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Best Practice for Preventing Surgical Site Infections in Open Heart Surgery Patients
ANNUAL ASPAN CONFERENCE ABSTRACTS ‘‘CHANGING THE PRACTICE OF NURSES AND PHYSICIANS: HOW ONE NURSE MADE A POSITIVE IMPACT ON PATIENT CARE’’ Sally Sackett, RN, BSN, CPAN Rochester General Hospital, Rochester New York Hydrothermal Ablation (HTA) patients in the GYN Surgical Unit of Rochester General Hospital experienced severe post-op pain and remained in the Phase II unit an extended period which caused delays in admission to Phase II and discharges home for other patients. I wanted to ensure adequate pain relief for HTA patients and an efficient patient flow through the unit. I collected HTA patient data from the previous six months and I presented it to the GYN OR Steering Committee. The data included: anesthesia type, pain ratings, medications administered and length of stay. Recommendations from the HTA manufacture were obtained and presented to physicians. Inservices on the HTA procedure were given to OR, PACU and Phase II staff. The following changes were instituted: GYN surgeons developed perioperative guidelines for pain management and anesthesia agreed HTA patients be admitted to PACU regardless of MAC anesthesia. Data collection after implementation of changes revealed: use of IV narcotics in Phase II decreased by 25% and a decrease in the length of stay in Phase II by 30 minutes. With the implementation of these changes, Phase II patients were no longer in severe pain and the length of stay decreased. Nursing observations and patient advocacy inspired one nurse to take action by collecting data and presenting recommendations. This resulted in changing both physician and nursing practice which improved patient care.
BEST PRACTICE FOR PREVENTING SURGICAL SITE INFECTIONS IN OPEN HEART SURGERY PATIENTS Mary Gaglione, RN, MSN, CPAN, Elizabeth White, RN, BSN, CAPA, Nancy Kostel-Donlon, RN, C. MSN, CPAN, Laura Janczewski, RN, BSN, Mary Lou Soliday, RN, MPH, CIC St. Francis Hospital Roslyn, New York The CDC has recommended guidelines for preventing surgical site infections in open-heart surgery patients, also known as deep organ space sternal wound infections. Guidelines include the use of two preoperative chlorhexadine baths. Chlorhexadine bathing cloths were chosen to provide this prep because of their duration of action. Our Magnet organization performs greater than 1,200 open-heart surgeries per year. Objective: 1. To reduce the incidence of deep organ space sternal wound infections. A multidisciplinary team discussed methods to ensure proper preoperative skin prep. They chose a product to facilitate the compliance with the preoperative bath. Education was provided to patients and the healthcare team. Early implementation of proper skin preparation begins in the community, this improves patient outcomes. Patients were instructed to perform one bath at home or on the preoperative unit the night before surgery. The second bath was provided on the day of surgery in the PACU holding area. The PACU has reported 100% compliance with the two baths from March to November 2007. The incidence of deep sternal wound infections has decreased significantly among patients presenting with a NNIS index of 0 to 1.
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SURGICAL OBSERVATION UNIT: THE ANSWER FOR EXTENDED PERIANESTHESIA NURSING CARE Pamela E. Windle, MS, CNA, BC, CPAN, CAPA St. Luke’s Episcopal Hospital, Houston, Texas Overflow of postoperative surgical patients are continuing problems in the Post Anesthesia Care Unit and Outpatient Phase II recovery areas. Floor beds are not easily accessible due to high patient admission demands from the admitting and emergency departments. Because of the overstaying patients in the recovery phases, an increase patient and family complaints were identified. Discussion of ongoing issues was brought to the Perioperative management team and concerns of daily patient flow problems and feedback were also discussed in the OR Committee meetings. The formation of collaborative meetings, including admitting, nursing, chief of services, and other departments, were initiated; suggestions and recommendations were identified. The decision was to open a trial Surgical Observation Unit (SOU) department of eight beds for extended recovery patients who cannot be discharge home. Inspite of the negativity from surgeons, the staff and the management team showcased the positive outcomes of their patient’s experiences. After 5 years of operations, the SOU has been the most soughtout by surgeons with average of 95% occupancy. This department has received positive feedback from physicians, patients, families, staff; and has received three ‘‘GOLD’’ awards from patient satisfaction survey. Improved patient outcomes, individualized patient needs and open communication care between departments assures continuity of care.
