHO/SpR or
contact the Endoscopy Co-ordinator on Ext. 4409.
Booking patients for elective surgery
Fill in a yellow TCI card and hand it in to the Admissions Co-
ordinator (Admissions office Level C near entrance to
Bramshott/Ewhurst).
Upper GI MDT (Tuesday 8AM)
 MONDAYS: Late F1 have to prepare notes for MDT
 List of patients to be discussed and notes are in secretary
office
 Please prepare brief summary of every patient and
investigation results.
M&M Meetings (Thursdays 08:15AM)
Anaesthetic Seminar Room on Level A
Email Nicola Gilford (ngilford@nhs.net) when you join the Upper GI
team and she will ensure that you receive an email copy of the M&M
agenda in advance of the meeting.
You will need to prepare and present a PowerPoint on Upper GI
patients on the list for discussion

07:45AM: Attend Handover Meeting at EAU Doctor’s Office Preparing patients for Theatre
All patients admitted in last 24-hours discussed and images
presented by night SHO and SpR. Procedure Xmatch/G&S
Colectomy/Hemi-colectomy 2 Units
Routine Ward Round (SpR-led) for current in-patients followed by Rectopexy G&S
Post-take Ward Round (Consultant-led) if Upper GI Team on take. Rectum Pouch/ Resection/ Excision 4 Units
 TUESDAYS ward rounds are Consultant-led → Ensure notes Appendicectomy G&S
trolleys, bloods and lists are updated

End-of-day duties CARING FOR THE POST-OP PATIENT

 Team brief to catch up on jobs done/ outstanding
 Update list with new take patients
 Update bloods and investigations
 Write blood forms for all the patients on the list who will need
bloods the next day
 Handover important outstanding jobs for Surgical twilight (71-
0202) to chase.
FRIDAY ADDITIONAL DUTIES
Add patients who need reviewing over the weekend on to the
Weekend Handover List
Shared > Surgery > General Surgery Weekend Handover
Print all the Upper GI theatre lists on APASfor the week ahead. Be
sure that you check all the Ad-Hoc General Surgery lists and print
any that will be overseen by an Upper GI Consultant.
Check through all of the lists for cases requiring ITU beds post-op
(Oesophagectomy Level 3 bed and Gastrectomy Level 2 bed)
Fill out booking form in ITU sister’s office and discuss with ITU
Consultant.
ADDITIONAL TIPS & ADVICE
Stomas
For patients who are going to theatre for stoma formation, contact
the Stoma Nurses (Katie, Fiona and Di –Ext. 2558 or Bleep #0911)
to ‘site’ the patient. This means that they mark the most appropriate
place on the abdomen to bring out a stoma.
TPN Referrals
Fill out TPN referral form (Shared > Surgery > Colorectal List >
Referral Forms) and email to rsc-tr.RSCH-NST@nhs.net
CEPOD Booking
Fill in a pink CEPOD form (found at theatre reception desk). Always
have patients’ details, blood results, NBM timings at hand.
Discuss to the CEPOD nurse-in-charge (Bleep #4399) and on-call
anaesthetist (Bleep #0008) before booking form will be accepted.
Contrast Studies (Gastrograffin)
Fill out X-ray
Prescribe laxatives (ie. phosphate enemas) and prokinetics (ie.
metoclopramide) with caution in post-op patients (risk of anastamotic
leaks and bowel perforation).
Pain is often a problem in our post-op patients, especially those who
have had laparotomies. We usually avoid prescribing codeine as it is
constipating and promotes ileus, and often use tramadol instead.
Pain Team can be contacted for advice 71-0027 (out-of-hours and
weekends → on-call anaesthetist on Bleep #0008)
They can help with epidurals and PCAs which are commonly used
post-op, and will be make you aware of relevant prescribing
restrictions (ie. IV morphine)
TWOC clinic appointment
Ask the Compton Ward Clerk for a TWOC Clinic form. Complete this
and put it in the Compton Ward Book. The appointment will then be
booked by the Ward Clerk.
ADDITIONAL MEETINGS,TEACHINGS
Tuesdays – MDT 8AM Anaesthetic Seminar Room
Thursdays
 M&M 08:15 Anesthetic Seminar Room
 Surgical Teaching 10AM with Professor Gatenby (OG)
Education Centre
 Foundation Teaching 2-3pm Education Centre
USEFUL CONTACTS:
Karl Shipsey (Surgery Specialty Manager): Fracture Clinic
Office Ext 2327, Bleep 71-2031
Rota, Leaves, manpower concerns
Stoma Nurses (Katie, Fiona and Di)–Ext. 2558 or Bleep
#0911
Endoscopy Co-ordinator – Ext. 4409
Pain Team (71-0027)

Endoscopy/EUS Bookings