Perioperative Care Of The Paeditric Patient Essay.

Perioperative Care Of The Paeditric Patient Essay.


“A century that commenced with children having virtually no rights finished with children getting the most effective legal instrument recognising and guarding their Human Privileges”. (Bellamy 1999).Perioperative Care Of The Paeditric Patient Essay.


Changes in the UK’s health care setting like the introduction in the Children’s Work 1989, up to date in 2004, with which the Government aspires to provide support for children in several ways including provision of healthcare in hospital configurations.Perioperative Care Of The Paeditric Patient Essay.

Paediatric attention has changed noticeably since the launch of statutory rules, the Convention on the Protection under the law of the Child and recommendations put in place to guarantee the provision of patient centred high quality child attention. This has evolved following realisation and increased knowing of children’s vulnerability and the result experiences can have on the sociological and psychological development and wellbeing.

Children are individuals and could present troubles for healthcare experts in decision making regarding care and attention and consent. Children should be involved in the care process and enlightened of the decisions made about them and be given the chance of making decisions as long as they be competent to take action as complete under “Fraser Competence”. This was produced from a legal ruling issued by the House of Lords in 1985.

Lord Fraser sent judgement based after a child’s maturity and level of understanding regarding the nature of treatment and consent required. This ruling shows in part Children’s Protection under the law in the present day healthcare system.Perioperative Care Of The Paeditric Patient Essay.

Planning and putting into action individualised care are key factors in health care planning children in the perioperative setting up. My recent research study of seven yr old “David”, a pseudonym to safeguard his true id, seeks to consider if effective individualised attention planning is carried out in my own trust and will take regard of correct care plan saving as well as effective communication within the documentation and has awareness for the safeness and consent issues of the patient.Perioperative Care Of The Paeditric Patient Essay.

Accompanied by his daddy David was to truly have a foreign body removed from his ear to be completed under basic anaesthesia carrying out a routine pre diagnosis several days prior. This process was to determine David’s suitability and fitness for the prepared procedure and establish his health background. Previous bronchial disorder as a child was known but otherwise he previously no other serious health background. These details are recorded in web pages four to eight of the attached copy good care plan documentation.Perioperative Care Of The Paeditric Patient Essay.


The dependence on care planning is accepted practice among medical professionals. Yet, in the perioperative phase of an patients care the planning becomes critical to the patients ultimate final result. It can perhaps be the most difficult phase of care and attention planning to record thoroughly due to time constraints enforced in a busy operating department and may become a procedure for procedural records highlighting only certain components of the procedure that are perhaps just a little unusual.

Care documentation should include full patient details, name, birthdate, address and patient medical center number together with any allergy symptoms. Printed patient stickers are being used for this in my trust.

Documenting the procedure of treatment is well organised in our day surgery device. A step-by-step tick box record is used making certain each element in the patient’s voyage is known as. Pre-assessment, consent, and continuation of the process through to discharge in a simple format ensures a clean process. However whilst it could assist in the speed and efficiency of patient treatment planning in a occupied department does it really make for an authentic plan of care for an individual patient.Perioperative Care Of The Paeditric Patient Essay.

Detailing the patient’s perioperative treatment should give a complete picture of that treatment and eventual results. It therefore depends heavily on conscientious completion throughout, providing an accurate and in depth record of the good care given from patient admission to release (Spry & Jenkins 1991).

Documentation should be designed as the key to providing planning and delivery of specific patient care so when a basis for analyzing the health care provided. Continuity of treatment should be considered so that the information included within can be easily communicated to other health care professionals who may need to continue care of the individual in their quest. Concise documents becomes an essential tool so that continuity and benefits are maintained.Perioperative Care Of The Paeditric Patient Essay.

Patient examination is important within the planning process and should be ongoing throughout each stage of the perioperative voyage with modifications designed to the plan if possible. Health background and pre-assessment details alongside the patient’s clinical status should be accounted for, as it was with David. It is also important to consider other factors such as a patient’s cultural, ethnic and religious requirements. Patients personal elements maybe important to their psychological wellbeing and really should not be forgotten. Healthcare professionals must consider their patient’s spiritual needs to be able to provide total patient attention (Govier 2000).

I have yet to see in my own trust where these elements are accounted for within the care documents and planning. It is almost certainly a location that may be better by the inclusion of an additional page with relevant questions. However it seems that many healthcare experts have a difficulty in giving thought to this element of care resulting in non consideration of this factor (McSherry 2000).Perioperative Care Of The Paeditric Patient Essay.

Collaboration in good care planning within the perioperative environment is essential to ensure safe and positive patient outcomes. Few customers of the team work individually, with associates often relying intensely on their colleagues so ensuring correct and concise conclusion of the health care plan paperwork is paramount.Perioperative Care Of The Paeditric Patient Essay.

