Contact our services using the key contacts below.

Contact Details

This page gives you information about your right to decline a blood transfusion or blood products as part of your treatment.

If you are a Jehovah’s Witness, you may have heard ‘blood products’ described as ‘fractions.’

Can anyone decline a blood transfusion?

Yes. North Bristol NHS Trust wants to be sure that we treat every patient in a way that recognises and respects their individual, cultural and religious beliefs.

As a Trust, we have a programme to conserve blood and minimise the number of transfusions given to patients. If you decline treatment with blood products we want to ensure that you make an informed decision; your doctor will discuss the possible risks and benefits of treatment with and without blood products.

• It is your decision whether or not you are willing to accept the risks declining a blood transfusion and blood products. If you are a Jehovah’s Witness you may wish to discuss this with your ministers.
• Please be aware that your doctor has the right to decide if they are unwilling to perform your surgery under these circumstances. 
• If this is the case he or she will need to work with you to make a referral to a consultant who is known, in principle, to accept patients who request non-blood management. Your local Jehovah’s Witness Hospital Liaison Committee may be able to assist you or your doctors with this process.
• This can be done using the Trust ‘Checklist’ and if you are a Jehovah’s Witness you may have an ‘Advance Decision to Refuse Specified Medical Treatment’ (this is provided by your local Ministers and is sometimes known as a ‘No Blood Form’). Show these documents to your medical team so that they can take copies and include them in your medical notes. 
• You may have to go over the ‘Checklist’ more than once during your admission so that doctors directly involved in your care, who did not see you in Pre-Assessment Clinic, can confirm your wishes. This will definitely be required if more procedures are required than was originally expected.
• At all times during your hospital admission, even if an emergency arises, we will respect your wishes.

What happens if I am admitted to hospital as an emergency?

If you are admitted to hospital as an emergency and we know your wishes, they will be respected. A team of medical professionals and the Jehovah’s Witnesses’ Bristol Hospital Liaison Committee have put together a plan of care for dealing with such situations and you can be confident that you will receive the best possible care and treatment during your hospital stay.

It is possible that in an emergency situation you may not be able to communicate your wishes. Therefore, it is essential that once you decide you do not wish to receive blood products you carry an ‘Advance Decision Form’ and may consider wearing a ‘No Blood Wristband’. 

I want to decline a blood transfusion and blood products

Once you have decided that you do not wish to receive a blood transfusion or blood products, there are several things you must do to help us respect your wishes:

• Inform us in writing that you do not wish to receive blood transfusion or blood products. This can be done by completing the Trust ‘Checklist for Jehovah’s Witnesses and Other Patients who Decline Blood Transfusion’.
• Carry an ‘Advance Decision Form’ with you at all times so that, if you are found unwell and cannot communicate, your wishes will be respected.
• Before any operation sign a standard consent form, clearly indicating that you consent to the planned procedure but that you do not consent to a blood transfusion/ specified products.

What happens if I have a planned admission to hospital?

Before attending hospital for your surgery, you will be invited to a Pre-Assessment Clinic where you will see a doctor or nurse. At this appointment please make the nurse or doctor aware that you do not wish to receive a blood transfusion and any blood products you have specified as part of your treatment. 

If you can assist in this process by attending with a Trust ‘Checklist’ pre-prepared that will be helpful but, in any event, you should let the hospital team know your wishes as early as possible, so that they may plan your care. 

Please ensure that your wishes are specified in writing. 

What if I change my mind?

You have the right to change your mind about receiving a blood transfusion or blood products at any time. 

If you do change your mind, you must let your medical team know immediately so that your decision may be recorded in your medical records, and your treatment plan may be adapted according to your wishes.

I have further questions

If you have any further questions or concerns that are not covered by this leaflet, please discuss them with a member of your medical team. If they are unable to answer your questions they will find someone who can.

Further help for Jehovah’s Witnesses

Further help is available from:

Your local minister.

The Bristol Hospital Liaison Committee for Jehovah’s Witnesses. Contact details can be provided by a member of your medical team, or alternatively you can make contact by email: info@bristol-hlc.org.uk

© North Bristol NHS Trust. This edition published April 2023. Review due April 2026. NBT003190.

Information for patients about anti-synthetase syndrome. 

Anti-synthetase syndrome is an autoimmune disease. This means that the condition and the symptoms associated with it, are caused by your immune system being over-active. Anti-synthetase syndrome presents with a set of symptoms, together with the identification of one of several specific antibodies against your own cells, known as anti-synthetase autoantibodies. These autoantibodies are immune system proteins that target specific proteins within your own body (the tRNA synthetase enzymes).

Eight anti-synthetase antibodies have been identified so far as being significant in this disease. By far the most common of these is anti-Jo-1. Others include PL-7 and PL-12. Five additional anti-synthetase antibodies have been identified so far, but these are much rarer.

What are the symptoms?

What tests will I have?

What treatment is available?

How can I help myself?

Further information and resources

How to contact us

© North Bristol NHS Trust.  This edition published May 2024. Review due May 2027. NBT003470.

Care of plaster casts

Your cast may be made out of plaster of Paris or a synthetic material. The following advice is for both types. You will also be given verbal advice.

It is important that you eat a healthy diet and drink plenty of fluids to help with bone and wound healing while you are in a cast. 

