Pathway for patients undergoing surgery for Brain or Spinal Tumours
Date: June 2023
Review Date: June 2025
Ref: A-297/ward/LD/Pathway brain or spinal tumours v9
PDF: Pathway brain or spinal tumours final June 2023 v9.pdf[pdf] 319KB
The Neuro-Oncology Specialist Nurse Team are:
Name:
Helen Cooper Lead Specialist Nurse
Louise Davies Specialist Nurse
Lara Blanchard Specialist Nurse
Debbie Dingle Specialist Nurse
Claire Owen Support Worker
Contact Details: 01752 431210
Messages collected Monday- Friday 9am to 3.30pm (Excluding Bank Holidays). The team endeavour to respond to messages within 24hours
Specialist Nurse/Key Worker Role
You will have a Specialist Nurse/Key Worker linked to your care. As a team we work closely with the Doctors, Nurses and other health care professionals at University Hospitals Plymouth both within neurosciences and across other specialities.
We are here to support you and those close to you from initial presentation through to diagnosis. We can advise on tests and treatments that you may require.
Our aim is to be easily accessible in order to:
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Help coordinate your care from diagnosis to treatment, through to follow up care within University Hospitals Plymouth. Those patients having investigations or follow up care at other hospitals will be supported and managed by their local team
Be a familiar face who can provide:
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Information on tests, investigations and treatment options
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Support and advice on symptom control
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Information and education about your illness or diagnosis
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Information to services and professionals who might be involved in your care and who may be helping to provide you with additional support.
Often when leaving the hospital you may think of things you should have asked or wish to have things explained further. We are available to help at this time.
With your permission, we are also available to speak to your spouse, partner or family. They may have their own questions about your care.
If your enquiry is about:
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A clinic appointment or an admission date for surgery, then please contact your Consultants secretary.
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A scan appointment MRI or CT scan then please contact the Radiology Department on 01752 439283/439282.
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A scan result please contact your Consultant’s secretary if you have not heard about your results within 4 – 6 weeks of the scan. The secretary will NOT be able to give you any, results but they will be able to inform your Consultant.
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NB: If your require urgent intervention or treatment then the Neurosurgical Team will coordinate this.
The specialist nurse team are available Monday to Friday 8am to 4pm. We provide a telephone advice service and messages are collected throughout the day between the hours of 9am and 3.30pm if you leave an answer phone message the team will endeavour to respond within 24 hours.
We are not an acute telephone service and therefore if you have an urgent medical concern then please contact your General Practitioner Service or phone NHS 111 for medical advice, however in an emergency, dial 999 for an ambulance.
Useful Telephone numbers:
University Hospitals Plymouth NHS Trust
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University Hospitals Plymouth Switchboard
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01752 202082 |
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Pre – assessment: Main outpatient Department Level 6
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01752 439067 01752 439065 |
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Admissions: Postbridge Ward Level 4
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Daytime – 01752 431225 Out of hours – 01752 431189
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Post – operative high dependency/ICU ward Pencarrow Level 4
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01752 431439 |
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Erme Ward - Post-operative Neurosurgical care
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01752 438114 01752 792544 |
Consultant Neurosurgeons:
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Consultant |
Secretaries |
Telephone |
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Mr Berei Mr Manning
Mr Muquit
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Lauren Parsons/ Amy Green
Tina O’Farrell/ Maddy Roffey
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01752 439305
01752 437667 |
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Mr Fewings Mr Germon Mr Jeffrey
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Anne Pengelly/ Sam Rowe |
01752 439381 |
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Professor Palmer |
Tracey Manser/ Sarah Carlisle
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01752 432271 |
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Professor Whitfield
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Jeanne Weeden/ Kirstie Tychyna |
01752 431114 |
1st Clinic Consultation - Neurosurgery
Date: ……………………………………………………………………
Consultant: …………………………………………………………….
Specialist Nurse/Key Worker: ………………………………………..
Consultation notes:
Treatment Care Plan:
Medication Plan:
Steroids and / anticonvulsants
Holistic Needs Assessment
A Holistic Needs Assessment is a simple questionnaire that allows you to highlight the most important issues you have at this time. You can contact a member of the team Clinical Nurse Specialist or the Support Worker if you have any issues you wish to discuss.
These can relate to:
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Symptoms and physical concerns (e.g., side-effects from treatments, pain, fatigue)
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Feelings and emotions (you may feel low or worried)
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Difficulty with relationships (home, social or work)
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Money worries (you may want to know more about the financial help available to you)
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Other concerns
Your responses will be used to develop a care and support plan with your Clinical Nurse Specialist or Key worker/Support Worker, which will enable your needs to be met in a timely and appropriate way.