Preoperative checklists are used in my trust care documentation to ensure that regular steps are completed prior to the patient arriving in theatre. This checklist has a dual goal getting used to communicate information to the theatre practitioner about treatment regimes that have been completed prior to patient delivery in theatre. Theatre practitioners may then validate the information with the individual, and parent prior to technique.

This information will encompass lots of elements but will include such fine detail as, patient identification, consent, vital indicators, procedure details and medical history.Perioperative Care Of The Paeditric Patient Essay.

In addition to these bank checks the trust implements the surgical safety check list good World Health Organisation (WHO) under their Safe Surgery Saves Lives Problem (WHO 2009).

Currently my Trust uses a separate WHO safety list of guidelines but debate is ongoing associated with its printed addition within the treatment doc itself.

Accurate tracking keeping is vital to ensure correct outcomes. Additionally appropriate completion of care documentation is similarly very important to purposes such as legal process. Patient litigation increases each year with patient data becoming evidential documents in court docket so exact and effective tracking of information is important (Kemmy 1993). Inability to document effectively the care given may give go up for courts to suppose that the right level of good care was not given. Additionally non documents may itself be construed as neglect (Murphy 1987).

Each of the components detailed so far are relevant to all patient care planning and incorporate techniques for both adult and paediatric treatment programs. My Trusts approach to the paperwork is the same for any patients and makes no differentiation for paediatric patients. The question this boosts is should this be the case? As we have learned children aren’t small adults and as such varying methods to their own particular circumstances need individual consideration.

Colleagues confirm to me that paediatric surgery can boost special challenges and for that reason it’s important to discover and meet the broad spectral range of needs that can be a requirement of the paediatric patient. This then must imply that focus on these needs should be satisfied within the care planning process from the point of pre-assessment.Perioperative Care Of The Paeditric Patient Essay.

David exhibited appreciable anxiety in regards his impending method and was quite bodily resistant. Corresponding to his pre-assessment documents nothing in this respect was noted at that time and his father confirmed that he was fine and calm in this process. However after our greeting David in the reception area he immediately exhibited his anxiety which promoted levels of panic in his father, displayed as mild anger at the kid.

Page ten of the good care documentation offers a short section with regards to patient panic and scores this from one to three, three being severe. David was a three and it got some time and effort to quiet him down and provide premedication by means of Temasepam.

David’s stress and anxiety was observed in the health care plan and duly have scored together with only a short note as to why he was so troubled but does not connect sufficient information for the line of personnel that he was to meet on his trip, specifically the anaesthetic team. Missing in the dialogue were details surrounding his physical behavior which may have helped the anaesthetic team appreciate prior to his appearance how he may potentially behave.

His induction was inhalational and incredibly difficult. He cried out and struggled considerably requiring restraint by four people of staff and his father. In my own opinion Personally i think that the strain came across by David in this technique was too great causing him excessive levels of panic and creating higher degrees of anger in his dad, created I believe partly by his shame at his son’s behaviour and matter for his child.

After the procedure I voiced my concerns to the anaesthetist about the amount of restraint used in this circumstance and that it is needed for all parties engaged to act in the needs of the child. The response was almost dismissive of the problem although she arranged that the situation had gotten relatively out of hand.Perioperative Care Of The Paeditric Patient Essay.

General concensus shows that it is satisfactory to use ways to keep children from moving during a procedure, thus guaranteeing the success of treatment (Tomlinson 2004). However guidelines in respect of the are relatively unclear and it seems that the decision is manufactured almost as a subject of process in that the more a kid struggles the greater the level of restraint until anaesthetised.

Safety and consent are elements of the Childrens Work and also warrant talk about in the Governments Every Child Issues initiatives. Level of restraint is a gray area and I really believe beyond a certain level it becomes unsafe to literally restrain a struggling child.

On speaking to David’s dad about the anaesthetic process he proved that he was unaware that the procedure might include such an even of restraint and although he was area of the process, by default, he was remaining feeling somewhat annoyed and assumed that he might have been advised of the opportunity beforehand.

Clearly each patient, and their mother or father, should have a simple understanding of and what will eventually them and just why, with their emotions and desires given regard (Hinchliff 2003).

Interestingly after his treatment and following waking in the restoration room David exhibited no more signs of stress and anxiety. He was happy to speak to the recovery personnel and once went back to the ward enjoyed contentedly along with his own toy helped bring from your home until discharge.


In reviewing my Trust’s day surgery unit paperwork it generally fulfils certain requirements of a brief day case scenario by covering the full patient trip as it obviously arises from pre-assessment to discharge.Perioperative Care Of The Paeditric Patient Essay.

However having said that it will only be as good as the people in charge of its completion and in this I noted certain discrepancies across a number of care strategies completed by various users of staff that I reviewed on the day of my research study. Concise completion of the notes is important irrespective of how small the details maybe, as it is often small information that can perhaps go towards creating the bigger picture.

