Enhanced Recovery Patient Diary

I found the diary was helpful. I was able to chart my progress and see a difference. I was eating more each day and able to shower myself. I found it to be encouraging. - MARGARET (PATIENT) NAME OF SURGERY 2

Getting Better Sooner What is enhanced recovery? The goal of the Enhanced Recovery Program is to help you recover as quickly as possible after your operation. The sooner you are out of bed, eating and drinking, the sooner you can go home and get back to your normal activities. t only will this speed your recovery, but it can also make complications or other problems less likely. What to Expect During your recovery, you can expect to feel some pain and/or nausea. The nursing staff can give you medication to manage this. You will probably feel very tired for some time after your surgery and it may take several weeks to return to normal. Your appetite may be small and your bowel movements may be irregular for a while after your operation. Your surgeon and nursing team should give you an idea of how long you will be in the hospital after your operation. It may be 2-3 days or up to 7 days or more depending on your operation and how your body handles recovery. If you have questions at any time, ask a member of your recovery team. Remember, they can answer your questions and help you manage pain and other symptoms. Day of your operation: You may be admitted on the day of your operation. Once your operation is completed, we will attempt to sit you up in bed or a chair. We may offer you chewing gum, something to drink or a light snack depending on how you feel. After Surgery Day One: It is important to get you up and about as much as possible. On day one you should expect to be sitting out of bed and taking short walks with the nursing staff. If possible, we will remove your catheter and other lines that will allow you to get around easier. You may be encouraged to eat light meals and should continue drinking fluids as you are able. Day Two: You should now be able to move around easier and your appetite should be back to normal now. We encourage you to be as independent as possible. Day Three: Ideally, you should be thinking about going home in the next day or so. If you have a stoma (colostomy), the nurses will work with you to learn how to look after this yourself. Our wound care team will also support you as needed. DMC DETROIT MEDICAL CENTER 3

Enhanced Recovery Patient Diary Tell us how you are doing. The diary can give us important feedback to improve your experience and enhance your recovery. We will be looking at things such as moving around, pain and nausea, eating and drinking, and how you are feeling in general. Please take some time to use this diary every day, as it will help you reflect on how you are doing. What will the diary involve me doing? Using this diary is completely voluntary. The Nurses and Surgical Residents can help you complete the diary. Please circle the answers that best show how you are feeling and whether you think you are able to do the things in the recovery plan. What will happen to the diary when I go home? We will collect the diary at the time of discharge with your permission. We will look at the diary to see what we can learn to improve our service. How are you feeling? There are a list of words on page 20 that can be used to describe your thoughts about the hospital throughout your journey. Please take a few moments to circle the key words that best describe how you are feeling at each stage of your experience. Pain Scale 0 2 4 6 8 10 The Wong-Baker FACES Pain Rating Scale is a tool patients can use to describe the amount of pain they feel. The scale starts at 0, no hurt, and goes up to 10, or Hurts Worst. Patients can choose which level or face best fits their pain. OPTIONAL FOR PATIENTS HAVING COLON SURGERY ONLY: On the day before surgery did you... Do a bowel prep? Take antibiotics by mouth? Drink a large glass of Gatorade? On the morning of surgery did you... Drink Gatorade 2 hours before surgery? 4 ENHANCED PATIENT RECOVERY JOURNAL

The Evening After Surgery FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to t offered My surgeon did not want me Feeling sick to at this time BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement GETTING OUT OF BED Getting out of bed helps your breathing and circulation after surgery. It is OK to get out of bed with an IV and catheter. Have you been out of bed for 2 hours? If not, why? DEEP BREATHING Deep breathing and coughing are essential to keep your lungs clear. Have you practiced deep breathing exercises? If not, why? t feeling well t comfortable t feeling well Too painful t asked to Don t want to t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 5

Day One FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to Did not like the taste Feeling sick t offered FOODS Eating is not dangerous after bowel surgery. Even small amounts of food speed up your recovery by giving you an appetite and making the muscles and nerves in your bowel work again. Please circle how much food you ate today. Breakfast Some Half Most All Lunch Some Half Most All Dinner Some Half Most All Any Snacks? Chewing Gum Once Twice 3 Times Please list snacks that you enjoyed. BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement *Patients with a colostomy, please refer to colostomy patient information. 6 ENHANCED PATIENT RECOVERY JOURNAL

Day One GETTING OUT OF BED It is important to get up and about as much as possible. This includes short walks. I have been out of bed for at least 6 hours today. How many times have you walked today? 1 2 3 4 More than 4 I have been able to circle the nursing unit... Once Twice More than twice If you have not been able to get out of bed or walk today it was because you were... t feeling well t comfortable Didn t want to t able to/too weak t asked to get up DEEP BREATHING Deep breathing and coughing are essential to keep your lungs clear. Have you practiced deep breathing exercises? If not, why? t feeling well Too painful t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? ANY OTHER THOUGHTS OR FEELINGS? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 7