With your agreement the person carrying out your assessment may refer or sign post you to other services that may be able to help to you with highlighted concerns. Alternatively, if you prefer, you will be given written information about these services.
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Concerns and worries (Holistic Needs Assessment) Record your concerns
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Patients own notes and questions:
Pre operatively:
If the outcome of your clinic consultation is for you to have an operation then you will need to attend for a pre-operative review.
This will involve a further appointment with the pre-assessment team based on level 6, University Hospitals Plymouth. It may be possible for you to see the team after your clinic review, however if they are unable to accommodate you at that time you will need to come back for an outpatient appointment at a later date.
Unfortunately if you live outside of the Plymouth catchment area this assessment cannot be undertaken at your local hospital.
Pre-assessment is about checking your general health and fitness for surgery. Please see attached leaflet.
If you have not had pre-assessment at the time of your clinic review, your consultant’s secretary will arrange an appointment for you. You should receive a telephone call or a letter outlining the details of your appointment once booked. If you have any questions or concerns around the date or time of your appointment please contact us using the telephone number on your appointment letter.
You will need to have a COVID test prior to surgery; your consultant’s secretary will arrange this for you. You should self-isolate following this test leading up to your admission and minimize contact with others. Current guidance will be given to you at pre-assessment appointment.
If you have not had a COVID vaccination but are due to have either your first one or have had one already and are due to have your second, please discuss with your Consultant the timing of this vaccination if your plan is to have surgery.
Your consultant may want you to have further investigations before surgery, for example a brain or spine CT or MRI scan. These will be organised for you and undertaken at either your local hospital or co-ordinated with your pre-assessment appointment at University Hospitals Plymouth.
Once you have attended pre-assessment and had any further investigations required you will then be ready for surgery.
Surgery :
A surgery date will be sent to you in the post or your consultant’s secretary will telephone you with a date along with any specific admission details. Your consultant might be able to give you an indication as to when your surgery will take place when you are seen in clinic, but please note this will only be a provisional date and you will need to await final confirmation by letter or phone.
Patients undergoing neurosurgical procedures are admitted on the day of surgery to Postbridge Ward, University Hospitals Plymouth, level 4 unless otherwise advised. Instructions will be sent to you in the post outlining your specific admission details.
Provisional surgery date:
Please note:
Every effort is made to ensure your operation goes ahead as planned, however due to the nature of neurosurgery it is important that you are cared for in the ward area best suited to your post-operative needs. This often involves being cared for in the high dependency / intensive care area for a 12 - 24 hour period.
If you require a higher level of care following surgery and the appropriate area is not available for you this may lead to a delay in your surgery. Every effort is made to avoid this but sometimes this situation is unavoidable.
Accommodation :
Unfortunately, University Hospitals Plymouth does not have any accommodation on site for relatives. There are however a number of hotels available within close proximity to the hospital. If relatives wish to stay locally it is their responsibility to arrange this. The neuro oncology team will be able to offer you some local information.
Parking :
If you need advice regarding parking or parking costs please speak with the parking team based at the main reception desk they will be able to advise you, alternatively details are held on the main hospital website.
How long will I be in hospital?
This will depend on the procedure you are undergoing and admission can range from 1 to 7 days. Your consultant will have discussed this with you in clinic, but if you remain unsure then contact the consultant’s secretary who will be able to make enquiries on your behalf.
Estimated length of hospital stay:
How will I be followed up after my surgery?
This will depend on your particular situation and whether you are waiting for results or require referral for further treatment. Ward staff will be able to advise you prior to discharge.
Post-surgery follow up will either involve:
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Post-operative clinic appointment which will be sent to you in the post
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Post-operative scan either MRI or CT prior to discharge or at a later date at your local hospital
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Surveillance Programme, clinical and radiological follow up which will be guided by your consultant
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Discharged
Note: Not all patients require a clinic appointment or scan following discharge. This will be decided on an individual basis by the consultant managing your care.
When should my clips/sutures be removed?
Once you are home you will need to arrange an appointment with your Practice Nurse or District Nurse this can be done via your General Practitioner (GP).
Ward staff please complete prior to discharge
Date for removal:
Clip removers:
Wound dressings:
When will I be allowed to wash my hair?
We would normally recommend that you avoid washing your hair until after your clips/sutures have been removed, you can then wash your hair the following day.
Note: Those patients having had surgery under the care of Mr Palmer can wash their hair the day after surgery.
What should I do if my wound becomes sore or inflamed? If your wound becomes, red, inflamed, painful, and/or you have a temperature please contact your GP within 24 hours for a review, antibiotics or a neurosurgical consultation might be required.
