A Discovery top 20 hospital
Patient Welcome Pack
A
hearty welcome to you, our valuable guest. We hope that your journey with us will be an extremely positive experience and that you will have a successful recovery.
The difference We offer something that few others do, passion, personalized service and tailor-made health care. With the majority of our shareholders and directors being medical practitioners, you can be assured that our main focus is your family’s health.
June 2016
In This Guide •
Everything you need to know about the surgery and Lowveld Hospital
•
What to expect every step of the way
•
Different phases of care after your surgery
The proof is in the pudding In 2015, Lowveld Hospital was rated the number one hospital in the Discovery top 20 hospital awards. This award is based on how members perceive the service they received from hospitals. We are humbled by this recognition, but can assure you that we will continuously strive to improve our services to you.
“I was so impressed with the efficiency, cleanliness, speed and treatment by Lowveld Hospital staff for this procedure. I was feeling anxious, and your staff made me feel at ease and comfortable. First class all the way. Thank you.” - W Goosen
WHAT YOU CAN EXPECT FROM
LOWVELD HOSPITAL Our Staff will always: •
Introduce themselves to you
•
Wear a name badge
•
Keep you up to date about important times and schedules
•
Ask permission before they attend to you
•
Tell you what, why and when they are giving you medication
•
Discuss your care plan during your stay, and your discharge plan when you leave
WHAT WE EXPECT FROM
YOU We expect you: •
To treat your fellow patients and our staff with respect
•
To follow the instructions from your health care provider 2
MEET THE TEAM
CHAIRMAN
CEO
Dr Attie van Wyk
Armand vd Merwe
FINANCIAL MANAGER
NURSING MANAGER
THEATRE MANAGER
WARD MANAGER
Michelle Pienaar
Christine Crous
Dumisane Singwane
Alta v Nieuwenhuizen
UM - HIGH CARE
IN CHARGE - O/N WARD
IN CHARGE - DAY WARD
FACILITATOR
Tessa v Wyk
Linda Mapungwana
Shilarne Brooderyk
Louise Fouche
SHEQ
PHARMACIST
TECH MANAGER
HOSPITALITY
Delana Le Roux
Melanie Viljoen
Johann v Rooyen
Mariska Joubert
Website: www.lowveldhospital.co.za | Telephone: 013 752 7576 3
SURGICAL PROCEDURES AT LOWVELD HOSPITAL
OPEN
LAPAROSCOPY
MICRO
Orthopaedic
Opthalmology
Otolaryngology
Oral and Maxillofacial
Plastic & Cosmetic
Dermatology
Dental
Gynaecology
Endocrine
General
Breast
Urology
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THE WAIT Theatre times are a best estimate only There are many reasons why your scheduled time may be delayed. The human body is complex, and delays are part of all operating theatres worldwide. We are truly sorry about the frustration caused by delays, and we understand that you would like to get the procedure done as soon as possible. Going to the theatre whilst angry or shouting at a nurse, who has no control over theatre time, doesn’t help either. Please try to stay calm and relaxed. Our nursing staff will try to communicate with you as often as possible.
We would like to encourage you, as a patient at Lowveld Hospital, to speak openly to your health care team, take part in your treatment choices, and promote your own safety by being well informed and involved in your care. We want you to think of yourself as a partner in your care. 5
YOUR ACCOUNT Medical Aid Patients If you are a medical aid patient, we will obtain authorisation before your admission. Your authorisation will include the procedure and the number of days the medical aid approve. If you stay longer that your original approved stay, we will obtain additional authorisation from your fund. Your account will be submitted electronically to your medical aid within 60 hours after your discharge. Authorisation by the medical aid is not a guarantee of payment. Payment may still be refused or short paid for various reasons. YOU REMAIN RESPONSIBLE FOR THE ACCOUNT UNTIL IT HAS BEEN SETTLED IN FULL.
Should your medical aid refuse to pay your account or part thereof we will contact you and ask you to consult with your medical aid. If non-payment is due to a valid reason, you will be asked to settle the account yourself.
Private patients Depending on your procedure your account may be a fixed fee or an estimate fee only. It is not always possible to provide a fixed fee as we are unsure about the theatre time or amount of medication or surgical materials that will be used. In such circumstances we will provide you with an estimate. On discharge the actual account will be calculated on a fee for service basis and you will receive a back payment, or will be required to pay in the difference between the estimate and actual amount.