Day Two FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to Did not like the taste Feeling sick t offered FOODS Eating is not dangerous after bowel surgery. Even small amounts of food speed up your recovery by giving you an appetite and making the muscles and nerves in your bowel work again. Please circle how much food you ate today. Breakfast Some Half Most All Lunch Some Half Most All Dinner Some Half Most All Any Snacks? Chewing Gum Once Twice 3 Times Please list snacks that you enjoyed. BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement *Patients with a colostomy, please refer to colostomy patient information. 8 ENHANCED PATIENT RECOVERY JOURNAL

Day Two GETTING OUT OF BED It is important to get up and about as much as possible. This includes short walks. I have been out of bed for at least 6 hours today. How many times have you walked today? 1 2 3 4 More than 4 I have been able to circle the nursing unit... Once Twice More than twice If you have not been able to get out of bed or walk today it was because you were... t feeling well t comfortable Didn t want to t able to/too weak t asked to get up DEEP BREATHING Deep breathing and coughing are essential to keep your lungs clear. Have you practiced deep breathing exercises? If not, why? t feeling well Too painful t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? ANY OTHER THOUGHTS OR FEELINGS? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 9

Day Three FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to Did not like the taste Feeling sick t offered FOODS Eating is not dangerous after bowel surgery. Even small amounts of food speed up your recovery by giving you an appetite and making the muscles and nerves in your bowel work again. Please circle how much food you ate today. Breakfast Some Half Most All Lunch Some Half Most All Dinner Some Half Most All Any Snacks? Chewing Gum Once Twice 3 Times Please list snacks that you enjoyed. BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement *Patients with a colostomy, please refer to colostomy patient information. 10 ENHANCED PATIENT RECOVERY JOURNAL

Day Three GETTING OUT OF BED It is important to get up and about as much as possible. This includes short walks. I have been out of bed for at least 6 hours today. How many times have you walked today? 1 2 3 4 More than 4 I have been able to circle the nursing unit... Once Twice More than twice If you have not been able to get out of bed or walk today it was because you were... t feeling well t comfortable Didn t want to t able to/too weak t asked to get up DEEP BREATHING Deep breathing and coughing are essential to keep your lungs clear. Have you practiced deep breathing exercises? If not, why? t feeling well Too painful t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? ANY OTHER THOUGHTS OR FEELINGS? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 11

Day Four FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to Did not like the taste Feeling sick t offered FOODS Eating is not dangerous after bowel surgery. Even small amounts of food speed up your recovery by giving you an appetite and making the muscles and nerves in your bowel work again. Please circle how much food you ate today. Breakfast Some Half Most All Lunch Some Half Most All Dinner Some Half Most All Any Snacks? Chewing Gum Once Twice 3 Times Please list snacks that you enjoyed. BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement *Patients with a colostomy, please refer to colostomy patient information. 12 ENHANCED PATIENT RECOVERY JOURNAL

Day Four GETTING OUT OF BED It is important to get up and about as much as possible. This includes short walks. I have been out of bed for at least 6 hours today. How many times have you walked today? 1 2 3 4 More than 4 I have been able to circle the nursing unit... Once Twice More than twice If you have not been able to get out of bed or walk today it was because you were... t feeling well t comfortable Didn t want to t able to/too weak t asked to get up DEEP BREATHING Deep breathing and coughing are essential to keep your lungs clear. Have you practiced deep breathing exercises? If not, why? t feeling well Too painful t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? ANY OTHER THOUGHTS OR FEELINGS? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 13

Day Five FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to Did not like the taste Feeling sick t offered FOODS Eating is not dangerous after bowel surgery. Even small amounts of food speed up your recovery by giving you an appetite and making the muscles and nerves in your bowel work again. Please circle how much food you ate today. Breakfast Some Half Most All Lunch Some Half Most All Dinner Some Half Most All Any Snacks? Chewing Gum Once Twice 3 Times Please list snacks that you enjoyed. BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement *Patients with a colostomy, please refer to colostomy patient information. 14 ENHANCED PATIENT RECOVERY JOURNAL

Day Five GETTING OUT OF BED It is important to get up and about as much as possible. This includes short walks. I have been out of bed for at least 6 hours today. How many times have you walked today? 1 2 3 4 More than 4 I have been able to circle the nursing unit... Once Twice More than twice If you have not been able to get out of bed or walk today it was because you were... t feeling well t comfortable Didn t want to t able to/too weak t asked to get up DEEP BREATHING Deep breathing and coughing are essential to keep your lungs clear. Have you practiced deep breathing exercises? If not, why? t feeling well Too painful t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? ANY OTHER THOUGHTS OR FEELINGS? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 15

