"Hip Replacement Operation"

About: Grantham & District Hospital / Trauma and orthopaedics

(as the patient),

I was admitted for surgery 3 weeks after my initial slot was deferred by 3 weeks. It was initially going to be a 7 week delay until I came home from the hospital, on the day I was informed of a problem with available beds 2 hours after arriving at the Day Ward, and checked nhs rules on the internet.

The day of my second attempt it was clear that the situation with medical beds was worse as the Day Ward was now a medical ward full of patients waiting for care packages and discharge. Thankfully my operation for a total hip replacement was O. K. to go ahead.

I could not fault the treatment that I received from then on.

I awoke on the ward at about lunchtime and was told that the physiotherapist would be in about four o'clock. The physiotherapist returned as promised. I wriggled out of bed painfully and was rewarded with a zimmer frame. We did a gentle circuit of my room and was told that I would be visited next day to see if I could manage stairs.

Sleeping at night was non-existent as lying on your back or even sitting on your back, as ordered by the rules for avoiding dislocation, is not a natural position and adds a "numb bum" to the discomfort.

My blood pressure took a dive so this meant blood tests and discussion as to whether this would delay departure. At this point I am eternally grateful for the care and concern of a junior doctor who took blood tests and checked on my blood pressure regularly - giving me updates on the results frequently.

Luckily, with a bit of jiggling of medicine, a lot of drinking of water and the subsequent struggling to the toilet, the blood pressure started to move upwards(not sure which part of the procedure worked).

After another sleepless night the blood pressure started to look as if it would behave and I was sent for X-ray to confirm correct placement of metal hip joint.

The physios turned up as a duo and swapped zimmer for two sticks. With height adjusted we set off for the stairs. Amazingly it was less painful to go up one flight and down again than to manage getting in and out of bed and the toilet trips in between.

I was declared fit for departure and informed that all that remained was for the pharmacy to sort out the requisite pills and then freedom beckoned.

3 days for what was once a long stay in hospital is nothing short of miraculous!

However I am a young, reasonably fit 65 year old with a brain and access to the internet!

I was on the enhanced recovery programme.

I was given a ton of leaflets and booklets to read and follow instructions. The booklet has slots for telephone numbers and space for notes from physiotherapist.

Although I took my booklet with me to hospital dutifully -no-one has filled in any notes. I have not seen the physiotherapist since I climbed the stairs.

I read in the booklet that my dressing should be changed before I left hospital - I requested it myself(it was not volunteered). I was told that an appointment would be made for the district nurse to remove my staples(again because I asked about it). I checked with my GP surgery the following week and was told a discharge letter had gone to them but there was no mention of the staples needing removal. I asked them to arrange a visit from the district nurse and they have done so.

I was telephoned at home by the ward a couple of days after discharge to check that I had sufficient painkillers and was told to call the ward if there was a problem.

According to the booklet there is supposed to be a 24 hour support line - is that the ward? I can imagine calling at busy times or during the night how helpful that would be!

I have scoured the internet and found many people asking the same questions as they go through the recovery process - a lot of the answers are very helpful.

My feelings in the first week of recovery ranged from frustration and anger to despair. I am feeling better now and can see a light at the end of the tunnel.

After all this I'm not sure I want to repeat the process however bad the other hip gets. Most of the problem is fear of the unknown.

I think that a really useful outcome of this would be to give a class where someone who has gone through surgery could give a talk on their experience or maybe a video of several people's experiences could be shown. The class provided at the moment goes through the rules, talks about the pressure stockings and how to use the famous long shoe horn and grabber-fine but not enough in my experience.

How about offering a pneumatic ring for the "numb bum"?

How about organising a two tier bell system so patients can ring for non-urgent help and urgent(meaning urgent) help. I personally witnessed a lady in distress in the toilets and was able to help her while I was waiting my turn -the nurse responded to the bell as I was coming out of the toilet having used it! The previous lady could have been on the floor! ! ! !

To summarise I would say - enhanced recovery is basically your recovery is up to you. I would not like to be alone and frail with no access to information and support except the telephone. Do not expect any physical presence after discharge.

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Responses

Response from United Lincolnshire Hospitals NHS Trust

Dear Bionicwoman

As the sister on Ward 2, I can only apologise for the dressing but if it was clean and intact we do not change them for approx 5 - 7 days as the type of dressing we use warrants being "untouched" to allow healing. I apologise if this was not make clear to you.

We do discuss with patients about the removal of clips and ask them to contact their own GP Practice Nurse to organise an appointment It this is not possible then the ward would then make a suitable referral to the district nurse service. As we currently do not have any of your details as we would then be able to investigate your episode of care. If we had promised to make the referral then apologies if the correct discharge procedure was not followed.

In relations to the noise on the ward, Ward 2 does have patients with dementia who are usually assigned side rooms for their dignity and for the other patients but on occasion side rooms are not available and patients located in one of the general bays. We do try to reduce the noise levels by using motion mats and cushions for high risk patients and but unfortunately these can be very noisy.

With regards to the Enhanced Recovery Information booklet, this booklet was produced to the used across all the hospitals sites. Unfortunately Grantham, as you have mentioned does not have a dedicated helpline which is in place on the other 2 hospitals. We are currently reviewing the content of the booklet and following our comment we will altering the text for the dedicated helpline.

We would never discharge patients if they do not feel confident to go home, and if needed, pre- assessment / the ward arrange for the social department to see the patient on the ward to see if they need any input at home

Patients have told us that the physiotherapy classes can be painful but they need to put in the hard work after the operation to ensure the operation is successful. We are currently surveying patients who attend the classes 6 weeks post operation to seek their feedback on what went well and what can we improve on and perhaps the video you have suggested could be an excellent way to show patients awaiting surgery what to expect but from the patient perspective.

Sister Julie Record

Ward 2