Please help us look after your plaster. It is an essential part of your treatment. We hope the following information will help you. 

Do

• Exercise joints not held in the plaster as much as possible.
• Elevate the limb, especially during the first 2 weeks. Don’t let your limb hang down unless being used.
• Use sticks, crutches, or frames as instructed. Please return equipment when it is no longer needed after you are discharged.
• Keep your plaster completely dry.
• Wear the shoe provided if you are allowed to weight bear on the plaster.
• Take advice before driving.
• Take advice before flying or travelling. 

Do not

• Interfere with your plaster in any way.
• Poke anything down your plaster.
• Write on your plaster of Paris for 48 hours after it’s been applied.
• Write on your synthetic plaster for 2 hours after it’s been applied.
• Leave your limb unsupported or stand for long periods.
• Stand or put weight on your plastered limb unless instructed by the doctor, nurse, or physiotherapist.
• Cut your plaster.
• Get the plaster wet. It may disintegrate (fall apart) or cause skin problems.
• Smoke. Do not smoke as this slows down bone healing.

Please ring us if your plaster:

• Rubs.
• Cracks.
• Itches excessively.
• Softens.
• Becomes loose or uncomfortable.

Please ring us first, then return to the hospital immediately if the following happen (out of hours go to the Emergency Department): 

• Your toes or fingers become blue, pale, or discoloured.
• Sudden increase in swelling, numbness, or pins and needles.
• Your limb becomes more painful.
• You feel “pins and needles” or numbness.
• You have a blister-like pain or rubbing under the plaster.
• You have discharge, wetness, or smell under your cast.
• You drop any object down inside your cast.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

What is a DVT? 

A DVT is a blood clot that forms in a vein. It is possible for a DVT to form in any vein but it most commonly happens in the leg.

What is a PE?

A PE is a blood clot in the lungs, caused when part of a DVT breaks off and travels in the bloodstream to the lungs. 

What can I do to reduce my risk of getting a DVT/PE? 

• Stay as mobile as possible. If walking is difficult exercise your legs and feet by flexing your knees and ankles, rotating your feet, and wriggling your toes. Do this as often as you can.
• Drink plenty of fluids as dehydration increases your risk of getting a DVT or PE. (Renal patients, please check your fluid allowance with your renal clinical team).
• If you have been given stockings or injections to reduce the risk of DVT/PE, please use them as instructed.
• Eat a healthy diet and maintain a healthy weight.
• Don’t smoke.

How do I know if I have a DVT or PE?

Signs of a DVT include: 

• Pain.
• Swelling.
• Discolouration of the skin (red, purple, or blue).

Signs of a PE: 

• A cough - with or without blood stained phlegm.
• Breathlessness - more than usual for you.
• Chest pain.
• Collapsing (this is an emergency - phone 999).

If you develop any of the symptoms or a DVT or PE please get medical advice the same day. Phone 111, your GP surgery, or go to the nearest Accident and Emergency Department.

Remember

If you have any problems or concerns about your plaster, don’t hesitate to contact the staff. 

Driving advice

We advise that you do not drive whilst in a cast, boot, or splint.

Any concerns please contact your car insurer or the DVLA.

Holiday insurance advice

If you plan to go on holiday and you have taken out holiday insurance, please inform your insurance company.

If you plan to go on holiday and have not taken out holiday insurance we advise that you do. If you develop any complications whilst away you may not be covered.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002018

Information on your brace

This page should be used as a general guide only.

• Make sure you fasten the straps securely but not overly tight.
• Wear the brace next to skin - not over clothes.
• The brace should not hurt, but you may feel a little uncomfortable while you get used to it.
• Remove the brace to check the skin at regular intervals.
• If you have any rubs or red mars, contact the plaster room.
• Most braces can be washed with soap and water and left to air dry.
• Do not place on or near a heat source.
• If you are having any problems with the brace contact the plaster room.
• If you are concerned the brace is causing a sore, leave it off and contact the plaster room.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

What is a DVT? 

A DVT is a blood clot that forms in a vein. It is possible for a DVT to form in any vein but it most commonly happens in the leg.

What is a PE?

A PE is a blood clot in the lungs, caused when part of a DVT breaks off and travels in the bloodstream to the lungs. 

What can I do to reduce my risk of getting a DVT/PE? 

• Stay as mobile as possible. If walking is difficult exercise your legs and feet by flexing your knees and ankles, rotating your feet, and wriggling your toes. Do this as often as you can.
• Drink plenty of fluids as dehydration increases your risk of getting a DVT or PE. (Renal patients, please check your fluid allowance with your renal clinical team).
• If you have been given stockings or injections to reduce the risk of DVT/PE, please use them as instructed.
• Eat a healthy diet and maintain a healthy weight.
• Don’t smoke.

How do I know if I have a DVT or PE?

Signs of a DVT include: 

• Pain.
• Swelling.
• Discolouration of the skin (red, purple, or blue).

Signs of a PE: 

• A cough - with or without blood stained phlegm.
• Breathlessness - more than usual for you.
• Chest pain.
• Collapsing (this is an emergency - phone 999).