Your medical bills It is important to understand that there are different service providers which will bill you or your medical aid independently from each other. The hospital has no control over these fees and sometimes there may be co-payments when a service provider is not charging according to medical aid approved tariff. These service providers include pathology (blood analysis), radiology, physiotherapy and anaesthetists. It is your responsibility and right as a patient to discuss fees with any service provider.
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Happy
or
Not Happy?
It is important to us that you stay with us is a positive experience. We know that a surgical procedure is stressful and will do our best to make you as comfortable and relax as possible. If at any time during your stay you are not feeling happy about anything please talk to Christine Crous or ask for the Chief Executive Officer, Armand van der Merwe. You can also email Christine at nursingmanager@lowveldhospital.co.za or Armand at ceo@lowveldhospital.co.za Please be assured that any complaints or suggestions will be treated confidential and with respect. We also have a trusted and open relationship with our staff and you can be assure that no staff member will ever intimidate you or be allowed to be vindictive should you feel unhappy about anything. The best way to improve, is when you tell us. We will try to contact you a day or two after your procedure with a quick follow up. If we cannot reach you we will send you an sms with a link to a short web survey. We take your feedback seriously. 7
FOOD AND
ENTERTAINMENT
KAUAI is a Health Food Franchise which provides a range of healthy foods and drinks. Your menu will include choices from KAUAI.
Inform our nursing staff timeously about any special dietary requirements. Your doctor may also restrict your diet.
The nursing staff will offer you an Free Wi-Fi! Connect to LH HotSpot. English of Afrikaans newspaper in On the Log In site, enter the following: login: Hoswith | password: heart the morning.
We provide a range of DSTV and other channels, and provide complimentary earphones that you are welcome to take home! 8
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PREPARING FOR YOUR SURGERY Before your surgery your surgeon will likely: − − −
Evaluate your medical history and overall health; Provide a detailed description of the procedure and its risks and benefits, Explain the type of anaesthesia used during surgery
You may also be asked to: • •
Complete various lab tests Stop smoking for a certain period before and after surgery
Ask your surgeon whether you'll be able to go home the day of the surgery or whether you'll need to stay over in the hospital. Arrange for someone to drive you home after surgery. About 2 weeks before surgery stop all medication that could increase bleeding (like any antiinflammatory medication - see list of examples). Make sure your physician is aware of any medications, supplements, and herbs you are currently taking - you may need special instructions for stopping certain medications, so ask your doctor if you are unsure about what medicines to stop for surgery and how. (For e.g. do not stop Statins or Hypertension medication).
Examples of anti-inflammatory medications
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Make arrangements for someone to drive you to and from your hospital procedure as well as a friend or relative to stay with you for the first 24 hours after your booked procedure.
If you have small children, you may want to make arrangements for their care as well. Prepare extra food ahead of time and have plenty of fluids and crackers available. Minimize your responsibilities at work and at home so that you can have a few relaxing days to recover.
Make sure any prescription medications have been filled and are in a convenient location. Ask your physician when you can resume driving a car, having sex and exercising. The list of things you will need to bring with you on the day of your surgery is short. Generally, patients should have their identification and a small bag to carry medications and paperwork.
Eat a healthy diet and avoid drinking alcohol a few days prior to your procedure. 11
THE DAY BEFORE SURGERY
You will receive an SMS from Lowveld Hospital before your surgery confirming the time of admission. You will also receive a parking voucher by SMS and email.
Refrain from extremely vigorous exercise the day before your booked procedure
You may eat normally on the day before your surgery, but do not drink alcohol
Do not eat or drink anything, including water, after midnight the night before the procedure
Shower and wash your surgical areas with antimicrobial soap the night before, and morning of your surgery. Do not apply makeup, moisturizers, oils, creams or lotions after your shower.
Remove nail polish from at least one fingernail and toenail to help the anaesthetist monitor your blood circulation during your procedure. 12
Get a good night’s rest “SLEEP IS THE GOLDEN CHAIN THAT TIES HEALTH AND OUR BODIES TOGETHER.” Thomas Dekker
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THE DAY OF YOUR SURGERY
1.
