Search

Departments should develop and regularly review burn and plastic surgery referral guidelines and major incident plans.⁶⁶

Agreed local clinical guidelines should be in use, produced by an appropriately constituted multiprofessional team comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants or autonomously practising anaesthetists and managers. These guidelines should cover at least the following:

• airway management, including follow-up for difficult situations (both plastic surgery and burn reconstructive surgery)⁷⁶
• monitoring of free flaps^47...

Guidelines should be developed for the prevention, recognition and management of common postoperative geriatric complications and/or syndromes, including delirium, falls, functional decline and pressure areas.

In elderly patients undergoing surgery the institution of delirium prevention interventions should be considered. These include early mobilisation, avoidance of dehydration and avoidance of delirium triggering medications.^25,36

Provisions should be made for the assessment and management of pain in older people, and more specifically in those with dementia.³⁷

All staff managing patients in the postoperative period must be familiar the arrangements determining mental capacity in the part of the UK in which they are working and pathways of care for patients with dementia.^38,39,40

Mechanisms for the early recognition of patients requiring specialist postoperative input from geriatrician led services and/or critical care should be developed. These should include patients at risk of or presenting with delirium, multiple medical complications, functional decline or complex discharge planning.

In the postoperative period, the safety of obese patients may be improved by supplemental oxygen, non-invasive ventilation (continuous positive airway pressure), monitoring of sedation, and ideally continuous pulse oximetry and the post-anaesthesia care unit should have the necessary equipment and staff to provide this.⁴³

When members of the healthcare team are involved in a critical incident, the personal impact on individual team members can be significant.⁵⁶ A team debriefing should take place after a significant critical incident. Critical incident stress debriefing by trained facilitators, with further psychological support, may assist individuals to recover from a traumatic event.⁶⁶ After a significant critical incident...

The secondary recovery unit should not accept inpatient activity and even at times of severe hospital escalation, every effort should be made to avoid this as it will significantly affect the day surgery activity and quality of the care provided to the day surgery patients.