Name

Ward

Hosp no
DOB

(c
)
FO G
O
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IN H
FO Tr
u
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M 2
AT 0
1
IO 1
N
O
N

LY

Affix patient label

Inguinal hernia repair integrated care

pathway (ICP)

Inclusion criteria

Patients undergoing inguinal hernia repair aged under 3 months corrected gestational age

Instructions for using this ICP

The ICP incorporates the detail and information required for this patient journey/episode together with

specific activities and variance tracking, which compares planned and actual care.

When activities are completed the practitioner should initial in the met box and enter the date and time in

the adjacent boxes.

In the event of variance from the plan or if an activity is not met, the practitioner should initial the not met

box, enter the date and time and complete the variance tracking at the foot of the page.

Important

Each professional making an entry in this record must complete the signature sheet on page 2, after which

they should use only initials when making an entry.

In using this ICP the practitioner should refer to trust policies, clinical practice and procedure guidelines
and protocols, which provide evidence and support the activities contained herein.

This document complements rather than includes existing stand-alone documentation in use at GOSH.

The integrated care pathway forms part of the legal record of care received so must be completed fully.

Version: 1.0

Version date: Oct 11

Document development lead: Carole Irwin

Document status: PILOT

Review date: Oct 13

Great Ormond Street Hospital for Children NHS Trust, 2011

Page 1 of 16

Signature sheet
Designation

Signature

Initials

Date

(c
)
FO G
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1
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N
O
N

LY

Name

Abbreviations and glossary of terms used in ICP

Abbreviation

Term in full

FBC

Full blood count

U&E

Urea and electrolytes

G&S

Group and save

CNS

Clinical nurse specialist

NBM

Nil by mouth

EP

Electronic prescribing

CEWS

Childrens early warning score

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 2 of 16

Specific needs of child

Solution required

Action taken, date and initials

Child is hearing impaired and wears

Remove hearing aids for procedure but

Recovery staff informed

hearing aids

ensure put back in recovery

JB 31/3/2010

(c
)
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AT 0
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N
O
N

LY

Specific need
EXAMPLE

Discharge criteria

For this procedure, the child will be able to be discharged or transferred when the following criteria have been met:

Child is tolerating full feed volume

Wound is healing satisfactorily

Documentation accompanying this integrated care pathway

Family Form 2

Patient Assessment Form

Consent form

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 3 of 16

Pre-admission assessment - Complete prior to or on day of admission

ID

Activity

0001

Confirm child and family understanding of reason for admission

0002

Complete assessment using Family Form 2, Patient

Day shift

Night shift

Date:

Date:

Met

Not

N/A

Met

Not

N/A

met

met

Enter initials/time

Enter initials/time

forms
Confirm any allergies and document

0004

Identify any specific needs of child (disability, cultural or

(c
)
FO G
O
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IN H
FO Tr
u
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M 2
AT 0
1
IO 1
N
O
N

0003

LY

Assessment Form, Birth History and Immunisation History

language) and make arrangements for those to be met during

stay record on page 3

0005

Check that details on PiMS are correct including next of kin and
parental responsibility

0006

Admit child onto EP

0007

Ensure that family have been given appropriate written

information about the procedure if available

0008

Continue consent procedure with child and family

0009

Record weight and height/length and add to EP

0010

Record baseline temperature, pulse, respirations, blood

pressure and oxygen saturation

0011

Complete pressure area care assessment

0012

Complete moving and handling assessment

0013

Complete baseline pain assessment

0014

Inform parents/carers about what to do with regular

medications on day of surgery

0015

Confirm admission and fasting times with family

0016

Advise parents to ensure supply of pain relief at home

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 4 of 16

Outcomes for episode

Day shift
Met

Activity

X0001

All records for child available and up to date

X0002

Child and family understand reason for procedure

X0003

Parent understanding of fasting instructions confirmed

N/A

Met

Not

N/A

met

met

Enter initials

Enter initials

(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N

Notes

Not

LY

ID

Night shift

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 5 of 16

Between pre-operative assessment and night before admission

Activity

Night shift

Date:

Date:

Met

0017

Send other outstanding test results to consultant/team

0018

Arrange accommodation for one parent/carer

0019

Arrange transport if required

0020

Ensure notes are available and up to date

Not

N/A

Met

Not

met

met

Enter initials/time

Enter initials/time

(c
)
FO G
O
R S
IN H
FO Tr
u
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M 2
AT 0
1
IO 1
N
O
N

Outcomes for episode

Day shift

ID

X0004

Met

Activity

N/A

LY

ID

Day shift

Not

Night shift

N/A

Met

Not

N/A

met

met

Enter initials

Enter initials

All test results required seen by consultant/team

Night before admission

ID

Activity

Day shift

Night shift

Date:

Date:

Met

0021

Contact family to confirm that child is well and bed is available

0022

Confirm medications to take on day of procedure with family

0023

Confirm and check family understanding of fasting instructions

Not

N/A

Met

Not

N/A

met

met

Enter initials/time

Enter initials/time

Day shift

Night shift

Outcomes for episode

ID

Activity

X0005

Child confirmed to be fit and well

X0006

Parent understanding of fasting instructions confirmed

Met

Not

N/A

Met

Not

N/A

met

met

Enter initials

Enter initials

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 6 of 16

(c
)
FO G
O
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IN H
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M 2
AT 0
1
IO 1
N
O
N

LY

Notes

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 7 of 16

Day of admission Pre-procedural care

Activity

0024

Check child and family understanding of reason for admission

0025

Explain outline plan for stay to child and family

0026

Ensure assessment using Family Form 2, Patient Assessment

Form, Birth History and Immunisation History forms has been
completed previously and record any additional information

Date:

Date:

Met

Not

N/A

Met

Not

N/A

met

met

Enter initials/time

Enter initials/time

(c
)
FO G
O
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IN H
FO Tr
u
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M 2
AT 0
1
IO 1
N
O
N

and/or changes since completion at assessment

Night shift

LY

ID

Day shift

0027

Confirm that fasting has been completed as per protocol

0028

Complete consent process and ensure that person with

parental responsibility has signed consent form

0029

Complete surgical site marking documentation

0030

Attach patient identification wristband to child and explain its

importance to child and family

0031

Carry out baseline observations (temperature, pulse,

respirations, blood pressure and oxygen saturation) and record

0032

Repeat nose and throat swabs if child has attended another

healthcare facility since last assessment

0033

Admit child onto EP

0034

Measure height and weight and add to EP

0035

Check blood test results and transcribe to pre-operative

checklist

0036

Complete pre-operative checklist

0037

Review by anaesthetist

0038

Pre-medication prescribed and given if appropriate

0039

Accompany child to theatre

0040

Accompany parent/carer to post-operative ward

0041

Commence discharge planning using checklist on page 14

0042

Enter discharge date on PiMS

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 8 of 16

Outcomes for episode

Day shift
Met

Activity

X0007

All records for child available and up to date

X0008

Child confirmed prepared for anaesthetic and procedure

X0009

Child and family understand reason for procedure

X0010

Family have given informed consent

N/A

Met

Not

N/A

met

met

Enter initials

Enter initials

(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N

Notes

Not

LY

ID

Night shift

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 9 of 16

Operation report
Nature of operation
Date and time carried out

Surgeon

at

:
Sign

Print

1 dose co-amoxiclav

3 doses co-amoxiclav

Assistant
Anaesthetist
Report
None

(c
)
FO G
O
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IN H
FO Tr
u
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M 2
AT 0
1
IO 1
N
O
N

LY

Prophylactic antibiotics prescribed:

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 10 of 16

Day of admission - post-procedural care

Activity

Handover received from recovery nurse

0044

Bedside oxygen and suction checked and functioning

0045

Explain plan of care to family and negotiate care requirements

0046

Meet child and family and update on procedure

0047

Review by surgical team including medications and pain relief

0048

Commence oral feeds

Date:

Date:

