"Total knee replacement"
About: Royal Devon & Exeter Hospital (Wonford) Royal Devon & Exeter Hospital (Wonford) Exeter EX2 5DW http://www.rdehospital.nhs.uk/
Posted by Pete Fox
12th November I had a total knee replacement. The Anaesthtist, Surgeon and surgical outcome after 8 weeks has been very good and I have started to cycle. I have written specific feedback to the hospital via the PALS service, requesting it is forwarded to the Assistant Director of Nursing. My overall inpatient satisfaction was over 80% with many examples of outstanding and good examples of 6C care. There were three aspects of care which required improvement and one aspect of care was inadequate. Using the CQC and 6c models was very helpful in being specific about key aspects of my care. The inadequate red flag incident was inadequate pain relieve as the spinal anaesthetic lost its effect, the characteristic is know to be often quite a sudden loss of pain relief. As my pain score started to increase I requested pain relief which took 1 hour to arrive and my pain remained unmanaged with a score of 8 and more for 25 hours. During this period I was unable to exercise which is essential in knee replacement. It was not until the intervention of the acute pain nurse which I requested to see did my pain become managed. The route cause of this I believe to be insufficient registered nurses to care for the number of post operative and existing ward patients. The appeared to be one registered nurse and one health care assistant for 14 patient, with 5 or more who had undergone surgery that day. When consciously at your most dependent in the first 24 hours of care, compared with staffing levels in outpatients, pre op assessment, pre op admission and PACU there were significantly less staff caring for you when you most needed them as an inpatient. I would suggest after large joint replacement the ratio of registered nurse in the first 24 hours of care should be 4/6 patients per registered nurse. However I am not dissatisfied with my care, it is not a complaint, but effect pain management is critical in so many ways not least length of stay.