Take your routine medications (only as instructed by your doctor) with a small sip of water. Brush your teeth and rinse without swallowing. Shower with Anti-bacterial soap. NO MAKEUP, MOISTURIZERS, OILS, CREAMS OR LOTIONS AFTER YOUR SHOWER. Do not take medications for diabetes on the day of surgery.
2
Report to our admission desk on the 2nd floor several hours before the scheduled surgery time.
3.
You will be admitted to the day/overnight ward and receive an identification band which will be placed on your wrist. Your doctor will be notified of your admission.
4.
You’ll change into your theatre attire. You are allowed one or two friends or family members in the room. During your surgery, your family and friends may wait in any of several comfortable hospital waiting areas. Remember to leave valuables at home or with a family member.
5
Our staff will complete a record with your medical information and history, including previous operations and allergies. You will be asked to complete, review and sign an informed consent form. You need to understand what the surgeon will be doing during the procedure and understand the answers to the questions.
6
Your Anaesthetist will visit and prescribe a sedative to be taken before you go to theatre. When the operating room is ready, you will be escorted to the theatre by two nurses and handed over to the receiving nurse in theatre. 14
THEATRE
thetic nurse.
The receiving nurse will take all your
upper arm, ECG stickers on your chest
details over from the ward staff and al-
and a saturation probe on your finger.
so complete a safety checklist which
The baseline observations are done be-
will go with you to theatre.
fore you receive anaesthetic medica-
The theatre team will meet you at the
tion, which you will be monitored
theatre receiving area to introduce
against throughout the procedure. The
them to you.
anaesthetist will also check the infusion
A blood pressure cuff is placed on your
in your arm. The team will assist you to move over onto the theatre table and lay flat on
The anaesthetist will now give you a
your back.
light sedation which should relax you and ensure you sleep well.
Monitors will be set up by the anaes-
In theatre your needs and safety are our main priority, we will respect your privacy and treat you with dignity at all times.
The Theatre Team Professional nurse Assists the surgeon during the procedure. Anaesthetic nurse Makes sure that all the equipment and stock is available for the Anaesthetist, and assists the abovementioned persons. Circulating nurse Assists the sterile team in the event of them needing something. 15
Recovery Room After surgery you are taken to a recovery area where you will remain until you are fully awake You will gradually wake up during the immediate recovery period. You may feel groggy, dizzy and/or nauseous from the anaesthesia and you will still have tubes and monitors attached at various points on your body.
continued fluids, antibiotics and possible blood transfusions •
•
During this time, additional pain medication will be administered (as needed) and your vital signs will be monitored.
•
A wound drain (Porto-Vac) that will remove excess blood as healing occurs. A drain in your bladder (Foley catheter). A Patient Controlled Analgesia device (PCA) into the infusion area
There may also be any combination of the following, depending on the type of • An ice pack next to your incision surgery you had and your condition: The nurses will keep a close watch on • Special sequential compression your recovery and help make you as sleeves (SCD’s) and graduated com- comfortable as possible. If you need pression stockings (TED’s) on both legs pain medicine, don’t wait too long to to help circulation and prevent blood ask for it. It is easier to prevent pain than to stop or catch up with it once it clots. is out of control. • The original intravenous tube (IV) for
Intravenous tube
TED stockings
Catheter
Porto-Vac 16
PCA device
Transfer to Ward Once you are fully awake and stabilized in the recovery room (about 30 mins after surgery), you will move to a room in the Lowveld Hospital Overnight or Day ward. A nurse will receive you and continue to administer antibiotics and fluids through the IV line. You will be observed for several hours before you are released from the hospital if in Day ward. The Ward Team will regularly check your blood pressure, heart rate, breathing and temperature. Visits of one or two close family members or friends should be short to allow you to rest and heal. Hospital staff will also check for any adverse reactions to the anesthesia or the procedure. Only one or two very close family members or friends should visit you on this day to allow you to rest and heal. The timing of your release will vary and depends on your overall physical condition, the type of anesthesia used and your body’s reaction to the surgery. In some cases, you may have to remain in the hospital overnight or for a few days.
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In a high care ward patients receive much more attention than in a normal ward due to the lower ratio of patients to nursing staff. Some patients find the transition from high care to the normal ward difficult, as they feel that they are getting less attention. Be assured that our level of care in the normal ward is of a very high standard.