Met

Not

N/A

Met

Not

N/A

met

met

Enter initials/time

Enter initials/time

(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N

0043

Night shift

LY

ID

Day shift

0049

Record temperature, pulse, respirations and oxygen

saturations half-hourly for 2 hours then hourly (blood pressure if

required)

0050

Record pain scores as per protocol

0051

Check wound site hourly for 2 hours and then 4 hourly

0052

Check intravenous sites hourly

0053

Record strict fluid intake/output on fluid balance chart

0054

Assist with basic hygiene needs

0055

Medical handover sheet updated as necessary

0056

Nursing handover sheet updated as necessary

0057

Support patient and family

0058

Continue discharge planning using checklist on page 14

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 11 of 16

Outcomes for episode

Day shift
Met

Activity

X0011

Observations within CEWS acceptable ranges

X0012

Pain adequately controlled

X0013

No sign of immediate wound complications

X0014

Child and family updated on procedure

X0015

Feed is available on the ward

N/A

Met

Not

N/A

met

met

Enter initials

Enter initials

(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N

Notes

Not

LY

ID

Night shift

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 12 of 16

Post-procedure day 1

Activity

Night shift

Date:

Date:

Met

0059

Child assessed at beginning of shift with bedside handover

0060

Bedside oxygen and suction checked and functioning

0061

Explain plan of care to family and negotiate care requirements

0062

Review by team including medications and pain relief

0063

Record temperature, pulse, respirations and oxygen

Not

N/A

Met

Not

met

met

Enter initials/time

Enter initials/time

(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N

saturations 4 hourly (blood pressure if required)

0064

Record pain scores as per protocol

0065

Check wound site 4 hourly

0066

Record strict fluid intake/output on fluid balance chart

0067

Support patient and family

0068

Complete discharge planning using checklist on page 14

0069

Ensure cannulas removed

0070

Complete discharge notification and send to all relevant parties

N/A

LY

ID

Day shift

Outcomes for episode

Day shift

ID

Met

Activity

X0016

Child discharged safely

X0017

Discharge notification completed

Not

Night shift

N/A

Met

Not

N/A

met

met

Enter initials

Enter initials

Notes

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 13 of 16

Discharge checklist
Predicted date of discharge
Yes

Discharged to
No

Details

Initials

Medication
Prescribed

Collected

Explained

(c
)
FO G
O
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IN H
FO Tr
u
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M 2
AT 0
1
IO 1
N
O
N

LY

Transport

Equipment

Ordered

Delivered

Explained

Teaching

Follow up arrangements

Discharge contact made

Other GOSH

clinicians

Family doctor

(GP)

Local paediatrician

Community team

Social worker

Other

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the
professional judgement of individual clinicians. Staff should use their knowledge, experience and assessment of
the child as a basis for variance from this plan.
Page 14 of 16

Name

Variance tracking record

Instructions for use
Each time a task is not met, the variance should be recorded in the table below.
This page should be photocopied and used for variance analysis

31/11/08

10am

ID

What occurred?

Why?

What did you do about it?

LY

Time

DOB

Outcome

(c
)
FO G
R OS
IN H
FO Tr
u
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M 2
AT 0
1
IO 1
N
O
N

Date
Example

Hosp no

0013

Parents not given written

Computer network down

File copy requested

information

Parents given written

Affix patient label

Initials
JB

information

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the professional judgement of individual clinicians. Staff should
use their knowledge, experience and assessment of the child as a basis for variance from this plan.

Page 15 of 16

Name
Hosp no

Time

31/11/08

10am

ID

What occurred?

Why?

What did you do about it?

Outcome

(c
)
FO G
R OS
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N

Date
Example

LY

DOB

0013

Parents not given written

Computer network down

File copy requested

information

Parents given written

Affix patient label

Initials
JB

information

The sequence of events, prompts and recommendations contained in this ICP are not intended to replace the professional judgement of individual clinicians. Staff should
use their knowledge, experience and assessment of the child as a basis for variance from this plan.

Page 16 of 16