If you develop any of the symptoms or a DVT or PE please get medical advice the same day. Phone 111, your GP surgery, or go to the nearest Accident and Emergency Department.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003231

This information is for people who need to lower the potassium and phosphate levels in their blood.

Having chronic kidney disease can make potassium and phosphate levels in the blood too high. This can make you unwell. 

This page covers: 

• Which foods you can choose that are low in both potassium and phosphate.
• Which foods are high in phosphate and gives recommended serving sizes for some of these. 
• How to cook vegetables to make them lower in potassium.
• Which additives to try and avoid because they contain potassium and phosphate.

How can I lower my potassium and phosphate levels? 

To reduce the amount of potassium and phosphate in your diet:

• Eat a healthy diet and choose low potassium and low phosphate foods.
• Cook vegetables by boiling in water.
• Check ingredient labels and limit foods with potassium and phosphate additives.

Why do I need to reduce levels of potassium and phosphate in my blood?

Potassium is a mineral found in many foods. It helps our nerves, muscles, and heart to work well. Phosphate (also known as phosphorous) is needed for healthy bones.  

When the kidneys are not working properly, the levels of potassium and phosphate in the blood can rise too high.  

High levels of potassium can cause:

• A change to the way your heart beats, which can be very dangerous.

High levels of phosphate can cause: 

• Hardening of your blood vessels. 
• Damage to your heart .
• Weakening of your bones.
• Aching joints.
• Itchy skin.
• Sore eyes.

The normal blood levels are:

• Potassium between 3.5mmol/l and 5.5mmol/l
• Phosphate between 0.8mmol/l and 1.5mmol/l

What can I eat? 

Aim for five servings of lower potassium vegetables and fruit per day.

Vegetables and fruits are high in fibre and help to ensure you have a healthy gut and regular bowel movements. A higher fibre diet reduces the amounts of potassium and phosphate that gets into your blood stream. Vegetables and fruit help to manage potassium levels in the blood. They are best eaten spread out over the day.

Check the list later on this page for the best lower potassium options.

Choose wholegrain, starchy carbohydrate foods

Eat some pulses, fish, eggs, meat and other protein foods

To help manage your potassium and phosphate levels:

• Eat more meals based on beans, peas or lentils. There are some great recipes kidney friendly recipes from Kidney Kitchen:
  Kidney Kitchen | Kidney Care UK
• Eat eggs in moderation (about 4-6 per week).
• Eat fresh, home cooked pork, beef, chicken instead of processed cooked meats and sausages.

Eat some dairy and dairy alternatives

Eat foods high in fat, salt, and sugar less often and in small amounts

Cooking tips to reduce the potassium in potatoes and vegetables:

Why should I eat less potassium and phosphate additives?

Both potassium and phosphate are found naturally in all foods. They may also be used as food additives. The potassium and phosphate from food additives gets into your blood stream more easily than that found naturally in food. This will cause higher blood levels of potassium and phosphate.

How do I eat less potassium and phosphate additives?

The names of the additives, or their E numbers, are listed on the ingredients labels where they have been used. Additives with ‘pot’ or ‘phos’ in their name will contain potassium or phosphate.

Check ingredient labels for the additives below to avoid. 

Avoid these additives

I also have diabetes, what can I eat?

It can be difficult when you have other health conditions which also affect your eating. For your diabetes you should continue to follow a healthy diet. A diet with wholegrains and less processed food will be good for your diabetes and for your potassium and phosphate levels.  

In addition, you could:

• Choose low potassium and low phosphate foods – see lists later.
• Cook your vegetables and potatoes by boiling in plenty of water.
• Check ingredient labels and limit foods with the potassium and phosphate additives listed above.

Which foods can I eat?

Here is a list to help you choose foods that are lower in both potassium and phosphate.  

Here is some information to help you limit foods that are high in both potassium and phosphate: 

Foods that are higher or lower in potassium and phosphate

Foods high in fat, salt and sugar

This booklet gives a full range of foods that are low and high in both potassium and phosphate. It includes some foods that are high in fat, salt, and sugar such as savoury snacks, cakes and sweets. These are included to give you a variety of options. You may prefer not to eat these foods if you are trying to eat less fat, salt and sugar or if you have diabetes. 

What if the foods I eat are not listed here?

If a food you eat is missing ask your dietitian for guidance.  Our contact details are on the NBT Nutrition and Dietetics Service webpage:

Nutrition & Dietetics | North Bristol NHS Trust (nbt.nhs.uk)

How can I eat more sustainably?

Many people want to eat food that is more environmentally friendly. These ideas are good for the planet and for you too:

• Limit red and processed meats. Try some plant food sources of protein such as beans, lentils, soya mince, Quorn, tofu instead.
• Moderate the amount of dairy foods you eat and consider a plant based milk.
• Eat less processed food that is high in fat, sugar, and salt.

Summary

• This information has shown you ways you can eat less potassium and phosphate by:
• Eating a healthy diet and choosing low potassium and low phosphate foods.
• Cooking all vegetables by boiling.
• Checking ingredient labels and limiting foods with potassium and phosphate additives.

Useful webpages

© North Bristol NHS Trust.  This edition published May 2024. Review due May 2027. NBT003671.

