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Ensuring patients are in the optimal condition for surgical treatment

Theresa Maunganidze Orthopaedic Surgical Care Practitioner and MSK Enhanced Recovery Lead West Hertfordshire NHS Trust spoke at today’s Enhanced Recovery conference on; 

•    Improving pre-operative assessment to ensure enhanced recovery 
•    Current issues and challenges at West Herts
•    PROMs in enhanced recovery: update

Theresa’s presentation based on experience of implementing and delivering enhanced recovery in her organisation looked at how patients can be optimised for surgery via pre-operative assessment (POA) and patient education prior to surgery. It focused on the key points of a successful POA and how to achieve it. Examples of pathways were presented as well as potential challenges and threats to the pathway.  Theresa also looked at how data is collected to evaluate outcomes including PROMs.

"We want to identify and manage patient's expectations. They normally hear all the bad stories so they come with preconceived ideas of what goes wrong and they are often already very scared.

She said 'the surgeons job finishes when he puts the last stitch on your skin' and reflected that meant it was doubly important patients were empowered to talk about how they were feeling and what they needed going forward in their care.

“What we want is to try to encourage patients to optimise their own discharge before we come into hospital, to prepare for their discharge before they come in,” she said. 

“What we want to do is to ensure that our pathways work for all of our patients.”

She talked about the importance of providing patients with all the information they needed in order to empower them to do all they could to self manage their own recovery.

“What you want is the appropriately trained inter-professional teams, you don't just want numbers. 

“You need to look at what you are currently doing in your practices, there is no point in re-inventing the wheel, you want to look at what your current challenges are and how effective it is,” She said. 

She said that people working in surgery knew very little about what happened to a patient after they left surgery and what happened in their recovery pathway from there.

“Every now and again, on a six month basis, we have a steering group that looks at our practices and whether or not we have become stagnant,” she said. “But it's also about looking outside and seeing what other people are doing and that's what is so important about days like today.”

“When we do patient information seminars, we ask them to bring along a 'buddy' so if there are any concerns there is someone who we can contact afterwards.”

“It's about building patients expectations so they know what to expect, but you have to encourage your consultants to come,” she said. “It's relationship building too, patients like to put a face to a name. Once patients have got a familiar face it calms their nerves.”


Theresa’s full presentation is available for download at the end of this page.

Theresa Maunganidze
I originally trained at the University of Hertfordshire between 2000 and 2003 where I attained a Dip H.E Nursing. I then worked in Orthopaedic theatres prior to commencing my Surgical Care Practitioner Training at the University of Greenwich. I did this as part of a degree and attained a BSc Hons in Clinical Practice in 2009. During this time I also acquired a Post Graduate Certificate in Pain Management at the Universtity of Bedfordshire. I then commenced working privately as a Surgical Assistant whilst maintaining some contract hours with  East and North Hertfordshire NHS Trust in an Orthopaedic theatre. I started working at St Albans City Hospital (WHHT) in 2012 in a full time post as an Orthopaedic Surgical Care practitioner. I set up and run the Enhanced Recovery Programme for spine surgery and am the Lead Enhanced Recovery Coordinator for MSK procedures in Trust. As part of the ER Lead role, I conduct two patient education sessions a week covering Spine Surgery and Joint Replacements for an average audience of 30. I also manage the inpatient care of all the elective Orthopaedic patients (Spine, Joint Replacements) at our elective site and run follow-up clinics for Hip and Knee Replacements and  revisions as well as work as first assistant in Orthopaedic theatres. Throughout my career I have been on several Cadeveric Courses and have also presented at national level for Biomet UK.

Future events of interest:

British Association of Day Surgery Conference: Quality in Day Surgery
Thursday 20 November 2014 
ICO Conference Centre, London

National PROMs Summit 2014
Wednesday 3 December 2014 
Hallam Conference Centre, London

Measuring and Monitoring Quality
Tuesday 20 January 
ICO Conference Centre, London

Download: Theresa Maunganidze

2 October 2014


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