JOINT COMMISSION READINESS FOR PACU STAFF Pamela E. Windle, MS, CNA, BC, CPAN, CAPA, Tessie Santiago, BSN, BN, CPAN, Grace Woodmansee, BSN, RN, CPAN, Todd Snydar, RN, CPAN St. Luke’s Episcopal Hospital, Houston, Texas Joint Commission (JC) unannounced survey can be daunting and stressful and getting staff members ready for their visit, as well as preparing for tracer rounds. Institutional tracer rounds were done by management teams for each department and the Post Anesthesia care Unit (PACU) staff was not prepared to respond to questions asked. Months prior to the JC visit, we accelerated our ‘‘readiness level’’ by instituting continuous improvements on various programs such as: documentation monitoring, ‘‘read-back’’ verification order, hand-hygiene, patient identification, surgical site verification, and ‘‘time-out’’ procedure documentation. In PACU, a comprehensive and educational approach to teach staff was to individually question with the JC standards through weekly reviews, informal discussion and email communication. Questions were developed collaboratively by the Continuous Quality Improvement chairs, staff nurse council representative and the nurse manager. The weekly question and answer method was one of the best way the staff remembered. Quality initiatives, provision of care, treatment and services, environmental rounds, national patient safety goals, medication management, and core measures were utilized. This creativity was a significant impact on our ‘‘constant readiness’’ for the successful JC visit. The ultimate goal is delivery of safe, efficient, quality-driven cost effective care and maintaining compliance with JC standards program.
BEST PRACTICE FOR PREVENTING SURGICAL SITE INFECTIONS IN OPEN HEART SURGERY PATIENTS Mary Gaglione, RN, MSN, CPAN, Elizabeth White, RN, BSN, CAPA, Nancy Kostel-Donlon, RN, C. MSN, CPAN, Laura Janczewski, RN, BSN, Mary Lou Soliday, RN, MPH, CIC St. Francis Hospital Roslyn, New York The CDC has recommended guidelines for preventing surgical site infections in open-heart surgery patients, also known as deep organ space sternal wound infections. Guidelines include the use of two preoperative chlorhexadine baths. Chlorhexadine bathing cloths were chosen to provide this prep because of their duration of action. Our Magnet organization performs greater than 1,200 open-heart surgeries per year. Objective: 1. To reduce the incidence of deep organ space sternal wound infections. A multidisciplinary team discussed methods to ensure proper preoperative skin prep. They chose a product to facilitate the compliance with the preoperative bath. Education was provided to patients and the healthcare team. Early implementation of proper skin preparation begins in the community, this improves patient outcomes. Patients were instructed to perform one bath at home or on the preoperative unit the night before surgery. The second bath was provided on the day of surgery in the PACU holding area. The PACU has reported 100% compliance with the two baths from March to November 2007. The incidence of deep sternal wound infections has decreased significantly among patients presenting with a NNIS index of 0 to 1.
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SURGICAL OBSERVATION UNIT: THE ANSWER FOR EXTENDED PERIANESTHESIA NURSING CARE Pamela E. Windle, MS, CNA, BC, CPAN, CAPA St. Luke’s Episcopal Hospital, Houston, Texas Overflow of postoperative surgical patients are continuing problems in the Post Anesthesia Care Unit and Outpatient Phase II recovery areas. Floor beds are not easily accessible due to high patient admission demands from the admitting and emergency departments. Because of the overstaying patients in the recovery phases, an increase patient and family complaints were identified. Discussion of ongoing issues was brought to the Perioperative management team and concerns of daily patient flow problems and feedback were also discussed in the OR Committee meetings. The formation of collaborative meetings, including admitting, nursing, chief of services, and other departments, were initiated; suggestions and recommendations were identified. The decision was to open a trial Surgical Observation Unit (SOU) department of eight beds for extended recovery patients who cannot be discharge home. Inspite of the negativity from surgeons, the staff and the management team showcased the positive outcomes of their patient’s experiences. After 5 years of operations, the SOU has been the most soughtout by surgeons with average of 95% occupancy. This department has received positive feedback from physicians, patients, families, staff; and has received three ‘‘GOLD’’ awards from patient satisfaction survey. Improved patient outcomes, individualized patient needs and open communication care between departments assures continuity of care.
JOINT COMMISSION READINESS FOR PACU STAFF Pamela E. Windle, MS, CNA, BC, CPAN, CAPA, Tessie Santiago, BSN, BN, CPAN, Grace Woodmansee, BSN, RN, CPAN, Todd Snydar, RN, CPAN St. Luke’s Episcopal Hospital, Houston, Texas Joint Commission (JC) unannounced survey can be daunting and stressful and getting staff members ready for their visit, as well as preparing for tracer rounds. Institutional tracer rounds were done by management teams for each department and the Post Anesthesia care Unit (PACU) staff was not prepared to respond to questions asked. Months prior to the JC visit, we accelerated our ‘‘readiness level’’ by instituting continuous improvements on various programs such as: documentation monitoring, ‘‘read-back’’ verification order, hand-hygiene, patient identification, surgical site verification, and ‘‘time-out’’ procedure documentation. In PACU, a comprehensive and educational approach to teach staff was to individually question with the JC standards through weekly reviews, informal discussion and email communication. Questions were developed collaboratively by the Continuous Quality Improvement chairs, staff nurse council representative and the nurse manager. The weekly question and answer method was one of the best way the staff remembered. Quality initiatives, provision of care, treatment and services, environmental rounds, national patient safety goals, medication management, and core measures were utilized. This creativity was a significant impact on our ‘‘constant readiness’’ for the successful JC visit. The ultimate goal is delivery of safe, efficient, quality-driven cost effective care and maintaining compliance with JC standards program.