Information for kidney patients

This leaflet will tell you how to eat enough protein to keep you well or to help you recover from illness. You may need extra protein now because:

• Your body is losing protein through dialysis.
• Your body is losing more protein than usual. This happens during infections, especially peritonitis.
• Your appetite is small, and you are not eating enough protein.

Why are protein foods important?

We need protein in every part of our body. It is essential:

• For strong muscles.
• To fight off infections and help recovery.
• For healthy skin and blood.

What if I usually limit phosphate, potassium, and salt? 

You may not need to limit foods that are high in phosphate, potassium, or salt now.  Your dietitian will give you more guidance.  If you take phosphate binder tablets you should continue to take these as usual.   

Which foods are high in protein?

Meat, chicken, and fish:

• Fresh, unprocessed meat, chicken, and fish are lowest in salt and phosphate.

Dairy:

• Milk.
• Yoghurt – look for higher protein options with more than 7g of protein per 100g such as Skyr or Liberté.
• Cheese.
• Milk puddings such as rice, semolina and tapioca puddings, and custard.

Vegetarian options:

• Eggs.
• Beans, lentils (including dahl) and chickpeas (including hummus).
• Soya milk.
• Tofu and tempeh.
• Quorn.
• Nuts.
• Seitan.

How can I eat enough protein?

Protein cannot be stored by the body, so you need high protein foods 2-3 times a day. As a guide aim for the following portions and serving sizes: 

• Cooked meat or chicken about the size of half of your hand (90g). 
• Cooked fish about the size of your hand (140g).
• 2-3 eggs (120g-180g).
• Cheese about the size of your index and middle fingers (50g).
• About 4 tablespoons of beans or lentils (100-140g).
• About 3 tablespoons of nuts (50g).

If you have peritonitis, you will need to eat more protein than usual. Try to have 2-3 high protein snacks in addition to high protein meals. High protein snacks can also be helpful if you have a poor appetite and are eating smaller meals than usual. There are some ideas for meals on pages 6, 7, and 8.

Fatty and sugary foods

You should also try to eat more high fat and high sugar foods. This will help your body use the protein you eat. 

Swap low or reduced fat and sugar foods for full fat and full sugar options. For example, swapping semi-skimmed milk for full fat milk. 

If you have diabetes you may need to check your blood glucose levels more often at this time. You may also ask your diabetes team for advice. When you have recovered you should return to your usual healthy way of eating. 

What meals, snacks, and drinks are high in protein? 

Here are some ideas for high protein meals, snacks, and drinks:

High protein meals

High protein snacks

High protein drinks

Food labels

If you are buying a convenience meal, sandwich, or snack, it can be helpful to look at food labels to see how much protein is has. A main meal should have at least 20g protein, ideally more. 

Here is an example of a food label showing protein content: 

How can I eat enough protein if I have a small appetite?

Try to eat small portions, but more often. Have 2-3 high protein snacks or high protein drinks in between your meals every day.  

For more information ask for a copy of our leaflet ‘Diet for a poor appetite.’

Try protein boosters to fortify your meals. The quantities of protein boosters given below are for 1 portion. You may be able to add more than 1 booster per portion. 

Protein booster portions

Tips

• Aim to have high protein foods such as meat, chicken, fish, eggs, beans, lentils, nuts, or tofu at every meal.
• Eat the high protein part of your meal first.
• Have a generous portion of starchy food such as pasta, egg noodles, or quinoa to add more protein to your meal.
• Try to have milky desserts such as yoghurt, rice pudding, or soya dessert after or between your meals.
• Have high protein snacks between meals such as cheese and biscuits or falafel and hummus.
• If you are buying ready meals check the label and aim for at least 20g of protein for a meal.
• Have milk or soya drinks such as milkshakes or hot chocolate instead of tea, water, and squash.
• Keep drinks separate from meals.

Do I need supplement drinks prescribed? 

• If you are unable to eat enough protein, your dietitian may recommend nutritional supplements. These are available as milkshake style drinks, fruit juice style drinks, small ‘shot’ style drinks, desserts, or powders. Samples can be provided by your dietitian or they can be prescribed short-term by your GP. 
• For more information ask of our leaflet/page with tips for taking nutritional supplements. 

How much protein do I need?

Different people need different amounts of protein. 
These foods all supply 1 protein portion. Most people having dialysis treatment need 6-8 protein portions per day. Some people find it helpful to plan their protein portions across the day. Your dietitian can tell you how many protein portions you need to eat each day, and can help you plan meals: 

• 25g (1oz) cooked red meat, chicken or turkey.
• 40g (1½oz) cooked or tinned fish.
• 25g (1oz) cheese.
• 200ml (⅓ pint) milk.
• 125g / 1 small pot yoghurt or small portion custard or rice pudding.
• 1 egg.
• 100g (4oz) hummus.
• 50g (2oz) Quorn.
• 40g (1½oz) cooked tofu.
• 110g (4oz) cooked pulses such as lentils, dahl or baked beans.

How can I eat more sustainably?

Many people want to eat food that is more environmentally friendly. Below are some ideas you could consider. 