Accurate and comprehensive record keeping can be considered a task in a active operating theatre division but it is important to ensure that the plan of care for patients is adhered too and a positive results is achieved. The legal implications of inaccurate tracking keeping can be enormous, and this factor is known as within the report used by my division.

At the most notable of site two it is indicated that accurate completion of the care documentation is essential for “Legal Reasons”. Additionally it suggests that the document is required for “Clinical Audit”. Interestingly however it will not suggest that the doc needs accurate conclusion for the good thing about the patients worry planning. Is this an assumption therefore that Medical care Specialists will complete the report with the patient’s needs at heart or are they only being reminded of the particular trust deems to be the most crucial components of an administrative process?

Careful and correct good care documenting is important and the onus is on medical care professionals to ensure their practice is legal (Corfield L & Pomeroy A 2008).

Also on page two there’s a note to Doctors and Doctors which talks about consent for procedure and if the individual provides consent or selects to withdraw whenever. The form in my case study was duly signed by the father because of David’s years, but could his physical demeanour not be construed as an indicator of his not consenting to treatment despite his years? In the end, consent can be withdrawn at any time. Was the technique used in his best interests? Legally he cannot give or withdraw his consent and your choice was his fathers.Perioperative Care Of The Paeditric Patient Essay.

The consent form is page three of the doc, and is appropriately placed at the start of the treatment doc for if you are unable to gain consent the balance of the report becomes irrelevant. This doc was not signed before day of method and did not form part of the pre-assessment process four days and nights previously although this is standard practice within the Trust.

Page eight, the anaesthetic operative record, carries a very short area for notes and instructions, and in this case fails to feature the difficulties experienced within the anaesthetic room during induction other than a brief not near the top of the page stating that David was a “very difficult child”.

These experience should be noted more fully in order that post operative staff may take such difficulties into account when waking the patient in the recovery room as they could continue steadily to experience anxieties in addition to help expand doubts of the restoration room environment. An extra site could be included here to permit anaesthetists to record additional information associated with the anaesthetic aspect of an operation thus providing a better type of information to recovery staff.

A supplementary sheet is provided at page eighteen in the record but is “after the event” and therefore does not get into a logical sequence.

Continuity of the treatment plan should provide such details to ensure a continuing type of communication and co-operation between restoration and other departments (Wicker & O’Neill 2006).

Additionally the National Health Service Exec (NHSE 1999) shows that “the goal of health details is to ensure those arriving after you can see what has been done, or not done and just why and by whom”.

The recovery process is saved on site fourteen and it is relatively brief in its time scale allowed. This is in line with a straightforward day case but if the need come up for an individual to stay in restoration for an extended time period a continuation sheet comes in the same format. Again little room is given upon this page for considerable recovery notes predicated on the anticipated short stay, though it is feasible to keep onto the next nursing attention record page.Perioperative Care Of The Paeditric Patient Essay.

Discharge details form the total amount of the doc with a detachable section for the individual or parents to take home with post operative instructions as long as they be necessary.

It is evident that the documents under review seeks to hide all components of day circumstance surgery, and seems to do so quite well with a few exceptions as mentioned. These exceptions appear to be always a insufficient available webpages for noting and for that reason communication may are unsuccessful when it is most needed. Verbal communication of occasions during process is common, however as we’ve considered will not be reasonable should a legal concern arise in the foreseeable future. Memory is not any substitute for concise notes.


Individualised careful treatment planning and documentation is clearly an important aspect in the quest of the paediatric patient especially in the perioperative environment.

There exists many examples of care plan documents differing in design and content across differing NHS Trusts with certain degrees of importance given to the elements contained within but with hardly any standardisation amidst them.

The care plan is a written record of care and attention given to a patient and is merely as good as the person who has completed it. Entries can be difficult to read and might not be completely representative of the activities taken and the issues encountered through the patient trip. In David’s case further detail regarding his considerable anxieties and the issues experienced within the anaesthetic room should have been complete. Perhaps this is a merged problem for the reason that a lack of space available in the health care report and the team’s insufficient skill and understanding in the value of documenting such issues is the failure.

Criticising care documents is straightforward and has been by many creators for numerous reasons including being difficult to learn or understand, being difficult to use and for not providing enough information (Allen 1998). Effective attention planning is no optional extra in the care planning process. It forms a professional, legal and morally honest requirement and really should therefore be uppermost in the intellects of all professional medical specialists who are accountable for the procedure.Perioperative Care Of The Paeditric Patient Essay.

All practitioners must ensure that they are totally conversant with the practice of clear concise good care planning and tracking for the good thing about the patient, their colleagues, professional practice expectations, legal requirements and their own satisfaction.Perioperative Care Of The Paeditric Patient Essay.