Inguinal Hernia Repair ICP For WEB
Inguinal Hernia Repair ICP For WEB
Inguinal Hernia Repair ICP For WEB
Ward
Hosp no
DOB
(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N
LY
Inclusion criteria
Patients undergoing inguinal hernia repair aged under 3 months corrected gestational age
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
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
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
Signature sheet
Designation
Signature
Initials
Date
(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N
LY
Name
Abbreviation
Term in full
FBC
U&E
G&S
CNS
NBM
Nil by mouth
EP
Electronic prescribing
CEWS
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
hearing aids
JB 31/3/2010
(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
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:
Family Form 2
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
ID
Activity
0001
0002
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
(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N
0003
LY
0005
Check that details on PiMS are correct including next of kin and
parental responsibility
0006
0007
0008
0009
0010
0011
0012
0013
0014
0015
0016
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
Activity
X0001
X0002
X0003
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
Activity
Night shift
Date:
Date:
Met
0017
0018
0019
0020
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
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
ID
Activity
Day shift
Night shift
Date:
Date:
Met
0021
0022
0023
Not
N/A
Met
Not
N/A
met
met
Enter initials/time
Enter initials/time
Day shift
Night shift
ID
Activity
X0005
X0006
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
R S
IN H
FO Tr
u
R st
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
Activity
0024
0025
0026
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
Night shift
LY
ID
Day shift
0027
0028
0029
0030
0031
0032
0033
0034
0035
0036
0037
Review by anaesthetist
0038
0039
0040
0041
0042
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
Activity
X0007
X0008
X0009
X0010
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
1 dose co-amoxiclav
3 doses co-amoxiclav
Assistant
Anaesthetist
Report
None
(c
)
FO G
O
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N
LY
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
Activity
0044
0045
0046
0047
0048
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
0050
0051
0052
0053
0054
0055
0056
0057
0058
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
Activity
X0011
X0012
X0013
X0014
X0015
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
0060
0061
0062
0063
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
0064
0065
0066
0067
0068
0069
0070
N/A
LY
ID
Day shift
Day shift
ID
Met
Activity
X0016
X0017
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
R S
IN H
FO Tr
u
R st
M 2
AT 0
1
IO 1
N
O
N
LY
Transport
Equipment
Ordered
Delivered
Explained
Teaching
Follow up arrangements
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
31/11/08
10am
ID
What occurred?
Why?
LY
Time
DOB
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
Hosp no
0013
information
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?
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
information
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