• Try buying plant food sources such as beans, lentils, soya mince, Quorn, tofu, or nuts.
• When buying fish look for the Marine Stewardship Council or Aquaculture Stewardship Council symbols:

• Try calcium fortified plant milk such as soya or oat instead of cow’s milk.
• Opt for wholemeal breads and wholegrain versions of pasta and cereals.
• Choose local and seasonal produce.
• Try to limit fruit and veg that have been flown from abroad. 
• Avoid chopped, ready prepared and packaged fresh fruit, veg and salads if you can.
• Reduce food waste, especially of fresh fruit and veg, by choosing tinned and frozen alongside seasonal fresh produce.

Useful webpages for further information

Contact your dietitian if you need further help. 

© North Bristol NHS Trust.  This edition published May 2024. Review due May 2027. NBT003617.

The page has information about caring for your relative/friend at the end of life. 

The doctors and nurses looking after your relative/friend believe that there has been a change in their condition indicating that they are dying and are now in the last hours, days or weeks of life. This can be an extremely distressing and worrying time for everyone.

At North Bristol NHS Trust we want to be able to support you and your relative/friend as best we can. We are committed to providing high quality end of life care, which includes addressing pain and other symptoms, providing care in a way that ensures the privacy and dignity of your relative/friend, and by keeping everyone up to date about any changes in their condition or treatment.

Whilst the dying process is individual and we can’t always predict what will happen, there are some signs and symptoms that help us to recognise that someone is approaching the end of their life. This page aims to answer some of the questions you may have about your relative/friend’s care and what to expect when someone is dying.

What will happen next?

At North Bristol NHS Trust, we record the care given each day using a document called “The Purple Butterfly” framework which prompts staff to think about the individual needs of each person, ensuring that the most important aspects of care are addressed.  

Non-essential medications, routine tests, and observations such as blood pressure monitoring are reviewed and usually stopped at this time. Instead, any symptoms your relative/friend may experience such as pain, nausea, breathlessness and restlessness will be reviewed regularly and changes will be made to their care as needed. 

You and your relative/friend (if they are able) will be involved in the discussion regarding their care with the aim that you all fully understand the reasons why decisions are being made.

If your relative/friend’s condition improves then their plan of care will be reviewed and changed. All decisions will be reviewed regularly by the ward team. We will ask for the contact details of a named person so that we can keep you informed of any changes.

What documentation is used?

A symptom observation chart will be outside the room for staff to record any issues such as pain or distress that require intervention or medication from the doctors or nurses. The doctor will prescribe pain relief and other symptom-relieving medication on your relative/friend’s medication chart.

A purple butterfly sign will be placed on your relative/friend’s door as a way of communicating with all those involved in their care that they are in the last few days of life.

What can we expect during the dying process?

The dying process is unique to each person but in most cases there are signs which help to indicate that a person is dying, particularly when there has been a deterioration despite treatment in hospital. 

Diminished need for food and drink 

As someone becomes weaker and more unwell their appetite is likely to naturally reduce and eating and drinking become more difficult. Your relative/friend will be supported to take food and fluids if they so wish as long as they can safely do so; the treating team will guide you when this may no longer be possible.

Fluids via a drip are usually not needed when someone is dying, but it can be incredibly hard to see those we love not eating and drinking or receiving fluids. 

The nursing team can show you how to give mouthcare to your relative/friend to help relieve any sensation of dryness or thirst. We urge you to ask the medical team if you have any questions or concerns about food and fluids.

Changes in breathing

People who have suffered with breathlessness for a long time are often concerned that they will struggle with breathing at the end of their life. However, the effort of breathing may become easier as they become less active and the need for oxygen decreases. For others, their breathing may become more shallow and rapid and they may find the sensation distressing. Breathing difficulties can be made worse by feelings of anxiety and this is often relieved by knowing that someone is close at hand. There is also medication that can be given if we feel someone is experiencing distress with their breathing.

Sometimes people have a build-up of secretions in the back of the mouth which can cause a noisy rattle because they can no longer cough and clear the secretions. If this develops, your relative/friend may be given medication to reduce it and changes in position may help. Noisy breathing is not always improved by medication or a change in position and although it can be distressing to hear, it is not distressing for the dying person. 

Withdrawing from the world

This is a gradual process. Over a period of time, your relative/friend may spend more time sleeping and will often be drowsy when awake. This lack of interest in their surroundings is a natural process. Eventually they will lapse into unconsciousness, sometimes for a surprisingly long time.

When death is close their breathing pattern may change. It can sometimes appear more laboured and sometimes there are long pauses between breaths. This is normal and is not distressing to the dying person.

What else should we expect to happen during this time?

Medication and other treatments

Medication will be reviewed and anything that is no longer helpful may be stopped. New medication will be prescribed so that if a symptom occurs it can be addressed. Medication may be given as a small injection under the skin or as a continuous infusion using a syringe pump if it becomes difficult to swallow medication. If your friend/relative normally takes pain relief then this will be continued or given in an alternative way, usually via a syringe pump.

The staff will talk to you about the best way to maintain comfort by such things as looking at the position in bed, the use of a special mattress and mouth care. If your relative/friend is breathing through an open mouth, it is likely to become dry, so regular moistening and application of lipsalve will give comfort.

Spiritual, cultural and religious care needs

The team will wish to identify whether your relative/friend or you have any religious, cultural, or spiritual wishes, and if there are any particular things that may be important at this time. Please let staff know if you have any special requests or wishes relating to the moment of death or after death so that they can ensure that these are carried out .

