"Total knee replacement"

About: Royal Devon & Exeter Hospital (Wonford)

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.

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Response from Royal Devon & Exeter Hospital (Wonford)

Thank you for taking the time to share your experience with us. Our Assistant Director of Nursing for Surgical Services has provided the following response: Thank you very much for posting your feedback. As you note I have received your feedback via the PALS department, and very much appreciate the detail you were able to provide from a personal perspective as a recipient of our services. It is pleasing to hear that you have achieved a good outcome at 8 weeks following your surgery and I sincerely hope that recovery continues so positively. I was sorry to learn of the difficulties you experienced in relation your pain relief – clearly this is an important part of the post-operative recovery phase and is part of the basic care and attention we would aim to deliver to our patients. On this occasion it would seem that we have not met the high standards we would usually like to attain for our patients in the immediate post-operative recovery phase. Waiting an hour for pain relief is regretful and we are very sorry for the delay in responding to your request for pain relief. We will certainly look at reviewing our interventions for effective pain relief, including timely medication. Staffing levels are constantly reviewed by the Senior Nursing teams and staffing numbers are documented at the entrance to all wards, outlining the number of nurses that should be on shift and then the number actually on shift. All ward areas are reviewed daily to ensure the number of nurses on shift provide a safe environment for our patients to be cared for. There are always times when ward areas can be busier, but safe staffing is always maintained. I am sorry if on this occasion the levels seemed low, but I can assure you we are very attentive to the number of nurses available to care for our patients. I have asked the Senior Nurse for Trauma and Orthopaedics to review your recent submission via PALS and will be in touch again soon. I would like to thank you again for highlighting the areas you felt could be improved and also for your kind words in relation to many aspects of your care and treatment. Once again I hope your recovery continues to go well.