The Operating Theatre Journal - Flipbook - Page 9
Exposure was carried out. In line with NICE (2014), pressure areas were
checked and a risk assessment tool was used. Patient X scored 04
using the Waterlow Assessment (Judy-Waterlow.co.uk, 2005). Patient
X was low risk for pressure sores due to the surgery being a quick
procedure and they are young, 昀椀t and well. Patient X was encouraged
to reposition themselves in PACU to reduce the risk of pressure sores.
The surgical site was examined by observing any bleeding in the mouth
with a handheld torch. Patient X had 2 dental packs in place, which
were removed in PACU due to minimal bleeding. The absorbable sutures
were intact.
Sharif et al. (2014) proposes dry socket syndrome is a common
complication associated with 37% of dental extractions. Lodi, G. et
al. (2012) suggest evidence that prophylactic antibiotics reduce the
risk of infection and dry socket syndrome. In PACU it was ensured
that the prophylactic antibiotic had been given, patient X received coamoxiclav. Patient X was advised to keep their tongue away from the
socket clot allowing for good healing, as well as gentle mouth rinses.
This practice is supported by Sharif et al. (2014) stating dry socket
syndrome occurs when a clot fails to form or is dislodged.
NICE (2018) recommends mechanical venous thromboembolism (VTE)
prophylaxis, such as anti-embolism stockings, for patients undergoing
oral surgery. Also suggesting VTE prophylaxis should be continued until
mobility is no longer signi昀椀cantly reduced. Patient X’s mobility was still
reduced in PACU so thrombo-embolus deterrent (TED) stockings were in
place on arrival, meeting this standard of care.
Patient X’s temperature was taken using an indirect temperature
device, a Rycom infrared thermometer (Rycom, 2023). According to
NICE (2016) indirect temperature devices are permitted for use in
PACU but this device does not measure or state an equivalence to core
patient temperature therefore not making it an ideal device to use, and
not meeting national standards. NICE (2016) recommends temperature
is recorded on admission and then every 15 minutes. Patient X’s
temperature was recorded on arrival as 36.5˚C, after 15 minutes and
on discharged it was 36.4˚C. Thus not meeting this standard of care as
temperature was not recorded at 15 minute intervals.
In line with NICE (2016) patient X was asked if they were comfortably
warm, and stated they were. They were given a warm blanket on
arrival to PACU. NICE (2016) proposes that patients should be provided
with the minimum of 1 cotton sheet plus 2 blankets. This case did not
meet this standard of care as they only had 1 blanket.
Patient X was discharged home on the day of surgery as an impacted
wisdom tooth extraction is typically day surgery, handover was given
to the Discharge Unit. Handover again followed SBAR (NHS, 2021), as
recommend by NICE (2018), hence meeting this standard of care. RCoA
(2019) states locally devised protocols should be available for discharge.
Patient X was discharged from PACU following local discharge criteria,
it is not ascertained if this met national discharge standards. The
handover recommendations included the time for the next dose of
paracetamol and the prescribed analgesia which was dihydrocodeine.
Ibuprofen was recommended to be taken regularly once home. It was
urged that a soft diet should be maintained for the next few days and
hot drinks should be avoided for the next few hours to allow for the
LA to subside and to prevent bleeding. The TEDs should be kept on
until fully mobile (NICE, 2018). Gentle antiseptic mouth rinses were
suggested to prevent infection and dry socket syndrome (Sharif et al,
2014).
A National Early Warning Score (NEWS 2) (Royal College of Physicians,
2017) was calculated on discharge from PACU to ensure the patient is
sent to a safe place following PACU. Observations on discharge: SpO2
100% on room air, RR 16, NIBP 114/62, HR 74 and temperature 36.4˚C.
Patient X’s total NEWS2 score was 0. A NEWS2 score of 0 requires a
minimum of 12 hourly observations, the Discharge Unit was able to
provide this frequency of monitoring, meaning that they were sent to
an appropriate place following PACU.
In conclusion patient observations had returned to acceptable values,
showing the maintenance agents had cleared and the patient safe to
be discharged from PACU. Overall, some areas of care were examples
of best practice and met national standards including safe LA dosage,
昀氀uid re-assessment, safe monitoring for transfer, structured handover
including recommendations, the use of a systematic approach to assess
patient X and a NEWS2 score ensuring a safe destination for the patient.
There were areas of care that could be improved as the national
standards were not met including, core thermometry, appropriate
bedlinen provision, temperature recording and PACU discharge
standards.
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