You may be asked if either of you belong to a faith or community. If you do, you may wish for the staff to contact a faith leader from that community for support now or at the time of death.

You are welcome to meet a member of the hospital Spiritual/Pastoral Care Team (Chaplains phone number: 0117 414 3700). They are skilled people who can provide support even if you do not have a religious belief. They can be asked to visit and talk to you about any needs, fears, and worries.

How else can I help my relative/friend?

Don’t underestimate the importance of being with your relative/friend, even if you feel you aren’t doing much. Talking to your relative can help, even if they appear to be asleep. Telling them news from home, reading a book or the newspaper may be comforting to them, even though they may not be able to respond .

Please feel that you can hold your relative/friend‘s hand and touch them. 
It is sometimes possible to help with some simple aspects of care - moistening their mouth, providing them with a drink or brushing their hair, for example. Please feel free to speak with a member of staff if you are unsure or would like some guidance.

This is a difficult time. Do not forget to take care of yourself. Visiting can be a very stressful and tiring time. Do take breaks from the bedside, try to get some rest and eat well. There are quiet spaces available for you to use on the wards. Please ask the staff to show you where they are located.

What happens after my relative/friend has died?

The ward staff can go through this with you and there is a separate leaflet explaining everything that needs to happen.

What other support is there for me?

The Sanctuary / Chaplaincy

The Sanctuary is located at Gate 30 and offers a place for quiet, reflection, meditation, prayer, and worship. It is for people of any or no faith and is open for patients or visitors at any time. 

Purple Butterfly Volunteers. 

Our Purple Butterfly volunteers are available most weekdays to offer an extra layer of support to you and your relative/friend. They can sit and listen to you and your relative/friend, offer you refreshments and provide short periods of respite should you wish to take a break from being at the bedside. 

We can provide relatives/friends with a carers badge which allows access to the staff canteen (Vu, Level 5) giving you access to wider variety of hot food and drinks. The nursing team and Purple Butterfly volunteers can help you with this. 

For information about food and drink facilities in the Brunel building visit:

Cafes & Shops | North Bristol NHS Trust (nbt.nhs.uk)

Parking

Parking permits are available, please discuss this with the ward team. This will need to be taken to the security and parking office at the main entrance on Level 1 for authorisation.

Pay and display charges apply 24 hours a day, 365 days of the year. 

Parking Administrator Telephone: 0117 414 3335

Information/Communication

The team will be making regular assessments of your relative/friend’s condition. If you have any worries or concerns in between assessments, or at any time, please do not hesitate to let one of the doctors or nurses know. Being with someone at the end of their life can feel lonely and painful, so the staff are also here to offer you guidance, comfort and support.

If further support or symptom control is needed, the ward team will contact the Palliative Care Team:

Phone: 0117 414 0519 
Monday–Friday 9am-5pm

© North Bristol NHS Trust.  This edition published January 2024. Review due January 2027. NBT002815.

Severn Pathology reports into the NHSE/I national Pathology Quality Assurance Dashboard.

Reports are collated and presented within the Model Hospital Insight - Model Hospital.

This information has been written by the teams who will look after you during surgery. It aims to help you understand the surgery, guide you through these various phases of your operation, and inform you how you can best prepare and recover afterwards.

You may be given a paper copy of this information which you should bring with you on the day of your surgery. 

This page contains the following information:

• Preparing for your operation
• On the day of your operation
• Going home
• Physiotherapy advice
• Therapy advice

A joint replacement operation is done to improve your quality of life, It will hopefully allow you to do some of the things that have become difficult with your joint arthritis.

From the day you are admitted to hospital, the staff involved in your care will work together to assess your needs in preparation for leaving hospital. 

We ask you to provide us with all the necessary information that will help with planning your hospital care, and timely discharge as early as possible. 

You will need to make the arrangements for your own transport home prior to your admission. If you or your relatives/carers have any concerns about your hospital discharge or transfer, do not hesitate to ask a member of the team.

Discharge Lounge 

Where possible, discharge arrangements will be made so you are able to vacate your hospital bed. This may include transfer to the Discharge Lounge; we will prepare you and keep you informed.  

The Discharge Lounge is a safe area providing nursing care and regular refreshments and meals, including breakfast, where you can wait to be taken home.  

Pathway for recovery

Recovering from joint replacement surgery has changed a lot over the years. We know the sooner we get you up and walking after your surgery, the better your outcomes will be. To help you do this, we have developed a pathway using the expertise of other hospitals in this region and across the country. 

This should allow you to get back on your feet sooner and return home to do the things you enjoy.

Returning home as soon as safely possible, even on the same day as your operation

As a result of expert surgery and anaesthetics, and a highly skilled team of doctors, nurses, and allied health professionals, many patients will not need to stay in hospital overnight and will be ready to go home the same day.

This is the usual pathway in many orthopaedic centres across the country, providing an excellent standard of care with very positive results and patient feedback.

However, some patients may not be ready to return safely home the same day and will need a little longer. If this is the case, we would expect you to be able to go home the day after your surgery, or as soon as all treating teams are satisfied.

We will only discharge you once you are recovered and you are able to safely return home.

Managing and understanding the Process

It is important for you to have realistic expectations of having joint replacement surgery. You should have a clear understanding of what to expect at each stage. You must prepare appropriately for your surgery and work with the clinical teams you meet during your care.
 