Can I drive following my surgery?
Following a brain operation there may be a period of time when you are not allowed to drive by law. This will depend on the location and type of tumour, as well as the surgical intervention you have had and whether you have had or are at risk of seizures. It is your responsibility to inform the DVLA of your situation. Information can be accessed via the DVLA website.
The DVLA will advise you as to how long you will be exempt from driving dependent on the operation undertaken and your particular medical situation. The DVLA will want to know: the name of the Neurosurgical Consultant overseeing your care along with the operation undertaken.
Ward staff please complete prior to discharge
Consultant:
Date of Surgery:
Operation:
Is it normal to feel tired after surgery?
Yes, it is not unusual to feel tired following a brain operation. It is important to slowly increase your daily activities once home, however it is also important not to overdo things. Listen to your body, if you feel tired rest. Prior to discharge home the physiotherapist and/or occupational therapist might also have given you advice or instructions regarding the activities that are safe for you to undertake. If you’re not sure what you can and can’t do then speak with the nurse managing your care.
Will I have seizures?
Seizures can be complex therefore your individual situation should have been discussed with you prior to admission into hospital for surgery (elective admissions).
Occasionally patients who previously had seizures may find they have an increase in seizure activity due to the surgery before things settle down again. For those patients that have not had any previous seizures there might be an increased risk of seizures due to the nature of the operation undertaken.
For this reason we may prescribe anti-seizure medication as a precaution before and after the operation. Your consultant will advise you whether your anti-seizure medication needs to continue indefinitely or whether it will be reviewed at your follow-up clinic appointment. If you are known to have had or are at risk of seizures you will need to be given an epilepsy safety leaflet. (Please ask the ward staff)
On discharge it is really important to ensure all anti-convulsant medication is taken regularly. Unless advised by your consultant anti-convulsant medication should not be stopped.
What should I do if I get new symptoms and who should I contact?
If you experience:
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Headaches specifically on waking and not relieved by painkillers/analgesia
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Nausea and/or vomiting that doesn’t settle
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Seizures, new or worsening
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New or worsening limb weakness and/or altered sensation
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Visual disturbances
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Nasal leak or salty taste in the mouth
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Facial weakness
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New or worsening speech problems
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Swollen or painful calves (*risk deep vein thrombosis)
You should contact your GP, or for health enquiries dial 111 to speak with a NHS advisor and discuss your symptoms. However if you have any new symptoms within hours of being discharged to home contact the Neurosurgical Team on Moorgate Ward: Tel: 01752 431953/52.
If you have sudden onset of new symptoms that are not resolving or a medical emergency dial 999.
Who should I contact when my tablets are getting low?
When you leave hospital you will be given 28 days’ supply of medication. Repeat prescriptions should be obtained from your GP. It is important to ensure that these are ordered in advance so that you do not run out.
On leaving the ward you will be given a copy of your discharge summary which will list the current medications you are on. The ward will send a copy of your discharge summary to your GP, this will include information regarding your operation, a list of all your current medications and any ongoing care needs. We would advise that you make an appointment to see your GP after you have been discharged. The ward staff will explain all your medication prior to discharge, including what you are taking and why, as well as when and how they should be taken.
Who should I contact if I have any further questions or concerns about my ongoing care needs following my discharge?
It is YOUR responsibility to contact a member of the team if you have any questions and/or concerns about your ongoing care or follow up.
If your enquiry is regarding post-operative follow up, clinic or scan appointments please contact your consultant’s secretary.
If you are feeling unwell then you should contact your GP for a review.
Your specialist nurse/key worker is also available Monday – Friday to help with any other questions or concerns.
Community referrals:
If you have been under the care of the occupational therapist, physiotherapist or speech and language therapist during your admission and require ongoing follow up, they will discuss follow up arrangements with your local community teams as part of discharge planning.
Prior to discharge your therapy team will give you the contact details of the local team who will be involved in your ongoing/follow up care.
If you have been referred to a local therapy team prior to discharge home and have not heard from them within 2 weeks following discharge, then contact:
Name:
Telephone:
If you have any concerns regarding your follow up care please do not hesitate to contact us.
Following your discharge to home you will at some point be sent a follow up clinic appointment to see your Consultant Neurosurgeon. If you have not received an appointment within 6-8 weeks from discharge please contact the secretary.
Discharge Consultation: Care Plan
Date: ……………………………………………………………
Consultant: …………………………………………………….
Specialist Nurse/Key Worker: ……………………………….
Consultation Notes:
Treatment Care Plan:
Medication Plan: -
As per your discharge summary
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Concerns and worries (Holistic Needs Assessment)
Record your concerns
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