AFTER THE SURGERY & RECOVERY PAIN Depending on your procedure and your own capacity to handle pain you may experience anything from a mild discomfort to serious pain. Your nurse will monitor your pain levels but do not hesitate to ask if you feel that the pain is unbearable.
NATURE’S CALL Depending on your procedure and the process of recovery you may be able to use the bathroom independently or with help from the nursing staff. Do not hesitate to ask the nursing staff to help you should you require assistance.
WOUND CARE Your surgeon will inform you on caring for your wound. Normally you will be instructed to keep it clear from water for the first week. Looking after yourself and your wound after the procedure is as important as the procedure itself.
NORMALIZING Your doctor will determine when normal eating and drinking can be resumed.
You can usually resume all normal activities within a week, depending on the type of surgery you had and your doctor’s orders. 18
FOLLOW-UP You’ll need to attend a follow-up appointment with your doctor. If the procedure was for diagnosis of a condition or to view a diseased organ, you will meet with the doctor to go over the results of the exploratory surgery.
MEDICATION DOCTOR’S PRESCRIPTION MEDICATION (TTO) IS NOT PART OF YOUR HOSPITAL BILL. We do not have a retail pharmacy and when you are discharged you can get out of hospital medicines from your own preferred pharmacy. Most medical aids recover out of hospital medicines from your medical savings account. Take your medication as prescribed by your doctor with meals. Certain medication can cause constipation. Take only one type of pain killer at a time and do not drive afterwards. Do not resume taking supplements and other medications that affect blood clotting, until two weeks after surgery, or until your surgeon has determined it is safe. Store all medication out of reach of children.
CONSTIPATION A possible side effect of surgery and certain pain medicine could be constipation. We suggest the following actions to relieve the symptoms: − Drink plenty of water, avoid caffeinated drinks − Eat food high in fiber like apples, peaches, brown or whole wheat bread. Dried fruit, especially prunes, are good to promote regular bowel action. − Add digestive bran to breakfast cereals − Mild exercise also promote regular bowl action − Ask your doctor about natural laxatives 19
RISK AND COMPLICATIONS All surgical procedures come with a risk of complications. Here are eight of the most common. 1.
Pain
2.
Blood clots
3.
Fatigue and lack of energy
4.
Muscle Atrophy
5.
Anesthesia Effects: −
Confusion/dizziness
−
Nausea
−
Sore throat
−
Sleepiness
6. Confusion/Delirium 7.
Infection
8.
Loss of appetite
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If you are unable to reach your doctor, you should go to your nearest emergency room. −
Pain that can't be controlled with prescribed medication
−
Chills or fever
−
Nausea or vomiting
−
Bleeding, drainage, or redness from any of the incisions
−
Swelling of the surgical area
−
Inability to urinate
−
Chest pain and shortness of breath
−
Difficulty breathing
−
Sensation of heart racing
−
Red streaking color or warmth of surgical area
Prompt treatment usually prevents more serious complications. 21
THE IMPORTANCE OF
HAND WASHING Hand washing is often the most overlooked tactic in preventing diseases
Only 5% of people wash their hands with proper technique According to the Centres for Disease Control and Prevention, improved hand washing could: Prevent one million deaths per year
Significantly reduce food-borne illness transmission
Decrease respiratory illnesses by 16%
Decrease diarrhea-associated deaths by 50%
Correct hand washing:
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SMOKING AND HEALING DO NOT MIX By now, everyone understands that tobacco use of all kinds is detrimental to your health. However, it is important to understand that smoking and tobacco use have an especially adverse effect on the ability of your body to heal following surgery. Nicotine causes blood vessels to shrink, compromises the function of red blood cells, and lowers oxygen levels in the blood. Cells must divide and grow in order for wounds to heal, and without adequate oxygen, this process can be delayed considerably.
Nicotine causes blood vessels to shrink, compromises the function of red blood cells, and lowers oxygen levels in the blood Nicotine also compromises the function of white blood cells, which fight infection and foreign entities in the body. When white blood cells cannot properly consume any bacteria present in a wound, it can greatly increase your risk of infection. Perhaps it goes without saying, but patients are well advised to stop smoking altogether once they have stopped long enough to undergo surgery. 23