Preparation for your operation

On the day of your operation

Going home after your operation

Returning home

Everyone reaches their post-operative goals at different times. This determines whether it is safe for us to let you go home on the same day as your operation, or if you need to stay overnight with us at the hospital. 

Arrange for someone to collect you

When you have been cleared for discharge, you can contact your family or friends to come and collect you from the hospital. 

Arrange for support at home

If you live alone you will need to arrange for a friend or relative to stay with you overnight, post discharge and for a few days after returning home. You should arrange this before you come in to have your surgery. 

Wound dressing

Your wound is covered by a shower proof dressing so you can shower as soon as you feel able but do not aim water directly at the dressing. You will be seen by a healthcare professional two weeks after your operation to have your wound checked. Please leave any dressings in place and keep as dry as possible until this appointment. 

Keep active after your operation

The sooner you can get up and walk after your operation, the better and faster your recovery will be. You will also have a lower risk of complications after your surgery. Keeping still after your operation tends to result in your leg swelling, which ends up making it even more painful to walk. This can cause more side effects, which requires more pain relief, resulting in a vicious circle. 

Pain control

Joint replacement surgery is painful – just like any other surgery. The first few weeks can be a difficult period. However, it is important to stay active and keep up with your movement exercises. We will be giving you strong pain relief medication. However, you should expect there to still be mild to moderate pain on movement. It is not going to be 100% pain free.

The pain relief package you receive has been specially designed to try and control your pain as well as possible.  It starts from the day of your surgery and continues after your discharge home.  We will give you the same pain relief tablets whether you stay in hospital overnight or return home on the same day as your operation.

The pain relief package requires you to take your medicines at specific times.

Additional medications

We will be asking you to take additional medications to help minimise side effects, such as nausea or constipation. Other medications will be given to reduce the chance of certain complications, such as blood clots after your operation. You will be given clear information about the medicines you are sent home with, and when to take the doses. 

What to expect when you get home:

Swelling is common to have some generalised swelling of the leg below your hip replacement. Swelling will often get worse if you sit for prolonged periods, so we encourage you to remain gently active. To help reduce lower limb swelling you may need to rest for at least 20 minutes in the morning and / or afternoon on the bed initially. If you experience increasing swelling and pain, please seek medical advice.

Constipation is usually due to the pain relief medication you are taking. We will give you some laxative medication as part of the routine pain relief package. However, please ensure that you take these as prescribed, along with plenty of water to drink. Keeping mobile will also help reduce symptoms. If you struggle, then please discuss this with your GP. 

Pain is the biggest issue. It is something you should expect after your operation, but it is key that you do not stop doing your exercises. Please make sure that you follow the pain management programme you were discharged with to help control your pain. 

Sleepless nights: It is common for people to experience some disturbance in their normal sleep pattern in the first few weeks after an operation. Please do not worry as this usually improves with time. You can sleep in any position including lying on either side. 

What to look out for

Deep vein thrombosis (or DVT) Blood clots in the leg can occur after joint replacement surgery. If your leg becomes hard, swollen, hot and painful, especially in the calf area then this could be a sign of a blood clot. Please seek medical advice if you get these symptoms.

Infection is very rare. However, if your joint replacement or scar becomes hot, red and / or increasingly swollen or if you feel unwell, then please do seek medical assistance. 

Support after discharge

The Ward team will let you know what arrangements have been made for your follow-up appointments.

Following your discharge from hospital, there is always someone you can contact for advice. 

If you would like more information before your operation or have any questions after you have been discharged home or concerns about your wound, please ring 0117 414 1331 and one of the nursing staff will be able to advise you directly or be able to contact people from your surgical team for you.  

For therapy related queries, please contact Physiotherapy admin 0117 414 4412 or Occupational Therapy admin 0117 414 1272. 
 

Physiotherapy advice

Completing the exercises on the following pages will benefit your recovery, improve movement in the hip joint and develop the strength of muscles around it.

These exercises should be completed before and after your surgery. Doing these exercises before your operation will benefit your recovery.

We recommend you continue these exercises for a minimum of 6 weeks post-surgery. Complete your exercises 3 to 4 times a day, repeating each exercise up to 10 times.

Bed exercises 

To watch a video of exercises to do in bed visit: 

Hip replacement - bed Exercises (youtube.com)

Ankle pumps 

Lying on your back, point your toes up and down for the count of ten. Repeat every hour you are awake.
The aim of this exercise is to improve the circulation in the lower limbs, helping to prevent the formation of deep vein thrombosis (blood clots) and reduces swelling.

 

Knee bracing (static quadriceps)

Lying down on your back with your legs straight.
Pull your ankle up towards you and push the back of your knee down against the bed.
Hold for 5 seconds, then relax.
Repeat 10 times.
The aim of this exercise is to strengthen your thigh muscles ready for standing and walking.

Heel slides (on sliding sheet)

Lying down on your back with your legs straight.  
You will need assistance to place sliding sheet under your heel.  
Bend and straighten your hip and knee by sliding your foot towards your body and then away.
Repeat 5 – 10 times.
The aim of this exercise is to increase your hip movement.

