1. Enhanced Recovery after Surgery (ERAS)
Colette Burford
Advanced Nurse Consultant
ERAS Project
2017

5. ERAS Goals Reduction of stress response after surgery
Acceleration of Recovery
Return to pre admission function or better…
A happy patient at discharge who has felt well informed and involved in their care

7. ERAS Components Preoperative Postoperative Outpatients
Surgeon & patient discussion
Preadmission
Optimisation
Counselling
Discharge planning
Oral Supplements
Limited fasting
Admission day of surgery
Preventative & active pain control
Hydration (Avoid fluid overload)
Aggressive management of N&V
Early oral feeding
EARLY MOBILISATION
Early removal of IDC’s & drains
Early discharge planning

8. Preoperative discussion/counselling
Clear explanations of what will happen periop
Explanation of the role of the patient with regards to preop activity, food intake, oral nutritional drinks, limited fasting.
Expectations of patient postop; early eating, fluid intake, MOBILISATION, pain management, discharge planning.

9. Preoperative carbohydrate loading
Reduces preoperative thirst, hunger and anxiety.
Significantly reduces postoperative insulin resistance.

10. Postoperative Pain Control
opioids in postoperative analgesic regimens results in adverse effects, such as sedation, postoperative nausea and vomiting, urinary retention, ileus, and respiratory depression, which can delay discharge.
Multimodal analgesia, i.e., the use of more than one analgesic modality to achieve effective pain control while reducing opioid-related side effects, has become the cornerstone of enhanced recovery. 

11. Postoperative Hydration/ feeding
Encourage early oral intake
Facilitates early return of bowel function
Allows stopping of IVT’s
Aids mobilisation
Avoid IV fluid overload….
Excess fluid administration would result in several kilos in weight gain and even oedema. This was shown
to be a major cause for postoperative ileus and delayed gastric emptying and development of complications

12. Prevention of Postoperative Nausea and Vomiting (PONV)
PONV is unpleasant, delays gut function, affects mobility and has metabolic consequences.
Strict post-operative nausea and vomiting prophylaxis.

13. Early Mobilisation
Prolonged bed rest
Increased risk of thromboembolism
Decrease in muscle strength, pulmonary function and tissue oxygenation
ERAS
Patients get out of bed on day of surgery and increase activity daily with planned structured walks.
IDC’s and drains out early
Patients should be getting dressed in day clothes as so0n as possible.

14. Discharge Planning
The earlier discharge planning is undertaken the better
It’s all been said before……
Good planning requires anticipation of potential problems by good information gathering, early resolution of potential barriers to discharge, and timely referral to the multidisciplinary team
Planning involves close collaboration between the patient, the family, and the multidisciplinary team; this leads to improved patient and carer satisfaction

15. Team Members for Successful ERAS
Nurses
Dietitians
Physiotherapists
Pain Team
Theatre staff
Anaesthetists
Surgeons
Hospital management
Audit team
Anyone not mentioned who is involved in the care of the patient…..
WIDESPREAD STAFF AND PATIENT EDUCATION PRIOR TO ROLL OUT IS PIVOTAL TO A SUCCESSFUL OUTCOME OF ERAS PATHWAYS

16. Some patients will fall off the pathway
The challenge for the team is to reassess the needs for each patient and optimise the recovery within the changed pathway.

17. Acknowledgement Su White
Co Director Surgical Directorate/Director of Nursing RAH
CALHN