Day Six FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to Did not like the taste Feeling sick t offered FOODS Eating is not dangerous after bowel surgery. Even small amounts of food speed up your recovery by giving you an appetite and making the muscles and nerves in your bowel work again. Please circle how much food you ate today. Breakfast Some Half Most All Lunch Some Half Most All Dinner Some Half Most All Any Snacks? Chewing Gum Once Twice 3 Times Please list snacks that you enjoyed. BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement *Patients with a colostomy, please refer to colostomy patient information. 16 ENHANCED PATIENT RECOVERY JOURNAL

Day Six GETTING OUT OF BED It is important to get up and about as much as possible. This includes short walks. I have been out of bed for at least 6 hours today. How many times have you walked today? 1 2 3 4 More than 4 I have been able to circle the nursing unit... Once Twice More than twice If you have not been able to get out of bed or walk today it was because you were... t feeling well t comfortable Didn t want to t able to/too weak t asked to get up DEEP BREATHING Deep breathing and coughing are essential to keep your lungs clear. Have you practiced deep breathing exercises? If not, why? t feeling well Too painful t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? ANY OTHER THOUGHTS OR FEELINGS? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 17

Day Seven FLUIDS Try to drink as much as you feel able to. Write down what you drank: Water or juice Tea / Coffee Nutritional drinks Chewing gum If you have not had something to drink, why? Don t want to Did not like the taste Feeling sick t offered FOODS Eating is not dangerous after bowel surgery. Even small amounts of food speed up your recovery by giving you an appetite and making the muscles and nerves in your bowel work again. Please circle how much food you ate today. Breakfast Some Half Most All Lunch Some Half Most All Dinner Some Half Most All Any Snacks? Chewing Gum Once Twice 3 Times Please list snacks that you enjoyed. BOWELS It is normal to have irregular bowel function after surgery I have passed gas I have had a bowel movement *Patients with a colostomy, please refer to colostomy patient information. 18 ENHANCED PATIENT RECOVERY JOURNAL

Day Seven GETTING OUT OF BED It is important to get up and about as much as possible. This includes short walks. I have been out of bed for at least 6 hours today. How many times have you walked today? 1 2 3 4 More than 4 I have been able to circle the nursing unit... Once Twice More than twice If you have not been able to get out of bed or walk today it was because you were... t feeling well t comfortable Didn t want to t able to/too weak t asked to get up DEEP BREATHING Deep breathing and coughing is essential to keep your lungs clear Have you practiced deep breathing exercises? If not, why? t feeling well Too painful t asked to Don t want to PAIN AND NAUSEA Is your pain well controlled? Are you feeling sick to your stomach? Have you vomited? ANY OTHER THOUGHTS OR FEELINGS? PAIN SCALE Which picture best describes your pain? 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 19

Patient Experience Circle the words that best describe how you felt First contact with the Hospital My Recovery Talking to Staff My Hospital Experience Going Home Relaxed Relaxed Relaxed Relaxed Relaxed Supported Supported Supported Supported Supported Included Included Included Included Included Comfortable Comfortable Comfortable Comfortable Comfortable Safe Safe Safe Safe Safe Anxious Anxious Anxious Anxious Anxious Sad Sad Sad Sad Sad Stressed Stressed Stressed Stressed Stressed Worried Worried Worried Worried Worried : : : : : Explain why you felt this way. 20 ENHANCED PATIENT RECOVERY JOURNAL

Patient Discharge Goal If you meet certain goals, you will be allowed to go home: t needing pain control through an IV or injection Taking in enough liquids and solid food Independently up and around or same level as before admission The medical team believes you are ready for discharge You and your family are ready for your discharge Action Remember that you will be more tired than usual and it is important to rest regularly, continue with gentle exercise and gradually return to your normal activity as your body allows. You should avoid heavy lifting, gardening and heavy housework for a few weeks after your operation. Progress The Enhanced Recovery Program is to help you recover as quickly as possible from your operation so you can go home sooner and continue your recovery at home. Are you feeling comfortable (pain well controlled)? Are you able to get up and around independently? Are you able to eat solid food and drink adequately? Do you feel ready to go home? Any Further Thoughts. 0 2 4 6 8 10 DMC DETROIT MEDICAL CENTER 21

Contact Information Surgeon: Nurse Navigator: Clinic Contact: Pain Service: Ask Me 3 What is my main problem? What do I need to do? Why is it important to me? Please contact your surgeon or nurse navigator if you have: A fever greater than 101 F lasting greater than 1-2 hours. Excessive bleeding, drainage, redness, or other problems at the surgical site. Severe pain after taking prescribed pain medication. Persistent nausea, vomiting, or diarrhea. Hives, rash, or itching. An inability to have a bowel movement for several days or are unable to pass gas. Any incision that opens. Trouble urinating or pain with urination. Any other concerns. FOR COLORECTAL PATIENTS WITH QUESTIONS REGARDING STOMACH CARE, PLEASE CONTACT THE WOUND/OSTOMY NURSE. 22 ENHANCED PATIENT RECOVERY JOURNAL

tes Adapted with permission from the ERAS Society - erassociety.org. DMC DETROIT MEDICAL CENTER 23