Hip abduction (on sliding sheet)

Lying down on your back with your legs straight.
You will need assistance to place sliding sheet under your heel.
Slide your leg out to the side and back in.
Repeat 5 – 10 times.
Do not bring your leg back over your body’s midline.
The aim of this exercise is to increase your hip movement and strengthen the surrounding muscles to help with walking.

Bridging

Lying down on your back with your knees bent and feet flat on the bed.
Tense your tummy and bottom muscles and lift your bottom up off the bed.
Hold for 5 seconds. 
Repeat 5 – 10 times.
The aim of this exercise is to stabilise your pelvis during walking.

Standing exercises 

To watch a video of exercises to do while standing visit: 

Hip replacement - standing hip exercises (youtube.com)

Hip flexion in standing

Bend your hip and knee up in front of you and lower back down.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your muscles at the front of your hip.

Hip extension in standing

Keep your leg straight and take it behind you.
Try not to bend at the hips or knee.
Try to stand up tall.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your bottom muscles to help with walking.  

Hamstring curl in standing

Lift your foot off the floor behind you, bending your knee.
Try not to bend at the hips.
Repeat 5 – 10 times.
The aim of this exercise is to stretch the muscles at the front of your hip and strengthen your muscle on the back of your leg.

Hip abduction in standing

Keep your leg straight and take it out to the side.
Try not to bend at the knee. 
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your bottom and hip muscles to help with walking.   

Mini squats

Bend both your knees, pushing your bottom out behind you.
Keep your knees behind your feet.
Repeat 5 – 10 times.
Do not bend your hip more than 90 degrees.
The aim of this exercise is to strengthen your leg and hip muscles.

Calf raises

Raise up onto your toes on both feet.
Lower back down onto your flat feet.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your calf muscles.

Walking

Following your operation, you will be encouraged to get up and walk. It is important to walk on a regular basis and to steadily increase the distance as you recover. It is normal to be allowed to put full weight through your operated leg. 
As soon as possible, try and walk placing one foot past the other in a normal walking pattern. You can progress to using one crutch or a stick held on the side opposite to your operated leg as soon as you feel safe and comfortable to do so. If you are uncomfortable or if you limp when walking, continue to use your walking aids. 

Stairs

The therapist will practice with you how to safely complete the stairs before going home. To go up and down the stairs, use a banister rail if there is one.

Go up leading with the unoperated leg first, followed by the operated leg and then the crutch.

Going down, put the crutch on the step below then step down with the operated leg, followed by the unoperated leg.

Therapy advice

Activity

Walking is good for your new hip but remember your hip is an artificial joint. Pace your activity, walk and exercise regularly, little and often. The risk of dislocation is greatest in the first six weeks following surgery. To reduce the risk of dislocation whilst the tissues around your hip are healing, avoid forcing or overstretching movements. Avoid the combination of bending the hip and knee across the body towards the opposite shoulder as shown in the picture below.

Sleeping

You may sleep in any position including lying on either side. Initially when you lie on your non-operated side it may be more comfortable with a pillow between your legs to support the operated hip. When getting into bed, position your bottom back towards the centre of the bed and then slide yourself around into bed lifting your legs onto the bed. 

Sitting

Sit in a comfortable supportive chair after your operation (ideally with chair arms) to help you get up and down safely. Avoid low soft seating initially after your operation. 

Getting dressed

To put pants or trousers over your feet, hold the waistband and lower garment to your feet, inserting the operated leg first followed by the other leg before pulling them up. 

To undress, complete in reverse. When putting on shoes and socks, reach down on the inside of the operated leg to avoid uncomfortable twisting of your hip. A long handled reacher, shoehorn and sock aid can make dressing easier. These are readily available from mobility shops, pharmacies and online.  

Relationships

It is normal for your sex life to change initially following a joint replacement. Sexual intercourse may be resumed when you feel comfortable.

Driving

You can travel as a passenger in a car immediately following your operation. 

• It is best to sit in the front seat, have someone move it well back and reclined
• If possible, get into the car directly from the drive or road rather than the kerb or pavement
• Use your arms to lower yourself onto the edge of the car seat
• Keep your operated leg straight and out in front of you
• Slide back into the seat
• Lift both legs in as your body turns to sit upright in the seat.

You can usually resume driving around four to six weeks after your operation.  Stop regularly on longer journeys so you can get out of the car to change position and move around.  You must be safe to drive and be able to do an emergency stop.

We recommend that you inform your insurance company you have had a hip replacement before you start driving. 

Returning to full activities

Most people are ready to return to work at six to eight weeks after their operation. Air travel should be avoided whenever possible for the first six weeks. Depending on the sensitivity of the security scanner, your hip replacement may set off the alarm. 

You can resume most physical activities as soon as you feel comfortable and confident. You can swim once your wound has healed, swimming any stroke including breaststroke. Exercise bikes and treadmills can be used from six weeks, returning to outdoor cycling once comfortable. If you play golf, we suggest you can resume gradually after six weeks.

For activities such as tennis, badminton and cricket we suggest resuming from around 3 months. 

Contact sports are not advised following this surgery.

Equipment

The walking aids and any equipment prescribed to you after your surgery are provided by an equipment supplier. Please ring the number on the sticker on the equipment, to discuss its return.

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT003678.